curl --request POST \
  --url https://api.example.com/api/v2/clearinghouse/claim \
  --header 'Content-Type: application/json' \
  --data '
{
  "tradingPartnerServiceId": "<string>",
  "submitter": {
    "contactInformation": {
      "name": "<string>",
      "phoneNumber": "<string>",
      "faxNumber": "<string>",
      "email": "<string>",
      "phoneExtension": "<string>"
    },
    "organizationName": "<string>",
    "lastName": "<string>",
    "firstName": "<string>",
    "middleName": "<string>",
    "submitterIdentification": "<string>"
  },
  "receiver": {
    "organizationName": "<string>"
  },
  "subscriber": {
    "memberId": "<string>",
    "ssn": "<string>",
    "paymentResponsibilityLevelCode": "A",
    "organizationName": "<string>",
    "insuranceTypeCode": "12",
    "subscriberGroupName": "<string>",
    "firstName": "<string>",
    "lastName": "<string>",
    "middleName": "<string>",
    "suffix": "<string>",
    "gender": "M",
    "dateOfBirth": "<string>",
    "policyNumber": "<string>",
    "groupNumber": "<string>",
    "address": {
      "address1": "<string>",
      "city": "<string>",
      "address2": "<string>",
      "state": "<string>",
      "postalCode": "<string>",
      "countryCode": "<string>",
      "countrySubDivisionCode": "<string>"
    },
    "contactInformation": {
      "name": "<string>",
      "phoneNumber": "<string>",
      "faxNumber": "<string>",
      "email": "<string>",
      "phoneExtension": "<string>"
    }
  },
  "billing": {
    "providerType": "<string>",
    "npi": "<string>",
    "ssn": "<string>",
    "employerId": "<string>",
    "commercialNumber": "<string>",
    "locationNumber": "<string>",
    "stateLicenseNumber": "<string>",
    "providerUpinNumber": "<string>",
    "taxonomyCode": "<string>",
    "firstName": "<string>",
    "lastName": "<string>",
    "middleName": "<string>",
    "suffix": "<string>",
    "organizationName": "<string>",
    "address": {
      "address1": "<string>",
      "city": "<string>",
      "address2": "<string>",
      "state": "<string>",
      "postalCode": "<string>",
      "countryCode": "<string>",
      "countrySubDivisionCode": "<string>"
    },
    "contactInformation": {
      "name": "<string>",
      "phoneNumber": "<string>",
      "faxNumber": "<string>",
      "email": "<string>",
      "phoneExtension": "<string>"
    }
  },
  "claimInformation": {
    "claimFilingCode": "11",
    "claimChargeAmount": "<string>",
    "placeOfServiceCode": "01",
    "claimFrequencyCode": "1",
    "signatureIndicator": "N",
    "benefitsAssignmentCertificationIndicator": "N",
    "releaseInformationCode": "I",
    "planParticipationCode": "A",
    "healthCareCodeInformation": [
      {
        "diagnosisTypeCode": "BK",
        "diagnosisCode": "<string>"
      }
    ],
    "serviceLines": [
      {
        "serviceDate": "<string>",
        "professionalService": {
          "procedureIdentifier": "ER",
          "procedureCode": "<string>",
          "lineItemChargeAmount": "<string>",
          "measurementUnit": "MJ",
          "serviceUnitCount": "<string>",
          "compositeDiagnosisCodePointers": {
            "diagnosisCodePointers": [
              "<string>"
            ]
          },
          "procedureModifiers": [
            "<string>"
          ],
          "description": "<string>",
          "placeOfServiceCode": "<string>",
          "emergencyIndicator": "Y",
          "epsdtIndicator": "Y",
          "familyPlanningIndicator": "Y",
          "copayStatusCode": "0"
        },
        "assignedNumber": "<string>",
        "serviceDateEnd": "<string>",
        "durableMedicalEquipmentService": {
          "days": "<string>",
          "rentalPrice": "<string>",
          "purchasePrice": "<string>",
          "frequencyCode": "1"
        },
        "serviceLineSupplementalInformation": [
          {
            "attachmentReportTypeCode": "03",
            "attachmentTransmissionCode": "AA",
            "attachmentControlNumber": "<string>"
          }
        ],
        "durableMedicalEquipmentCertificateOfMedicalNecessity": {
          "attachmentTransmissionCode": "AB"
        },
        "ambulanceTransportInformation": {
          "ambulanceTransportReasonCode": "A",
          "transportDistanceInMiles": "<string>",
          "patientWeightInPounds": "<string>",
          "roundTripPurposeDescription": "<string>",
          "stretcherPurposeDescription": "<string>"
        },
        "durableMedicalEquipmentCertification": {
          "certificationTypeCode": "I",
          "durableMedicalEquipmentDurationInMonths": "<string>"
        },
        "ambulanceCertification": [
          {
            "certificationConditionIndicator": "N",
            "conditionCodes": [
              "01"
            ]
          }
        ],
        "hospiceEmployeeIndicator": true,
        "conditionIndicatorDurableMedicalEquipment": {
          "certificationConditionIndicator": "Y",
          "conditionIndicator": "38",
          "conditionIndicatorCode": "38"
        },
        "serviceLineDateInformation": {
          "prescriptionDate": "<string>",
          "certificationRevisionOrRecertificationDate": "<string>",
          "beginTherapyDate": "<string>",
          "lastCertificationDate": "<string>",
          "treatmentOrTherapyDate": "<string>",
          "hemoglobinTestDate": "<string>",
          "serumCreatineTestDate": "<string>",
          "shippedDate": "<string>",
          "lastXRayDate": "<string>",
          "initialTreatmentDate": "<string>"
        },
        "ambulancePatientCount": 123,
        "obstetricAnesthesiaAdditionalUnits": 123,
        "testResults": [
          {
            "measurementReferenceIdentificationCode": "OG",
            "measurementQualifier": "HT",
            "testResults": "<string>"
          }
        ],
        "contractInformation": {
          "contractTypeCode": "01",
          "contractAmount": "<string>",
          "contractPercentage": "<string>",
          "contractCode": "<string>",
          "termsDiscountPercentage": "<string>",
          "contractVersionIdentifier": "<string>"
        },
        "serviceLineReferenceInformation": {
          "repricedLineItemReferenceNumber": "<string>",
          "adjustedRepricedLineItemReferenceNumber": "<string>",
          "priorAuthorization": [
            {
              "priorAuthorizationOrReferralNumber": "<string>",
              "otherPayerPrimaryIdentifier": "<string>"
            }
          ],
          "mammographyCertificationNumber": "<string>",
          "clinicalLaboratoryImprovementAmendmentNumber": "<string>",
          "referringCliaNumber": "<string>",
          "immunizationBatchNumber": "<string>",
          "referralNumber": [
            "<string>"
          ]
        },
        "salesTaxAmount": "<string>",
        "postageTaxAmount": "<string>",
        "fileInformation": [
          "<string>"
        ],
        "additionalNotes": "<string>",
        "goalRehabOrDischargePlans": "<string>",
        "thirdPartyOrganizationNotes": "<string>",
        "purchasedServiceInformation": {
          "purchasedServiceProviderIdentifier": "<string>",
          "purchasedServiceChargeAmount": "<string>"
        },
        "linePricingRepricingInformation": {
          "pricingMethodologyCode": "00",
          "repricedAllowedAmount": "<string>",
          "repricedSavingAmount": "<string>",
          "repricingOrganizationIdentifier": "<string>",
          "repricingPerDiemOrFlatRateAmount": "<string>",
          "repricedApprovedAmbulatoryPatientGroupCode": "<string>",
          "repricedApprovedAmbulatoryPatientGroupAmount": "<string>",
          "rejectReasonCode": "T1",
          "policyComplianceCode": "1",
          "exceptionCode": "1"
        },
        "drugIdentification": {
          "serviceIdQualifier": "EN",
          "nationalDrugCode": "<string>",
          "nationalDrugUnitCount": "<string>",
          "measurementUnitCode": "F2",
          "linkSequenceNumber": "<string>",
          "pharmacyPrescriptionNumber": "<string>"
        },
        "renderingProvider": {
          "providerType": "<string>",
          "npi": "<string>",
          "ssn": "<string>",
          "employerId": "<string>",
          "commercialNumber": "<string>",
          "locationNumber": "<string>",
          "payerIdentificationNumber": "<string>",
          "employerIdentificationNumber": "<string>",
          "claimOfficeNumber": "<string>",
          "naic": "<string>",
          "stateLicenseNumber": "<string>",
          "providerUpinNumber": "<string>",
          "taxonomyCode": "<string>",
          "firstName": "<string>",
          "lastName": "<string>",
          "middleName": "<string>",
          "suffix": "<string>",
          "organizationName": "<string>",
          "address": {
            "address1": "<string>",
            "city": "<string>",
            "address2": "<string>",
            "state": "<string>",
            "postalCode": "<string>",
            "countryCode": "<string>",
            "countrySubDivisionCode": "<string>"
          },
          "contactInformation": {
            "name": "<string>",
            "phoneNumber": "<string>",
            "faxNumber": "<string>",
            "email": "<string>",
            "phoneExtension": "<string>"
          },
          "otherIdentifier": "<string>",
          "secondaryIdentifier": [
            {
              "qualifier": "<string>",
              "identifier": "<string>",
              "otherIdentifier": "<string>"
            }
          ]
        },
        "purchasedServiceProvider": {
          "providerType": "<string>",
          "npi": "<string>",
          "stateLicenseNumber": "<string>",
          "commercialNumber": "<string>",
          "payerIdentificationNumber": "<string>",
          "ssn": "<string>",
          "employerId": "<string>",
          "locationNumber": "<string>",
          "employerIdentificationNumber": "<string>",
          "claimOfficeNumber": "<string>",
          "naic": "<string>",
          "providerUpinNumber": "<string>",
          "taxonomyCode": "<string>",
          "firstName": "<string>",
          "lastName": "<string>",
          "middleName": "<string>",
          "suffix": "<string>",
          "organizationName": "<string>",
          "address": {
            "address1": "<string>",
            "city": "<string>",
            "address2": "<string>",
            "state": "<string>",
            "postalCode": "<string>",
            "countryCode": "<string>",
            "countrySubDivisionCode": "<string>"
          },
          "contactInformation": {
            "name": "<string>",
            "phoneNumber": "<string>",
            "faxNumber": "<string>",
            "email": "<string>",
            "phoneExtension": "<string>"
          },
          "otherIdentifier": "<string>",
          "secondaryIdentifier": [
            {
              "qualifier": "<string>",
              "identifier": "<string>",
              "otherIdentifier": "<string>"
            }
          ]
        },
        "serviceFacilityLocation": {
          "organizationName": "<string>",
          "address": {
            "address1": "<string>",
            "city": "<string>",
            "address2": "<string>",
            "state": "<string>",
            "postalCode": "<string>",
            "countryCode": "<string>",
            "countrySubDivisionCode": "<string>"
          },
          "npi": "<string>",
          "phoneName": "<string>",
          "phoneNumber": "<string>",
          "phoneExtension": "<string>",
          "secondaryIdentifier": [
            {
              "qualifier": "<string>",
              "identifier": "<string>",
              "otherIdentifier": "<string>"
            }
          ]
        },
        "supervisingProvider": {
          "providerType": "<string>",
          "npi": "<string>",
          "ssn": "<string>",
          "employerId": "<string>",
          "commercialNumber": "<string>",
          "locationNumber": "<string>",
          "payerIdentificationNumber": "<string>",
          "employerIdentificationNumber": "<string>",
          "claimOfficeNumber": "<string>",
          "naic": "<string>",
          "stateLicenseNumber": "<string>",
          "providerUpinNumber": "<string>",
          "taxonomyCode": "<string>",
          "firstName": "<string>",
          "lastName": "<string>",
          "middleName": "<string>",
          "suffix": "<string>",
          "organizationName": "<string>",
          "address": {
            "address1": "<string>",
            "city": "<string>",
            "address2": "<string>",
            "state": "<string>",
            "postalCode": "<string>",
            "countryCode": "<string>",
            "countrySubDivisionCode": "<string>"
          },
          "contactInformation": {
            "name": "<string>",
            "phoneNumber": "<string>",
            "faxNumber": "<string>",
            "email": "<string>",
            "phoneExtension": "<string>"
          },
          "otherIdentifier": "<string>",
          "secondaryIdentifier": [
            {
              "qualifier": "<string>",
              "identifier": "<string>",
              "otherIdentifier": "<string>"
            }
          ]
        },
        "orderingProvider": {
          "providerType": "<string>",
          "npi": "<string>",
          "ssn": "<string>",
          "employerId": "<string>",
          "commercialNumber": "<string>",
          "locationNumber": "<string>",
          "payerIdentificationNumber": "<string>",
          "employerIdentificationNumber": "<string>",
          "claimOfficeNumber": "<string>",
          "naic": "<string>",
          "stateLicenseNumber": "<string>",
          "providerUpinNumber": "<string>",
          "taxonomyCode": "<string>",
          "firstName": "<string>",
          "lastName": "<string>",
          "middleName": "<string>",
          "suffix": "<string>",
          "organizationName": "<string>",
          "address": {
            "address1": "<string>",
            "city": "<string>",
            "address2": "<string>",
            "state": "<string>",
            "postalCode": "<string>",
            "countryCode": "<string>",
            "countrySubDivisionCode": "<string>"
          },
          "contactInformation": {
            "name": "<string>",
            "phoneNumber": "<string>",
            "faxNumber": "<string>",
            "email": "<string>",
            "phoneExtension": "<string>"
          },
          "otherIdentifier": "<string>",
          "secondaryIdentifier": [
            {
              "qualifier": "<string>",
              "identifier": "<string>",
              "otherIdentifier": "<string>"
            }
          ]
        },
        "referringProvider": {
          "providerType": "<string>",
          "npi": "<string>",
          "ssn": "<string>",
          "employerId": "<string>",
          "commercialNumber": "<string>",
          "locationNumber": "<string>",
          "payerIdentificationNumber": "<string>",
          "employerIdentificationNumber": "<string>",
          "claimOfficeNumber": "<string>",
          "naic": "<string>",
          "stateLicenseNumber": "<string>",
          "providerUpinNumber": "<string>",
          "taxonomyCode": "<string>",
          "firstName": "<string>",
          "lastName": "<string>",
          "middleName": "<string>",
          "suffix": "<string>",
          "organizationName": "<string>",
          "address": {
            "address1": "<string>",
            "city": "<string>",
            "address2": "<string>",
            "state": "<string>",
            "postalCode": "<string>",
            "countryCode": "<string>",
            "countrySubDivisionCode": "<string>"
          },
          "contactInformation": {
            "name": "<string>",
            "phoneNumber": "<string>",
            "faxNumber": "<string>",
            "email": "<string>",
            "phoneExtension": "<string>"
          },
          "otherIdentifier": "<string>",
          "secondaryIdentifier": [
            {
              "qualifier": "<string>",
              "identifier": "<string>",
              "otherIdentifier": "<string>"
            }
          ]
        },
        "ambulancePickUpLocation": {
          "address1": "<string>",
          "city": "<string>",
          "address2": "<string>",
          "state": "<string>",
          "postalCode": "<string>",
          "countryCode": "<string>",
          "countrySubDivisionCode": "<string>"
        },
        "ambulanceDropOffLocation": {
          "address1": "<string>",
          "city": "<string>",
          "address2": "<string>",
          "state": "<string>",
          "postalCode": "<string>",
          "countryCode": "<string>",
          "countrySubDivisionCode": "<string>"
        },
        "lineAdjudicationInformation": [
          {
            "otherPayerPrimaryIdentifier": "<string>",
            "serviceLinePaidAmount": "<string>",
            "procedureCode": "<string>",
            "paidServiceUnitCount": "<string>",
            "adjudicationOrPaymentDate": "<string>",
            "serviceIdQualifier": "ER",
            "procedureModifier": [
              "<string>"
            ],
            "procedureCodeDescription": "<string>",
            "bundledOrUnbundledLineNumber": "<string>",
            "claimAdjustmentInformation": [
              {
                "adjustmentGroupCode": "CO",
                "adjustmentDetails": [
                  {
                    "adjustmentReasonCode": "<string>",
                    "adjustmentAmount": "<string>",
                    "adjustmentQuantity": "<string>"
                  }
                ]
              }
            ],
            "remainingPatientLiability": "<string>"
          }
        ],
        "formIdentification": [
          {
            "formTypeCode": "AS",
            "formIdentifier": "<string>",
            "supportingDocumentation": [
              {
                "questionNumber": "<string>",
                "questionResponseCode": "N",
                "questionResponse": "<string>",
                "questionResponseAsDate": "<string>",
                "questionResponseAsPercent": "<string>"
              }
            ]
          }
        ]
      }
    ],
    "propertyCasualtyClaimNumber": "<string>",
    "relatedCausesCode": [
      "AA"
    ],
    "autoAccidentStateCode": "<string>",
    "autoAccidentCountryCode": "<string>",
    "delayReasonCode": "1",
    "patientAmountPaid": "<string>",
    "fileInformation": "<string>",
    "fileInformationList": [
      "<string>"
    ],
    "claimPricingRepricingInformation": {
      "pricingMethodologyCode": "00",
      "repricedAllowedAmount": "<string>",
      "repricedSavingAmount": "<string>",
      "repricingOrganizationIdentifier": "<string>",
      "repricingPerDiemOrFlatRateAmount": "<string>",
      "repricedApprovedAmbulatoryPatientGroupCode": "<string>",
      "repricedApprovedAmbulatoryPatientGroupAmount": "<string>",
      "rejectReasonCode": "T1",
      "policyComplianceCode": "1",
      "exceptionCode": "1"
    },
    "serviceFacilityLocation": {
      "organizationName": "<string>",
      "address": {
        "address1": "<string>",
        "city": "<string>",
        "address2": "<string>",
        "state": "<string>",
        "postalCode": "<string>",
        "countryCode": "<string>",
        "countrySubDivisionCode": "<string>"
      },
      "npi": "<string>",
      "phoneName": "<string>",
      "phoneNumber": "<string>",
      "phoneExtension": "<string>",
      "secondaryIdentifier": [
        {
          "qualifier": "<string>",
          "identifier": "<string>",
          "otherIdentifier": "<string>"
        }
      ]
    },
    "deathDate": "<string>",
    "patientWeight": "<string>",
    "patientSignatureSourceCode": true,
    "pregnancyIndicator": "Y",
    "claimDateInformation": {
      "symptomDate": "<string>",
      "initialTreatmentDate": "<string>",
      "lastSeenDate": "<string>",
      "acuteManifestationDate": "<string>",
      "accidentDate": "<string>",
      "lastMenstrualPeriodDate": "<string>",
      "lastXRayDate": "<string>",
      "hearingAndVisionPrescriptionDate": "<string>",
      "disabilityBeginDate": "<string>",
      "disabilityEndDate": "<string>",
      "lastWorkedDate": "<string>",
      "authorizedReturnToWorkDate": "<string>",
      "admissionDate": "<string>",
      "dischargeDate": "<string>",
      "assumedAndRelinquishedCareBeginDate": "<string>",
      "assumedAndRelinquishedCareEndDate": "<string>",
      "repricerReceivedDate": "<string>",
      "firstContactDate": "<string>"
    },
    "claimSupplementalInformation": {
      "reportInformation": {
        "attachmentReportTypeCode": "03",
        "attachmentTransmissionCode": "AA",
        "attachmentControlNumber": "<string>"
      },
      "reportInformations": [
        {
          "attachmentReportTypeCode": "03",
          "attachmentTransmissionCode": "AA",
          "attachmentControlNumber": "<string>"
        }
      ],
      "priorAuthorizationNumber": "<string>",
      "referralNumber": "<string>",
      "claimControlNumber": "<string>",
      "cliaNumber": "<string>",
      "repricedClaimNumber": "<string>",
      "adjustedRepricedClaimNumber": "<string>",
      "investigationalDeviceExemptionNumber": "<string>",
      "claimNumber": "<string>",
      "mammographyCertificationNumber": "<string>",
      "medicalRecordNumber": "<string>",
      "demoProjectIdentifier": "<string>",
      "carePlanOversightNumber": "<string>",
      "medicareCrossoverReferenceId": "<string>",
      "serviceAuthorizationExceptionCode": "1"
    },
    "ambulanceTransportInformation": {
      "ambulanceTransportReasonCode": "A",
      "transportDistanceInMiles": "<string>",
      "patientWeightInPounds": "<string>",
      "roundTripPurposeDescription": "<string>",
      "stretcherPurposeDescription": "<string>"
    },
    "spinalManipulationServiceInformation": {
      "patientConditionCode": "<string>",
      "patientConditionDescription1": "A",
      "patientConditionDescription2": "<string>"
    },
    "ambulanceCertification": [
      {
        "certificationConditionIndicator": "N",
        "conditionCodes": [
          "01"
        ]
      }
    ],
    "patientConditionInformationVision": [
      {
        "codeCategory": "E1",
        "certificationConditionIndicator": "N",
        "conditionCodes": [
          "L1"
        ]
      }
    ],
    "claimContractInformation": {
      "contractTypeCode": "01",
      "contractAmount": "<string>",
      "contractPercentage": "<string>",
      "contractCode": "<string>",
      "termsDiscountPercentage": "<string>",
      "contractVersionIdentifier": "<string>"
    },
    "specialProgramCode": "02",
    "homeboundIndicator": true,
    "epsdtReferral": {
      "certificationConditionCodeAppliesIndicator": "N",
      "conditionCodes": [
        "AV"
      ]
    },
    "anesthesiaRelatedSurgicalProcedure": [
      "<string>"
    ],
    "conditionInformation": [
      {
        "conditionCodes": [
          "<string>"
        ]
      }
    ],
    "claimNote": {
      "additionalInformation": "<string>",
      "certificationNarrative": "<string>",
      "goalRehabOrDischargePlans": "<string>",
      "diagnosisDescription": "<string>",
      "thirdPartOrgNotes": "<string>"
    },
    "ambulancePickUpLocation": {
      "address1": "<string>",
      "city": "<string>",
      "address2": "<string>",
      "state": "<string>",
      "postalCode": "<string>",
      "countryCode": "<string>",
      "countrySubDivisionCode": "<string>"
    },
    "ambulanceDropOffLocation": {
      "address1": "<string>",
      "city": "<string>",
      "address2": "<string>",
      "state": "<string>",
      "postalCode": "<string>",
      "countryCode": "<string>",
      "countrySubDivisionCode": "<string>"
    },
    "otherSubscriberInformation": [
      {
        "paymentResponsibilityLevelCode": "A",
        "individualRelationshipCode": "01",
        "claimFilingIndicatorCode": "11",
        "benefitsAssignmentCertificationIndicator": "N",
        "releaseOfInformationCode": "I",
        "otherSubscriberName": {
          "otherInsuredQualifier": "1",
          "otherInsuredLastName": "<string>",
          "otherInsuredIdentifierTypeCode": "II",
          "otherInsuredIdentifier": "<string>",
          "otherInsuredFirstName": "<string>",
          "otherInsuredMiddleName": "<string>",
          "otherInsuredNameSuffix": "<string>",
          "otherInsuredAddress": {
            "address1": "<string>",
            "city": "<string>",
            "address2": "<string>",
            "state": "<string>",
            "postalCode": "<string>",
            "countryCode": "<string>",
            "countrySubDivisionCode": "<string>"
          },
          "otherInsuredAdditionalIdentifier": "<string>"
        },
        "otherPayerName": {
          "otherPayerOrganizationName": "<string>",
          "otherPayerIdentifierTypeCode": "PI",
          "otherPayerIdentifier": "<string>",
          "otherPayerAddress": {
            "address1": "<string>",
            "city": "<string>",
            "address2": "<string>",
            "state": "<string>",
            "postalCode": "<string>",
            "countryCode": "<string>",
            "countrySubDivisionCode": "<string>"
          },
          "otherPayerAdjudicationOrPaymentDate": "<string>",
          "otherPayerSecondaryIdentifier": [
            {
              "qualifier": "<string>",
              "identifier": "<string>",
              "otherIdentifier": "<string>"
            }
          ],
          "otherPayerPriorAuthorizationNumber": "<string>",
          "otherPayerPriorAuthorizationOrReferralNumber": "<string>",
          "otherPayerClaimAdjustmentIndicator": true,
          "otherPayerClaimControlNumber": "<string>"
        },
        "insuranceGroupOrPolicyNumber": "<string>",
        "otherInsuredGroupName": "<string>",
        "insuranceTypeCode": "12",
        "claimLevelAdjustments": [
          {
            "adjustmentGroupCode": "CO",
            "adjustmentDetails": [
              {
                "adjustmentReasonCode": "<string>",
                "adjustmentAmount": "<string>",
                "adjustmentQuantity": "<string>"
              }
            ]
          }
        ],
        "payerPaidAmount": "<string>",
        "nonCoveredChargeAmount": "<string>",
        "remainingPatientLiability": "<string>",
        "otherPayerReferringProvider": [
          {
            "otherPayerReferringProviderIdentifier": [
              {
                "qualifier": "<string>",
                "identifier": "<string>",
                "otherIdentifier": "<string>"
              }
            ]
          }
        ],
        "otherPayerRenderingProvider": [
          {
            "entityTypeQualifier": "1",
            "otherPayerRenderingProviderSecondaryIdentifier": [
              {
                "qualifier": "<string>",
                "identifier": "<string>",
                "otherIdentifier": "<string>"
              }
            ]
          }
        ],
        "otherPayerServiceFacilityLocation": [
          {
            "otherPayerServiceFacilityLocationSecondaryIdentifier": [
              {
                "qualifier": "<string>",
                "identifier": "<string>",
                "otherIdentifier": "<string>"
              }
            ]
          }
        ],
        "otherPayerSupervisingProvider": [
          {
            "otherPayerSupervisingProviderIdentifier": [
              {
                "qualifier": "<string>",
                "identifier": "<string>",
                "otherIdentifier": "<string>"
              }
            ]
          }
        ],
        "otherPayerBillingProvider": [
          {
            "entityTypeQualifier": "1",
            "otherPayerBillingProviderIdentifier": [
              {
                "qualifier": "<string>",
                "identifier": "<string>",
                "otherIdentifier": "<string>"
              }
            ]
          }
        ],
        "patientSignatureGeneratedForPatient": true,
        "medicareOutpatientAdjudication": {
          "reimbursementRate": "<string>",
          "hcpcsPayableAmount": "<string>",
          "claimPaymentRemarkCode": [
            "<string>"
          ],
          "endStageRenalDiseasePaymentAmount": "<string>",
          "nonPayableProfessionalComponentBilledAmount": "<string>"
        }
      }
    ]
  },
  "isTesting": true,
  "controlNumber": "<string>",
  "dependent": {
    "firstName": "<string>",
    "lastName": "<string>",
    "gender": "M",
    "dateOfBirth": "<string>",
    "relationshipToSubscriberCode": "01",
    "middleName": "<string>",
    "suffix": "<string>",
    "ssn": "<string>",
    "memberId": "<string>",
    "address": {
      "address1": "<string>",
      "city": "<string>",
      "address2": "<string>",
      "state": "<string>",
      "postalCode": "<string>",
      "countryCode": "<string>",
      "countrySubDivisionCode": "<string>"
    },
    "contactInformation": {
      "name": "<string>",
      "phoneNumber": "<string>",
      "faxNumber": "<string>",
      "email": "<string>",
      "phoneExtension": "<string>"
    }
  },
  "providers": [
    {
      "providerType": "<string>",
      "npi": "<string>",
      "ssn": "<string>",
      "employerId": "<string>",
      "commercialNumber": "<string>",
      "locationNumber": "<string>",
      "stateLicenseNumber": "<string>",
      "providerUpinNumber": "<string>",
      "taxonomyCode": "<string>",
      "firstName": "<string>",
      "lastName": "<string>",
      "middleName": "<string>",
      "suffix": "<string>",
      "organizationName": "<string>",
      "address": {
        "address1": "<string>",
        "city": "<string>",
        "address2": "<string>",
        "state": "<string>",
        "postalCode": "<string>",
        "countryCode": "<string>",
        "countrySubDivisionCode": "<string>"
      },
      "contactInformation": {
        "name": "<string>",
        "phoneNumber": "<string>",
        "faxNumber": "<string>",
        "email": "<string>",
        "phoneExtension": "<string>"
      }
    }
  ],
  "payToAddress": {
    "address1": "<string>",
    "city": "<string>",
    "address2": "<string>",
    "state": "<string>",
    "postalCode": "<string>",
    "countryCode": "<string>",
    "countrySubDivisionCode": "<string>"
  },
  "payToPlan": {
    "organizationName": "<string>",
    "primaryIdentifierTypeCode": "PI",
    "primaryIdentifier": "<string>",
    "address": {
      "address1": "<string>",
      "city": "<string>",
      "address2": "<string>",
      "state": "<string>",
      "postalCode": "<string>",
      "countryCode": "<string>",
      "countrySubDivisionCode": "<string>"
    },
    "taxIdentificationNumber": "<string>",
    "secondaryIdentifierTypeCode": "2U",
    "secondaryIdentifier": "<string>"
  },
  "payerAddress": {
    "address1": "<string>",
    "city": "<string>",
    "address2": "<string>",
    "state": "<string>",
    "postalCode": "<string>",
    "countryCode": "<string>",
    "countrySubDivisionCode": "<string>"
  },
  "referring": {
    "providerType": "<string>",
    "npi": "<string>",
    "commercialNumber": "<string>",
    "stateLicenseNumber": "<string>",
    "providerUpinNumber": "<string>",
    "taxonomyCode": "<string>",
    "firstName": "<string>",
    "lastName": "<string>",
    "middleName": "<string>",
    "suffix": "<string>",
    "organizationName": "<string>",
    "address": {
      "address1": "<string>",
      "city": "<string>",
      "address2": "<string>",
      "state": "<string>",
      "postalCode": "<string>",
      "countryCode": "<string>",
      "countrySubDivisionCode": "<string>"
    },
    "contactInformation": {
      "name": "<string>",
      "phoneNumber": "<string>",
      "faxNumber": "<string>",
      "email": "<string>",
      "phoneExtension": "<string>"
    }
  },
  "rendering": {
    "providerType": "<string>",
    "npi": "<string>",
    "commercialNumber": "<string>",
    "locationNumber": "<string>",
    "stateLicenseNumber": "<string>",
    "providerUpinNumber": "<string>",
    "taxonomyCode": "<string>",
    "firstName": "<string>",
    "lastName": "<string>",
    "middleName": "<string>",
    "suffix": "<string>",
    "organizationName": "<string>",
    "address": {
      "address1": "<string>",
      "city": "<string>",
      "address2": "<string>",
      "state": "<string>",
      "postalCode": "<string>",
      "countryCode": "<string>",
      "countrySubDivisionCode": "<string>"
    },
    "contactInformation": {
      "name": "<string>",
      "phoneNumber": "<string>",
      "faxNumber": "<string>",
      "email": "<string>",
      "phoneExtension": "<string>"
    }
  },
  "ordering": {
    "providerType": "<string>",
    "npi": "<string>",
    "ssn": "<string>",
    "employerId": "<string>",
    "commercialNumber": "<string>",
    "locationNumber": "<string>",
    "payerIdentificationNumber": "<string>",
    "employerIdentificationNumber": "<string>",
    "claimOfficeNumber": "<string>",
    "naic": "<string>",
    "stateLicenseNumber": "<string>",
    "providerUpinNumber": "<string>",
    "taxonomyCode": "<string>",
    "firstName": "<string>",
    "lastName": "<string>",
    "middleName": "<string>",
    "suffix": "<string>",
    "organizationName": "<string>",
    "address": {
      "address1": "<string>",
      "city": "<string>",
      "address2": "<string>",
      "state": "<string>",
      "postalCode": "<string>",
      "countryCode": "<string>",
      "countrySubDivisionCode": "<string>"
    },
    "contactInformation": {
      "name": "<string>",
      "phoneNumber": "<string>",
      "faxNumber": "<string>",
      "email": "<string>",
      "phoneExtension": "<string>"
    }
  },
  "supervising": {
    "providerType": "<string>",
    "npi": "<string>",
    "ssn": "<string>",
    "employerId": "<string>",
    "commercialNumber": "<string>",
    "locationNumber": "<string>",
    "stateLicenseNumber": "<string>",
    "providerUpinNumber": "<string>",
    "taxonomyCode": "<string>",
    "firstName": "<string>",
    "lastName": "<string>",
    "middleName": "<string>",
    "suffix": "<string>",
    "organizationName": "<string>",
    "address": {
      "address1": "<string>",
      "city": "<string>",
      "address2": "<string>",
      "state": "<string>",
      "postalCode": "<string>",
      "countryCode": "<string>",
      "countrySubDivisionCode": "<string>"
    },
    "contactInformation": {
      "name": "<string>",
      "phoneNumber": "<string>",
      "faxNumber": "<string>",
      "email": "<string>",
      "phoneExtension": "<string>"
    }
  },
  "tradingPartnerName": "<string>"
}
'

{
  "claimSubmissionId": "<string>",
  "patientControlNumber": "<string>"
}