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>"
},
"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>",
"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>",
"serviceLineSupplementalInformation": [
{
"attachmentReportTypeCode": "03",
"attachmentTransmissionCode": "AA",
"attachmentControlNumber": "<string>"
}
],
"ambulanceCertification": [
{
"certificationConditionIndicator": "N",
"conditionCodes": [
"01"
]
}
],
"hospiceEmployeeIndicator": true,
"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>"
}
],
"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>",
"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>",
"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>",
"otherIdentifier": "<string>",
"secondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<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>"
],
"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": {
"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"
},
"ambulanceCertification": [
{
"certificationConditionIndicator": "N",
"conditionCodes": [
"01"
]
}
],
"patientConditionInformationVision": [
{
"codeCategory": "E1",
"certificationConditionIndicator": "N",
"conditionCodes": [
"L1"
]
}
],
"specialProgramCode": "02",
"homeboundIndicator": true,
"anesthesiaRelatedSurgicalProcedure": [
"<string>"
],
"conditionInformation": [
{
"conditionCodes": [
"<string>"
]
}
],
"claimNote": {
"additionalInformation": "<string>",
"certificationNarrative": "<string>",
"goalRehabOrDischargePlans": "<string>",
"diagnosisDescription": "<string>",
"thirdPartOrgNotes": "<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>",
"otherInsuredAdditionalIdentifier": "<string>"
},
"otherPayerName": {
"otherPayerOrganizationName": "<string>",
"otherPayerIdentifierTypeCode": "PI",
"otherPayerIdentifier": "<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>",
"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>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
}
],
"referring": {
"providerType": "<string>",
"npi": "<string>",
"commercialNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<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>",
"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>",
"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>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"tradingPartnerName": "<string>"
}
'{
"claimSubmissionId": "<string>",
"patientControlNumber": "<string>"
}Submits an electronic claim for processing. The submission is handled asynchronously, and this endpoint returns an identifier to track the status of the claim submission.
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>"
},
"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>",
"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>",
"serviceLineSupplementalInformation": [
{
"attachmentReportTypeCode": "03",
"attachmentTransmissionCode": "AA",
"attachmentControlNumber": "<string>"
}
],
"ambulanceCertification": [
{
"certificationConditionIndicator": "N",
"conditionCodes": [
"01"
]
}
],
"hospiceEmployeeIndicator": true,
"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>"
}
],
"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>",
"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>",
"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>",
"otherIdentifier": "<string>",
"secondaryIdentifier": [
{
"qualifier": "<string>",
"identifier": "<string>",
"otherIdentifier": "<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>"
],
"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": {
"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"
},
"ambulanceCertification": [
{
"certificationConditionIndicator": "N",
"conditionCodes": [
"01"
]
}
],
"patientConditionInformationVision": [
{
"codeCategory": "E1",
"certificationConditionIndicator": "N",
"conditionCodes": [
"L1"
]
}
],
"specialProgramCode": "02",
"homeboundIndicator": true,
"anesthesiaRelatedSurgicalProcedure": [
"<string>"
],
"conditionInformation": [
{
"conditionCodes": [
"<string>"
]
}
],
"claimNote": {
"additionalInformation": "<string>",
"certificationNarrative": "<string>",
"goalRehabOrDischargePlans": "<string>",
"diagnosisDescription": "<string>",
"thirdPartOrgNotes": "<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>",
"otherInsuredAdditionalIdentifier": "<string>"
},
"otherPayerName": {
"otherPayerOrganizationName": "<string>",
"otherPayerIdentifierTypeCode": "PI",
"otherPayerIdentifier": "<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>",
"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>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
}
],
"referring": {
"providerType": "<string>",
"npi": "<string>",
"commercialNumber": "<string>",
"stateLicenseNumber": "<string>",
"providerUpinNumber": "<string>",
"taxonomyCode": "<string>",
"firstName": "<string>",
"lastName": "<string>",
"middleName": "<string>",
"suffix": "<string>",
"organizationName": "<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>",
"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>",
"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>",
"contactInformation": {
"name": "<string>",
"phoneNumber": "<string>",
"faxNumber": "<string>",
"email": "<string>",
"phoneExtension": "<string>"
}
},
"tradingPartnerName": "<string>"
}
'{
"claimSubmissionId": "<string>",
"patientControlNumber": "<string>"
}1Show child attributes
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Claim submission initiated successfully. Returns an ID to track the claim submission.
Claim submission initiated successfully. Returns an ID to track the claim submission.