> ## Documentation Index > Fetch the complete documentation index at: https://docs.samplehc.com/llms.txt > Use this file to discover all available pages before exploring further. # Submit electronic claim > 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. ## OpenAPI ````yaml https://app.stainless.com/api/spec/documented/samplehc/openapi.documented.yml post /api/v2/clearinghouse/claim openapi: 3.0.3 info: title: Sample Healthcare API description: API for Sample Healthcare version: 1.0.0 servers: [] security: [] paths: /api/v2/clearinghouse/claim: post: tags: - Clearinghouse summary: Submit electronic claim description: >- 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. requestBody: content: application/json: schema: type: object properties: controlNumber: type: string tradingPartnerServiceId: type: string minLength: 1 submitter: type: object properties: organizationName: type: string minLength: 1 maxLength: 60 lastName: type: string minLength: 1 maxLength: 60 firstName: type: string minLength: 1 maxLength: 35 middleName: type: string minLength: 1 maxLength: 25 submitterIdentification: type: string minLength: 2 maxLength: 80 contactInformation: type: object properties: name: type: string phoneNumber: type: string faxNumber: type: string email: type: string phoneExtension: type: string additionalProperties: false required: - contactInformation additionalProperties: false receiver: type: object properties: organizationName: type: string minLength: 1 required: - organizationName additionalProperties: false subscriber: type: object properties: memberId: type: string minLength: 2 maxLength: 80 ssn: type: string pattern: ^\d{9}$ paymentResponsibilityLevelCode: type: string enum: - A - B - C - D - E - F - G - H - P - S - T - U organizationName: type: string insuranceTypeCode: type: string enum: - '12' - '13' - '14' - '15' - '16' - '41' - '42' - '43' - '47' subscriberGroupName: type: string firstName: type: string lastName: type: string middleName: type: string suffix: type: string gender: type: string enum: - M - F - U dateOfBirth: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ policyNumber: type: string groupNumber: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false contactInformation: type: object properties: name: type: string phoneNumber: type: string faxNumber: type: string email: type: string phoneExtension: type: string required: - name additionalProperties: false additionalProperties: false dependent: type: object properties: firstName: type: string lastName: type: string middleName: type: string suffix: type: string gender: type: string enum: - M - F - U dateOfBirth: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ ssn: type: string pattern: ^\d{9}$ memberId: type: string relationshipToSubscriberCode: type: string enum: - '01' - '19' - '20' - '21' - '39' - '40' - '53' - G8 address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false contactInformation: type: object properties: name: type: string phoneNumber: type: string faxNumber: type: string email: type: string phoneExtension: type: string required: - name additionalProperties: false required: - firstName - lastName - gender - dateOfBirth - relationshipToSubscriberCode additionalProperties: false providers: type: array items: type: object properties: providerType: type: string npi: type: string pattern: ^\d{10}$ ssn: type: string pattern: ^\d{9}$ employerId: type: string commercialNumber: type: string locationNumber: type: string stateLicenseNumber: type: string providerUpinNumber: type: string taxonomyCode: type: string minLength: 10 maxLength: 10 pattern: ^[A-Za-z0-9]{10}$ firstName: type: string lastName: type: string middleName: type: string suffix: type: string organizationName: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false contactInformation: type: object properties: name: type: string phoneNumber: type: string faxNumber: type: string email: type: string phoneExtension: type: string additionalProperties: false additionalProperties: false minItems: 1 maxItems: 2147483647 payToAddress: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false payToPlan: type: object properties: organizationName: type: string primaryIdentifierTypeCode: type: string enum: - PI - XV primaryIdentifier: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false secondaryIdentifierTypeCode: type: string enum: - 2U - FY - NF secondaryIdentifier: type: string taxIdentificationNumber: type: string minLength: 9 maxLength: 9 required: - organizationName - primaryIdentifierTypeCode - primaryIdentifier - address - taxIdentificationNumber additionalProperties: false payerAddress: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false billing: type: object properties: providerType: type: string npi: type: string pattern: ^\d{10}$ ssn: type: string pattern: ^\d{9}$ employerId: type: string commercialNumber: type: string locationNumber: type: string stateLicenseNumber: type: string providerUpinNumber: type: string taxonomyCode: type: string minLength: 10 maxLength: 10 pattern: ^[A-Za-z0-9]{10}$ firstName: type: string lastName: type: string middleName: type: string suffix: type: string organizationName: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false contactInformation: type: object properties: name: type: string phoneNumber: type: string faxNumber: type: string email: type: string phoneExtension: type: string additionalProperties: false additionalProperties: false referring: type: object properties: providerType: type: string npi: type: string pattern: ^\d{10}$ commercialNumber: type: string stateLicenseNumber: type: string providerUpinNumber: type: string taxonomyCode: type: string minLength: 10 maxLength: 10 pattern: ^[A-Za-z0-9]{10}$ firstName: type: string lastName: type: string middleName: type: string suffix: type: string organizationName: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false contactInformation: type: object properties: name: type: string phoneNumber: type: string faxNumber: type: string email: type: string phoneExtension: type: string additionalProperties: false additionalProperties: false rendering: type: object properties: providerType: type: string npi: type: string pattern: ^\d{10}$ commercialNumber: type: string locationNumber: type: string stateLicenseNumber: type: string providerUpinNumber: type: string taxonomyCode: type: string minLength: 10 maxLength: 10 pattern: ^[A-Za-z0-9]{10}$ firstName: type: string lastName: type: string middleName: type: string suffix: type: string organizationName: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false contactInformation: type: object properties: name: type: string phoneNumber: type: string faxNumber: type: string email: type: string phoneExtension: type: string additionalProperties: false additionalProperties: false ordering: type: object properties: providerType: type: string npi: type: string pattern: ^\d{10}$ ssn: type: string pattern: ^\d{9}$ employerId: type: string commercialNumber: type: string locationNumber: type: string payerIdentificationNumber: type: string employerIdentificationNumber: type: string claimOfficeNumber: type: string naic: type: string stateLicenseNumber: type: string providerUpinNumber: type: string taxonomyCode: type: string minLength: 10 maxLength: 10 pattern: ^[A-Za-z0-9]{10}$ firstName: type: string lastName: type: string middleName: type: string suffix: type: string organizationName: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false contactInformation: type: object properties: name: type: string phoneNumber: type: string faxNumber: type: string email: type: string phoneExtension: type: string additionalProperties: false additionalProperties: false supervising: type: object properties: providerType: type: string npi: type: string pattern: ^\d{10}$ ssn: type: string pattern: ^\d{9}$ employerId: type: string commercialNumber: type: string locationNumber: type: string stateLicenseNumber: type: string providerUpinNumber: type: string taxonomyCode: type: string minLength: 10 maxLength: 10 pattern: ^[A-Za-z0-9]{10}$ firstName: type: string lastName: type: string middleName: type: string suffix: type: string organizationName: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false contactInformation: type: object properties: name: type: string phoneNumber: type: string faxNumber: type: string email: type: string phoneExtension: type: string additionalProperties: false additionalProperties: false tradingPartnerName: type: string claimInformation: type: object properties: claimFilingCode: type: string enum: - '11' - '12' - '13' - '14' - '15' - '16' - '17' - AM - BL - CH - CI - DS - FI - HM - LM - MA - MB - MC - OF - TV - VA - WC - ZZ propertyCasualtyClaimNumber: type: string claimChargeAmount: type: string pattern: ^\d+(\.\d{1,2})?$ placeOfServiceCode: type: string enum: - '01' - '02' - '03' - '04' - '05' - '06' - '07' - '08' - '09' - '10' - '11' - '12' - '13' - '14' - '15' - '16' - '17' - '18' - '19' - '20' - '21' - '22' - '23' - '24' - '25' - '26' - '27' - '31' - '32' - '33' - '34' - '41' - '42' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '65' - '66' - '71' - '72' - '81' - '99' claimFrequencyCode: type: string enum: - '1' - '7' - '8' signatureIndicator: type: string enum: - 'N' - 'Y' benefitsAssignmentCertificationIndicator: type: string enum: - 'N' - W - 'Y' releaseInformationCode: type: string enum: - I - 'Y' relatedCausesCode: type: array items: type: string enum: - AA - EM - OA minItems: 1 maxItems: 2 autoAccidentStateCode: type: string autoAccidentCountryCode: type: string delayReasonCode: type: string enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - '9' - '10' - '11' - '15' patientAmountPaid: type: string pattern: ^\d+(\.\d{1,2})?$ fileInformation: type: string fileInformationList: type: array items: type: string minItems: 1 maxItems: 10 claimPricingRepricingInformation: type: object properties: pricingMethodologyCode: type: string enum: - '00' - '01' - '02' - '03' - '04' - '05' - '06' - '07' - '08' - '09' - '10' - '11' - '12' - '13' - '14' repricedAllowedAmount: type: string pattern: ^\d+(\.\d{1,2})?$ repricedSavingAmount: type: string pattern: ^\d+(\.\d{1,2})?$ repricingOrganizationIdentifier: type: string repricingPerDiemOrFlatRateAmount: type: string repricedApprovedAmbulatoryPatientGroupCode: type: string repricedApprovedAmbulatoryPatientGroupAmount: type: string pattern: ^\d+(\.\d{1,2})?$ rejectReasonCode: type: string enum: - T1 - T2 - T3 - T4 - T5 - T6 policyComplianceCode: type: string enum: - '1' - '2' - '3' - '4' - '5' exceptionCode: type: string enum: - '1' - '2' - '3' - '4' - '5' - '6' required: - pricingMethodologyCode - repricedAllowedAmount additionalProperties: false serviceFacilityLocation: type: object properties: organizationName: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false npi: type: string pattern: ^\d{10}$ phoneName: type: string phoneNumber: type: string phoneExtension: type: string secondaryIdentifier: type: array items: type: object properties: qualifier: type: string identifier: type: string otherIdentifier: type: string required: - qualifier - identifier additionalProperties: false minItems: 1 maxItems: 3 required: - organizationName - address additionalProperties: false deathDate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ patientWeight: type: string patientSignatureSourceCode: type: boolean pregnancyIndicator: type: string enum: - 'Y' claimDateInformation: type: object properties: symptomDate: type: string initialTreatmentDate: type: string lastSeenDate: type: string acuteManifestationDate: type: string accidentDate: type: string lastMenstrualPeriodDate: type: string lastXRayDate: type: string hearingAndVisionPrescriptionDate: type: string disabilityBeginDate: type: string disabilityEndDate: type: string lastWorkedDate: type: string authorizedReturnToWorkDate: type: string admissionDate: type: string dischargeDate: type: string assumedAndRelinquishedCareBeginDate: type: string assumedAndRelinquishedCareEndDate: type: string repricerReceivedDate: type: string firstContactDate: type: string additionalProperties: false claimSupplementalInformation: type: object properties: reportInformation: type: object properties: attachmentReportTypeCode: type: string enum: - '03' - '04' - '05' - '06' - '07' - '08' - '09' - '10' - '11' - '13' - '15' - '21' - A3 - A4 - AM - AS - B2 - B3 - B4 - BR - BS - BT - CB - CK - CT - D2 - DA - DB - DG - DJ - DS - EB - HC - HR - I5 - IR - LA - M1 - MT - NM - OB - OC - OD - OE - OX - OZ - P4 - P5 - PE - PN - PO - PQ - PY - PZ - RB - RR - RT - RX - SG - V5 - XP attachmentTransmissionCode: type: string enum: - AA - BM - EL - EM - FT - FX attachmentControlNumber: type: string required: - attachmentReportTypeCode - attachmentTransmissionCode additionalProperties: false reportInformations: type: array items: type: object properties: attachmentReportTypeCode: type: string enum: - '03' - '04' - '05' - '06' - '07' - '08' - '09' - '10' - '11' - '13' - '15' - '21' - A3 - A4 - AM - AS - B2 - B3 - B4 - BR - BS - BT - CB - CK - CT - D2 - DA - DB - DG - DJ - DS - EB - HC - HR - I5 - IR - LA - M1 - MT - NM - OB - OC - OD - OE - OX - OZ - P4 - P5 - PE - PN - PO - PQ - PY - PZ - RB - RR - RT - RX - SG - V5 - XP attachmentTransmissionCode: type: string enum: - AA - BM - EL - EM - FT - FX attachmentControlNumber: type: string required: - attachmentReportTypeCode - attachmentTransmissionCode additionalProperties: false minItems: 0 maxItems: 10 priorAuthorizationNumber: type: string referralNumber: type: string claimControlNumber: type: string cliaNumber: type: string repricedClaimNumber: type: string adjustedRepricedClaimNumber: type: string investigationalDeviceExemptionNumber: type: string claimNumber: type: string mammographyCertificationNumber: type: string medicalRecordNumber: type: string demoProjectIdentifier: type: string carePlanOversightNumber: type: string medicareCrossoverReferenceId: type: string serviceAuthorizationExceptionCode: type: string enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' additionalProperties: false ambulanceTransportInformation: type: object properties: patientWeightInPounds: type: string ambulanceTransportReasonCode: type: string enum: - A - B - C - D - E transportDistanceInMiles: type: string roundTripPurposeDescription: type: string stretcherPurposeDescription: type: string required: - ambulanceTransportReasonCode - transportDistanceInMiles additionalProperties: false spinalManipulationServiceInformation: type: object properties: patientConditionCode: type: string patientConditionDescription1: type: string enum: - A - C - D - E - F - G - M patientConditionDescription2: type: string required: - patientConditionCode additionalProperties: false ambulanceCertification: type: array items: type: object properties: certificationConditionIndicator: type: string enum: - 'N' - 'Y' conditionCodes: type: array items: type: string enum: - '01' - '04' - '05' - '06' - '07' - '08' - '09' - '12' minItems: 1 maxItems: 5 required: - certificationConditionIndicator - conditionCodes additionalProperties: false minItems: 1 maxItems: 3 patientConditionInformationVision: type: array items: type: object properties: codeCategory: type: string enum: - E1 - E2 - E3 certificationConditionIndicator: type: string enum: - 'N' - 'Y' conditionCodes: type: array items: type: string enum: - L1 - L2 - L3 - L4 - L5 minItems: 1 maxItems: 5 required: - codeCategory - certificationConditionIndicator - conditionCodes additionalProperties: false minItems: 1 maxItems: 3 claimContractInformation: type: object properties: contractTypeCode: type: string enum: - '01' - '02' - '03' - '04' - '05' - '06' - '09' contractAmount: type: string pattern: ^\d+(\.\d{1,2})?$ contractPercentage: type: string contractCode: type: string termsDiscountPercentage: type: string contractVersionIdentifier: type: string required: - contractTypeCode additionalProperties: false planParticipationCode: type: string enum: - A - B - C specialProgramCode: type: string enum: - '02' - '03' - '05' - '09' homeboundIndicator: type: boolean epsdtReferral: type: object properties: certificationConditionCodeAppliesIndicator: type: string enum: - 'N' - 'Y' conditionCodes: type: array items: type: string enum: - AV - NU - S2 - ST minItems: 1 maxItems: 3 required: - certificationConditionCodeAppliesIndicator - conditionCodes additionalProperties: false anesthesiaRelatedSurgicalProcedure: type: array items: type: string minItems: 1 maxItems: 2 conditionInformation: type: array items: type: object properties: conditionCodes: type: array items: type: string minItems: 1 maxItems: 12 required: - conditionCodes additionalProperties: false minItems: 1 maxItems: 2 claimNote: type: object properties: additionalInformation: type: string certificationNarrative: type: string goalRehabOrDischargePlans: type: string diagnosisDescription: type: string thirdPartOrgNotes: type: string additionalProperties: false ambulancePickUpLocation: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false ambulanceDropOffLocation: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false healthCareCodeInformation: type: array items: type: object properties: diagnosisTypeCode: type: string enum: - BK - ABK - BF - ABF diagnosisCode: type: string required: - diagnosisTypeCode - diagnosisCode additionalProperties: false minItems: 1 maxItems: 12 serviceLines: type: array items: type: object properties: assignedNumber: type: string serviceDate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ serviceDateEnd: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ professionalService: type: object properties: procedureIdentifier: type: string enum: - ER - HC - IV - WK procedureCode: type: string procedureModifiers: type: array items: type: string minItems: 1 maxItems: 4 description: type: string minLength: 1 maxLength: 80 lineItemChargeAmount: type: string pattern: ^\d+(\.\d{1,2})?$ measurementUnit: type: string enum: - MJ - UN serviceUnitCount: type: string placeOfServiceCode: type: string compositeDiagnosisCodePointers: type: object properties: diagnosisCodePointers: type: array items: type: string minItems: 1 maxItems: 2147483647 required: - diagnosisCodePointers additionalProperties: false emergencyIndicator: type: string enum: - 'Y' epsdtIndicator: type: string enum: - 'Y' familyPlanningIndicator: type: string enum: - 'Y' copayStatusCode: type: string enum: - '0' required: - procedureIdentifier - procedureCode - lineItemChargeAmount - measurementUnit - serviceUnitCount - compositeDiagnosisCodePointers additionalProperties: false durableMedicalEquipmentService: type: object properties: days: type: string rentalPrice: type: string purchasePrice: type: string frequencyCode: type: string enum: - '1' - '4' - '6' required: - days - rentalPrice - purchasePrice - frequencyCode additionalProperties: false serviceLineSupplementalInformation: type: array items: type: object properties: attachmentReportTypeCode: type: string enum: - '03' - '04' - '05' - '06' - '07' - '08' - '09' - '10' - '11' - '13' - '15' - '21' - A3 - A4 - AM - AS - B2 - B3 - B4 - BR - BS - BT - CB - CK - CT - D2 - DA - DB - DG - DJ - DS - EB - HC - HR - I5 - IR - LA - M1 - MT - NM - OB - OC - OD - OE - OX - OZ - P4 - P5 - PE - PN - PO - PQ - PY - PZ - RB - RR - RT - RX - SG - V5 - XP attachmentTransmissionCode: type: string enum: - AA - BM - EL - EM - FT - FX attachmentControlNumber: type: string required: - attachmentReportTypeCode - attachmentTransmissionCode additionalProperties: false minItems: 1 maxItems: 10 durableMedicalEquipmentCertificateOfMedicalNecessity: type: object properties: attachmentTransmissionCode: type: string enum: - AB - AD - AF - AG - NS required: - attachmentTransmissionCode additionalProperties: false ambulanceTransportInformation: type: object properties: patientWeightInPounds: type: string ambulanceTransportReasonCode: type: string enum: - A - B - C - D - E transportDistanceInMiles: type: string roundTripPurposeDescription: type: string stretcherPurposeDescription: type: string required: - ambulanceTransportReasonCode - transportDistanceInMiles additionalProperties: false durableMedicalEquipmentCertification: type: object properties: certificationTypeCode: type: string enum: - I - R - S durableMedicalEquipmentDurationInMonths: type: string required: - certificationTypeCode - durableMedicalEquipmentDurationInMonths additionalProperties: false ambulanceCertification: type: array items: type: object properties: certificationConditionIndicator: type: string enum: - 'N' - 'Y' conditionCodes: type: array items: type: string enum: - '01' - '04' - '05' - '06' - '07' - '08' - '09' - '12' minItems: 1 maxItems: 5 required: - certificationConditionIndicator - conditionCodes additionalProperties: false minItems: 1 maxItems: 3 hospiceEmployeeIndicator: type: boolean conditionIndicatorDurableMedicalEquipment: type: object properties: certificationConditionIndicator: type: string enum: - 'Y' - 'N' conditionIndicator: type: string enum: - '38' - ZV conditionIndicatorCode: type: string enum: - '38' - ZV required: - certificationConditionIndicator - conditionIndicator additionalProperties: false serviceLineDateInformation: type: object properties: prescriptionDate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ certificationRevisionOrRecertificationDate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ beginTherapyDate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ lastCertificationDate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ treatmentOrTherapyDate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ hemoglobinTestDate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ serumCreatineTestDate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ shippedDate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ lastXRayDate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ initialTreatmentDate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ additionalProperties: false ambulancePatientCount: type: number obstetricAnesthesiaAdditionalUnits: type: number testResults: type: array items: type: object properties: measurementReferenceIdentificationCode: type: string enum: - OG - TR measurementQualifier: type: string enum: - HT - R1 - R2 - R3 - R4 testResults: type: string required: - measurementReferenceIdentificationCode - measurementQualifier - testResults additionalProperties: false minItems: 1 maxItems: 5 contractInformation: type: object properties: contractTypeCode: type: string enum: - '01' - '02' - '03' - '04' - '05' - '06' - '09' contractAmount: type: string pattern: ^\d+(\.\d{1,2})?$ contractPercentage: type: string contractCode: type: string termsDiscountPercentage: type: string contractVersionIdentifier: type: string required: - contractTypeCode additionalProperties: false serviceLineReferenceInformation: type: object properties: repricedLineItemReferenceNumber: type: string adjustedRepricedLineItemReferenceNumber: type: string priorAuthorization: type: array items: type: object properties: priorAuthorizationOrReferralNumber: type: string otherPayerPrimaryIdentifier: type: string required: - priorAuthorizationOrReferralNumber additionalProperties: false minItems: 1 maxItems: 5 mammographyCertificationNumber: type: string clinicalLaboratoryImprovementAmendmentNumber: type: string referringCliaNumber: type: string immunizationBatchNumber: type: string referralNumber: type: array items: type: string minItems: 1 maxItems: 5 additionalProperties: false salesTaxAmount: type: string postageTaxAmount: type: string pattern: ^\d+(\.\d{1,2})?$ fileInformation: type: array items: type: string minItems: 1 maxItems: 10 additionalNotes: type: string goalRehabOrDischargePlans: type: string thirdPartyOrganizationNotes: type: string purchasedServiceInformation: type: object properties: purchasedServiceProviderIdentifier: type: string purchasedServiceChargeAmount: type: string required: - purchasedServiceProviderIdentifier - purchasedServiceChargeAmount additionalProperties: false linePricingRepricingInformation: type: object properties: pricingMethodologyCode: type: string enum: - '00' - '01' - '02' - '03' - '04' - '05' - '06' - '07' - '08' - '09' - '10' - '11' - '12' - '13' - '14' repricedAllowedAmount: type: string pattern: ^\d+(\.\d{1,2})?$ repricedSavingAmount: type: string pattern: ^\d+(\.\d{1,2})?$ repricingOrganizationIdentifier: type: string repricingPerDiemOrFlatRateAmount: type: string repricedApprovedAmbulatoryPatientGroupCode: type: string repricedApprovedAmbulatoryPatientGroupAmount: type: string pattern: ^\d+(\.\d{1,2})?$ rejectReasonCode: type: string enum: - T1 - T2 - T3 - T4 - T5 - T6 policyComplianceCode: type: string enum: - '1' - '2' - '3' - '4' - '5' exceptionCode: type: string enum: - '1' - '2' - '3' - '4' - '5' - '6' required: - pricingMethodologyCode - repricedAllowedAmount additionalProperties: false drugIdentification: type: object properties: serviceIdQualifier: type: string enum: - EN - EO - HI - N4 - 'ON' - UK - UP nationalDrugCode: type: string nationalDrugUnitCount: type: string measurementUnitCode: type: string enum: - F2 - GR - ME - ML - UN linkSequenceNumber: type: string pharmacyPrescriptionNumber: type: string required: - serviceIdQualifier - nationalDrugCode - nationalDrugUnitCount - measurementUnitCode additionalProperties: false renderingProvider: type: object properties: providerType: type: string npi: type: string pattern: ^\d{10}$ ssn: type: string pattern: ^\d{9}$ employerId: type: string commercialNumber: type: string locationNumber: type: string payerIdentificationNumber: type: string employerIdentificationNumber: type: string claimOfficeNumber: type: string naic: type: string stateLicenseNumber: type: string providerUpinNumber: type: string taxonomyCode: type: string minLength: 10 maxLength: 10 pattern: ^[A-Za-z0-9]{10}$ firstName: type: string lastName: type: string middleName: type: string suffix: type: string organizationName: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false contactInformation: type: object properties: name: type: string phoneNumber: type: string faxNumber: type: string email: type: string phoneExtension: type: string additionalProperties: false otherIdentifier: type: string secondaryIdentifier: type: array items: type: object properties: qualifier: type: string identifier: type: string otherIdentifier: type: string required: - qualifier - identifier additionalProperties: false minItems: 1 maxItems: 20 required: - providerType additionalProperties: false purchasedServiceProvider: type: object properties: providerType: type: string npi: type: string pattern: ^\d{10}$ stateLicenseNumber: type: string commercialNumber: type: string payerIdentificationNumber: type: string ssn: type: string pattern: ^\d{9}$ employerId: type: string locationNumber: type: string employerIdentificationNumber: type: string claimOfficeNumber: type: string naic: type: string providerUpinNumber: type: string taxonomyCode: type: string minLength: 10 maxLength: 10 pattern: ^[A-Za-z0-9]{10}$ firstName: type: string lastName: type: string middleName: type: string suffix: type: string organizationName: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false contactInformation: type: object properties: name: type: string phoneNumber: type: string faxNumber: type: string email: type: string phoneExtension: type: string additionalProperties: false otherIdentifier: type: string secondaryIdentifier: type: array items: type: object properties: qualifier: type: string identifier: type: string otherIdentifier: type: string required: - qualifier - identifier additionalProperties: false minItems: 1 maxItems: 20 additionalProperties: false serviceFacilityLocation: type: object properties: organizationName: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false npi: type: string pattern: ^\d{10}$ phoneName: type: string phoneNumber: type: string phoneExtension: type: string secondaryIdentifier: type: array items: type: object properties: qualifier: type: string identifier: type: string otherIdentifier: type: string required: - qualifier - identifier additionalProperties: false minItems: 1 maxItems: 3 required: - organizationName - address additionalProperties: false supervisingProvider: type: object properties: providerType: type: string npi: type: string pattern: ^\d{10}$ ssn: type: string pattern: ^\d{9}$ employerId: type: string commercialNumber: type: string locationNumber: type: string payerIdentificationNumber: type: string employerIdentificationNumber: type: string claimOfficeNumber: type: string naic: type: string stateLicenseNumber: type: string providerUpinNumber: type: string taxonomyCode: type: string minLength: 10 maxLength: 10 pattern: ^[A-Za-z0-9]{10}$ firstName: type: string lastName: type: string middleName: type: string suffix: type: string organizationName: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false contactInformation: type: object properties: name: type: string phoneNumber: type: string faxNumber: type: string email: type: string phoneExtension: type: string additionalProperties: false otherIdentifier: type: string secondaryIdentifier: type: array items: type: object properties: qualifier: type: string identifier: type: string otherIdentifier: type: string required: - qualifier - identifier additionalProperties: false minItems: 1 maxItems: 20 required: - providerType additionalProperties: false orderingProvider: type: object properties: providerType: type: string npi: type: string pattern: ^\d{10}$ ssn: type: string pattern: ^\d{9}$ employerId: type: string commercialNumber: type: string locationNumber: type: string payerIdentificationNumber: type: string employerIdentificationNumber: type: string claimOfficeNumber: type: string naic: type: string stateLicenseNumber: type: string providerUpinNumber: type: string taxonomyCode: type: string minLength: 10 maxLength: 10 pattern: ^[A-Za-z0-9]{10}$ firstName: type: string lastName: type: string middleName: type: string suffix: type: string organizationName: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false contactInformation: type: object properties: name: type: string phoneNumber: type: string faxNumber: type: string email: type: string phoneExtension: type: string required: - name additionalProperties: false otherIdentifier: type: string secondaryIdentifier: type: array items: type: object properties: qualifier: type: string identifier: type: string otherIdentifier: type: string required: - qualifier - identifier additionalProperties: false minItems: 1 maxItems: 20 additionalProperties: false referringProvider: type: object properties: providerType: type: string npi: type: string pattern: ^\d{10}$ ssn: type: string pattern: ^\d{9}$ employerId: type: string commercialNumber: type: string locationNumber: type: string payerIdentificationNumber: type: string employerIdentificationNumber: type: string claimOfficeNumber: type: string naic: type: string stateLicenseNumber: type: string providerUpinNumber: type: string taxonomyCode: type: string minLength: 10 maxLength: 10 pattern: ^[A-Za-z0-9]{10}$ firstName: type: string lastName: type: string middleName: type: string suffix: type: string organizationName: type: string address: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false contactInformation: type: object properties: name: type: string phoneNumber: type: string faxNumber: type: string email: type: string phoneExtension: type: string additionalProperties: false otherIdentifier: type: string secondaryIdentifier: type: array items: type: object properties: qualifier: type: string identifier: type: string otherIdentifier: type: string required: - qualifier - identifier additionalProperties: false minItems: 1 maxItems: 20 required: - providerType additionalProperties: false ambulancePickUpLocation: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false ambulanceDropOffLocation: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false lineAdjudicationInformation: type: array items: type: object properties: otherPayerPrimaryIdentifier: type: string serviceLinePaidAmount: type: string pattern: ^\d+(\.\d{1,2})?$ procedureCode: type: string procedureModifier: type: array items: type: string minItems: 1 maxItems: 4 procedureCodeDescription: type: string paidServiceUnitCount: type: string bundledOrUnbundledLineNumber: type: string claimAdjustmentInformation: type: array items: type: object properties: adjustmentGroupCode: type: string enum: - CO - CR - OA - PI - PR adjustmentDetails: type: array items: type: object properties: adjustmentReasonCode: type: string adjustmentAmount: type: string pattern: ^\d+(\.\d{1,2})?$ adjustmentQuantity: type: string required: - adjustmentReasonCode - adjustmentAmount additionalProperties: false minItems: 1 maxItems: 6 required: - adjustmentGroupCode - adjustmentDetails additionalProperties: false minItems: 1 maxItems: 5 adjudicationOrPaymentDate: type: string pattern: ^\d{4}(0[1-9]|1[0-2])(0[1-9]|[12]\d|3[01])$ remainingPatientLiability: type: string pattern: ^\d+(\.\d{1,2})?$ serviceIdQualifier: type: string enum: - ER - HC - HP - IV - WK required: - otherPayerPrimaryIdentifier - serviceLinePaidAmount - procedureCode - paidServiceUnitCount - adjudicationOrPaymentDate - serviceIdQualifier additionalProperties: false minItems: 1 maxItems: 15 formIdentification: type: array items: type: object properties: formTypeCode: type: string enum: - AS - UT formIdentifier: type: string supportingDocumentation: type: array items: type: object properties: questionNumber: type: string questionResponseCode: type: string enum: - 'N' - W - 'Y' questionResponse: type: string questionResponseAsDate: type: string questionResponseAsPercent: type: string required: - questionNumber additionalProperties: false minItems: 1 maxItems: 99 required: - formTypeCode - formIdentifier additionalProperties: false required: - serviceDate - professionalService additionalProperties: false otherSubscriberInformation: type: array items: type: object properties: paymentResponsibilityLevelCode: type: string enum: - A - B - C - D - E - F - G - H - P - S - T - U individualRelationshipCode: type: string enum: - '01' - '18' - '19' - '20' - '21' - '39' - '40' - '53' - G8 insuranceGroupOrPolicyNumber: type: string otherInsuredGroupName: type: string insuranceTypeCode: type: string enum: - '12' - '13' - '14' - '15' - '16' - '41' - '42' - '43' - '47' claimFilingIndicatorCode: type: string enum: - '11' - '12' - '13' - '14' - '15' - '16' - '17' - AM - BL - CH - CI - DS - FI - HM - LM - MA - MB - MC - OF - TV - VA - WC - ZZ claimLevelAdjustments: type: array items: type: object properties: adjustmentGroupCode: type: string enum: - CO - CR - OA - PI - PR adjustmentDetails: type: array items: type: object properties: adjustmentReasonCode: type: string adjustmentAmount: type: string pattern: ^\d+(\.\d{1,2})?$ adjustmentQuantity: type: string required: - adjustmentReasonCode - adjustmentAmount additionalProperties: false minItems: 1 maxItems: 6 required: - adjustmentGroupCode - adjustmentDetails additionalProperties: false minItems: 1 maxItems: 5 payerPaidAmount: type: string pattern: ^\d+(\.\d{1,2})?$ nonCoveredChargeAmount: type: string pattern: ^\d+(\.\d{1,2})?$ remainingPatientLiability: type: string pattern: ^\d+(\.\d{1,2})?$ benefitsAssignmentCertificationIndicator: type: string enum: - 'N' - W - 'Y' releaseOfInformationCode: type: string enum: - I - 'Y' otherPayerReferringProvider: type: array items: type: object properties: otherPayerReferringProviderIdentifier: type: array items: type: object properties: qualifier: type: string identifier: type: string otherIdentifier: type: string required: - qualifier - identifier additionalProperties: false minItems: 1 maxItems: 3 required: - otherPayerReferringProviderIdentifier additionalProperties: false otherPayerRenderingProvider: type: array items: type: object properties: entityTypeQualifier: type: string enum: - '1' - '2' otherPayerRenderingProviderSecondaryIdentifier: type: array items: type: object properties: qualifier: type: string identifier: type: string otherIdentifier: type: string required: - qualifier - identifier additionalProperties: false minItems: 1 maxItems: 3 required: - entityTypeQualifier additionalProperties: false otherPayerServiceFacilityLocation: type: array items: type: object properties: otherPayerServiceFacilityLocationSecondaryIdentifier: type: array items: type: object properties: qualifier: type: string identifier: type: string otherIdentifier: type: string required: - qualifier - identifier additionalProperties: false minItems: 1 maxItems: 3 required: - >- otherPayerServiceFacilityLocationSecondaryIdentifier additionalProperties: false otherPayerSupervisingProvider: type: array items: type: object properties: otherPayerSupervisingProviderIdentifier: type: array items: type: object properties: qualifier: type: string identifier: type: string otherIdentifier: type: string required: - qualifier - identifier additionalProperties: false minItems: 1 maxItems: 3 required: - otherPayerSupervisingProviderIdentifier additionalProperties: false otherPayerBillingProvider: type: array items: type: object properties: entityTypeQualifier: type: string enum: - '1' - '2' otherPayerBillingProviderIdentifier: type: array items: type: object properties: qualifier: type: string identifier: type: string otherIdentifier: type: string required: - qualifier - identifier additionalProperties: false minItems: 1 maxItems: 2 required: - entityTypeQualifier - otherPayerBillingProviderIdentifier additionalProperties: false patientSignatureGeneratedForPatient: type: boolean medicareOutpatientAdjudication: type: object properties: reimbursementRate: type: string hcpcsPayableAmount: type: string pattern: ^\d+(\.\d{1,2})?$ claimPaymentRemarkCode: type: array items: type: string minItems: 1 maxItems: 5 endStageRenalDiseasePaymentAmount: type: string pattern: ^\d+(\.\d{1,2})?$ nonPayableProfessionalComponentBilledAmount: type: string pattern: ^\d+(\.\d{1,2})?$ additionalProperties: false otherSubscriberName: type: object properties: otherInsuredQualifier: type: string enum: - '1' - '2' otherInsuredLastName: type: string otherInsuredFirstName: type: string otherInsuredMiddleName: type: string otherInsuredNameSuffix: type: string otherInsuredIdentifierTypeCode: type: string enum: - II - MI otherInsuredIdentifier: type: string otherInsuredAddress: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false otherInsuredAdditionalIdentifier: type: string required: - otherInsuredQualifier - otherInsuredLastName - otherInsuredIdentifierTypeCode - otherInsuredIdentifier additionalProperties: false otherPayerName: type: object properties: otherPayerOrganizationName: type: string otherPayerIdentifierTypeCode: type: string enum: - PI - XV otherPayerIdentifier: type: string otherPayerAddress: type: object properties: address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string required: - address1 - city additionalProperties: false otherPayerAdjudicationOrPaymentDate: type: string otherPayerSecondaryIdentifier: type: array items: type: object properties: qualifier: type: string identifier: type: string otherIdentifier: type: string required: - qualifier - identifier additionalProperties: false minItems: 1 maxItems: 2 otherPayerPriorAuthorizationNumber: type: string otherPayerPriorAuthorizationOrReferralNumber: type: string otherPayerClaimAdjustmentIndicator: type: boolean otherPayerClaimControlNumber: type: string required: - otherPayerOrganizationName - otherPayerIdentifierTypeCode - otherPayerIdentifier additionalProperties: false required: - paymentResponsibilityLevelCode - individualRelationshipCode - claimFilingIndicatorCode - benefitsAssignmentCertificationIndicator - releaseOfInformationCode - otherSubscriberName - otherPayerName additionalProperties: false minItems: 1 maxItems: 10 required: - claimFilingCode - claimChargeAmount - placeOfServiceCode - claimFrequencyCode - signatureIndicator - benefitsAssignmentCertificationIndicator - releaseInformationCode - planParticipationCode - healthCareCodeInformation - serviceLines additionalProperties: false isTesting: type: boolean required: - tradingPartnerServiceId - submitter - receiver - subscriber - billing - claimInformation - isTesting additionalProperties: false required: true responses: '200': description: >- Claim submission initiated successfully. Returns an ID to track the claim submission. content: application/json: schema: type: object properties: claimSubmissionId: type: string description: Sample's internal ID of the claim submission. patientControlNumber: type: string description: >- The patient control number we send to the clearinghouse for identification. This is a alphanumeric string with <= 20 characters. required: - claimSubmissionId - patientControlNumber additionalProperties: false '400': description: Default Response content: application/json: schema: type: object properties: error: type: string description: The error message. message: type: string description: The message. statusCode: type: number description: The status code. details: type: object additionalProperties: {} description: The details of the error additionalProperties: true '500': description: Default Response content: application/json: schema: type: object properties: error: type: string description: >- Error message if the claim submission fails due to a server-side issue, such as database errors or problems with the processing queue. required: - error additionalProperties: false ````