Enhanced Claim Status Configuration API Documentation

Submitted by khoeppner on Mon, 04/17/2023 - 18:54
ECS Configuration Workflow


Contents

Revision History 1

Overview 1

Configurations Call for ECS 1

Examples of Configurations API for ECS 2

Sample Scenario 1: Viewing Payers Supporting Certain subtypeId 2

Sample Scenario 2: View All Subtypes Supported by a Certain payerId 5

Sample Scenario 3: View Required Fields for a payerId subtypeId 6

VALUE_ADDS_277 Request Fields 13

Steps for Anthem VALUE_ADDS_277 requestType 13

Fields for Anthem VALUE_ADDS_277 requestType 14

Example for Anthem VALUE_ADDS_277 requestType 14

Helpful Notes 14


Revision History

Revision

Date

Section

Description

Changed By

Initial Version

04/28/2022

All

Initial Version

Katie Ruhl

1.1

05/26/2022

All

Changed to single spacing formatting Added Overview section

Updated Notes to Helpful Notes Updated type

Updated subtypeId Updated version

Updated example configuration calls

Added “VALUE_ADDS_277 Request

Fields” section

Katie Ruhl












Overview

This document reviews how to utilize the configurations call for information around how to format requests for the claim-status (Enhanced Claim Status) API.


Configurations Call for ECS

type: This is the type for Enhanced Claim Status

  • enhanced-claim-status


    subtypeId: This categorizes the type of Enhanced Claim Status Call

  • HIPAA_276

  • VALUE_ADDS_277

  • SUMMARY

  • DETAIL


    version: This helps identify the search types that are supported

  • HIPAA_276

  • VALUE_ADDS_277

  • CLAIM_NUMBER

  • CLAIM_HISTORY

  • SERVICE_DATE

  • CHECK_NUMBER

  • MEMBER_ID


Table of Sub Type and Version

subtypeid

Version

HIPAA_276

HIPAA_276

VALUE_ADDS_277

VALUE_ADDS_277

SUMMARY

CLAIM_HISTORY SERVICE_DATE CHECK_NUMBER

MEMBER_ID

DETAIL

CLAIM_NUMBER


Examples of Configurations API for ECS

Sample Scenario 1: Viewing Payers Supporting Certain subtypeId

Description: You would submit the type and subtypeId

type: enhanced-claim-status subtypeId: SUMMARY


Request:

curl --location --request GET 'https://api.availity.com/availity/v1/configurations?type=enhanced-claim-status&subtypeId=SUMMARY' \


Response:

{

"totalCount": 20,

"count": 20,

"offset": 0,

"limit": 50,

"links": {

"self": {

"href": "https://clmsmgmt/claim-status/v1/configurations?type=enhanced-claim-status&sourceId=API&subtypeId=SUMMARY"

}

},

"configurations": [

{

"type": "enhanced-claim-status",

"subtypeId": "SUMMARY", "payerId": "00390",

"payerName": "BCBS TENNESSEE",

"version": "MEMBER_ID"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "00390",

"payerName": "BCBS TENNESSEE",

"version": "CHECK_NUMBER"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "00390",

"payerName": "BCBS TENNESSEE",

"version": "SERVICE_DATE"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "93095",

"payerName": "LIFEWISE ASSURANCE COMPANY",

"version": "MEMBER_ID"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "93095",

"payerName": "LIFEWISE ASSURANCE COMPANY",

"version": "SERVICE_DATE"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "93093",

"payerName": "LIFEWISE HEALTH PLAN OF OREGON",

"version": "MEMBER_ID"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "93093",

"payerName": "LIFEWISE HEALTH PLAN OF OREGON",

"version": "SERVICE_DATE"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "MCCVA",

"payerName": "MOLINA COMPLETE CARE - MEDICAID",

"version": "MEMBER_ID"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "MCCVA",

"payerName": "MOLINA COMPLETE CARE - MEDICAID",

"version": "CHECK_NUMBER"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "MCCVA",

"payerName": "MOLINA COMPLETE CARE - MEDICAID",

"version": "SERVICE_DATE"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "00430",

"payerName": "PREMERA BLUE CROSS (WA)",

"version": "MEMBER_ID"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "00430",

"payerName": "PREMERA BLUE CROSS (WA)",

"version": "SERVICE_DATE"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "00934",

"payerName": "PREMERA BLUE CROSS BLUE SHIELD OF ALASKA",

"version": "MEMBER_ID"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "00934",

"payerName": "PREMERA BLUE CROSS BLUE SHIELD OF ALASKA",

"version": "SERVICE_DATE"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "SHMS1",

"payerName": "SHARED HEALTH MISSISSIPPI",

"version": "MEMBER_ID"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "SHMS1",

"payerName": "SHARED HEALTH MISSISSIPPI",

"version": "CHECK_NUMBER"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "SHMS1",

"payerName": "SHARED HEALTH MISSISSIPPI",

"version": "SERVICE_DATE"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "VAPCCC3",

"payerName": "TRIWEST HEALTHCARE ALLIANCE",

"version": "MEMBER_ID"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "VAPCCC3",

"payerName": "TRIWEST HEALTHCARE ALLIANCE",

"version": "CLAIM_HISTORY"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "VAPCCC3",

"payerName": "TRIWEST HEALTHCARE ALLIANCE",

"version": "SERVICE_DATE"

}

]

}


Sample Scenario 2: View All Subtypes Supported by a Certain payerId

Description: You would submit the type and payerId type: enhanced-claim-status

payerId: BCBSF


Request:

curl --location --request GET 'https://api.availity.com/availity/v1/configurations?type=enhanced-claim-status&payerId=BCBSF' \


Response:

{

"totalCount": 5,

"count": 5,

"offset": 0,

"limit": 50,

"links": {

"self": {

"href": "https://clmsmgmt/claim-status/v1/configurations?type=enhanced-claim-status&sourceId=API&payerId=BCBSF"

}

},

"configurations": [

{

"type": "enhanced-claim-status", "subtypeId": "HIPAA_276", "payerId": "BCBSF", "payerName": "FLORIDA BLUE", "version": "HIPAA_276"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "BCBSF", "payerName": "FLORIDA BLUE", "version": "MEMBER_ID"

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "BCBSF", "payerName": "FLORIDA BLUE", "version": "SERVICE_DATE"

},

{

"type": "enhanced-claim-status", "subtypeId": "DETAIL", "payerId": "BCBSF", "payerName": "FLORIDA BLUE", "version": "CLAIM_NUMBER"

},

{

"type": "enhanced-claim-status", "subtypeId": "VALUE_ADDS_277", "payerId": "BCBSF",

"payerName": "FLORIDA BLUE", "version": "VALUE_ADDS_277"

}

]

}


Sample Scenario 3: View Required Fields for a payerId subtypeId

Description: You must submit type, subtype and payerId to get all required elements for a request type: enhanced-claim-status

subtypeId: SUMMARY payerId: BCBSF Request:

curl --location --request GET

'https://api.availity.com/availity/v1/configurations?type=enhanced-claim-status&subtypeId=SUMMARY&payerId=BCBSF' \

Response:

{

"totalCount": 2,

"count": 2,

"offset": 0,

"limit": 50,

"links": {

"self": {

"href": "https://clmsmgmt/claim-status/v1/configurations?type=enhanced-claim-status&sourceId=API&subtypeId=SUMMARY&payerId=BCBSF"

}

},

"configurations": [

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "BCBSF", "payerName": "FLORIDA BLUE", "version": "MEMBER_ID", "elements": {

"patientAccountNumber": { "type": "Text",

"label": "Patient Account Number",

"order": 0, "allowed": true, "required": false,

"errorMessage": "Enter a valid Patient Account Number (patientAccountNumber) consisting of 1 -50 alpha or numeric characters.",

"pattern": "^[a-zA-Z0-9\\s!&,()+'\\-./;?=#\\\\]{1,50}$",

"maxLength": 50

},

"toDate": { "type": "Date",

"label": "Claim Service Date To", "order": 1,

"allowed": true, "required": true,

"errorMessage": "Enter a valid date. The date must be within a 31 day span of the f rom date. It

cannot be a future date. It must be after the f rom date.", "min": "2002-01-01T05: 00:00.000+0000", "max": "2022-05-27T03:59:59.999+0000",

"dependentDateField": { "f romDate": {

"span": "31d",

"spanErrorMessage": "Enter a valid date. The date must be within a 31 day span of the f rom date. It cannot be a future date. It must be after the f rom date."

}

}

},

"f romDate": { "type": "Date",

"label": "Claim Service Date From", "order": 2,

"allowed": true, "required": true,

"errorMessage": "Enter a valid date. The f rom date must be within the previous 39 months. It cannot be a future date. It must be after the patient's date of birth.",

"min": "2019-02-26T05: 00:00.000+0000",

"max": "2022-05-27T03:59:59.999+0000"

},

"payerAssignedProviderId": { "type": "Unsupported",

"label": "Provider Payer Assigned Provider ID", "order": 3,

"allowed": false,

"errorMessage": "This f ield is not supported."

},

"providerTaxId": { "type": "Text",

"label": "Provider Tax ID",

"order": 4, "allowed": true, "required": false,

"errorMessage": "Enter a valid Tax ID containing nine numeric digits and no dashes.", "pattern": "^[0-9]{9}$",

"maxLength": 9

},

"providerNpi": { "type": "Text",

"label": "Provider NPI", "order": 5,

"allowed": true, "required": true,

"errorMessage": "Enter a valid Requesting Provider National Provider Identifier (providerNpi) containing 10 numeric digits and beginning with a 1, 2, 3, or 4.",

"pattern": "^[1-4][0-9]{9}$",

"maxLength": 10

},

"groupNumber": {

"type": "Unsupported", "label": "Group Number", "order": 6,

"allowed": false,

"errorMessage": "This f ield is not supported."


allowed.",

},

"memberId": { "type": "Text",

"label": "Patient ID",

"order": 7, "allowed": true, "required": true,

"errorMessage": "Enter a valid alphanumeric Member ID. Punctuation and special charact ers are not


"pattern": "^[a-zA-Z0-9]{2,80}$", "maxLength": 80

},

"traceId": {

"type": "Text",

"label": "Trace ID", "order": 8, "allowed": true, "required": false,

"errorMessage": "Enter a valid Trace ID.", "pattern": "^[a-zA-Z0-9-]{1,35}$", "maxLength": 35

},

"payerId": { "type": "Text",

"label": "Payer ID", "order": 9, "allowed": true, "required": true,

"errorMessage": "Enter a valid Payer ID.", "pattern": "^[a-zA-Z0-9]{2,80}$", "maxLength": 80

},

"requestType": {

"type": "Enumeration", "label": "Request Type", "order": 10,

"allowed": true, "required": true,

"errorMessage": "Please select a valid request type.",

"mode": "DropDown", "values": [

{

"code": "BY_MEMBER_ID",

"value": "Search By Member ID"

},

{

"code": "BY_SUBSCRIBER_ID",

"value": "Search By Subscriber ID"

},

{

"code": "BY_PROVIDER_ID",

"value": "Search By Provider ID"

},

{

"code": "BY_PROCESSED_DATE",

"value": "Search By Processed Date"

},

{

"code": "BY_CHECK_NUMBER",

"value": "Search By Check Number"

},

{

"code": "BY_CLAIM_HISTORY",

"value": "Search By Claim History"

},

{

"code": "BY_CLAIM_NUMBER",

"value": "Search By Claim Number"

},

{

"code": "VALUE_ADDS_277",

"value": "Value Add Search"

}

]

}

},

"requiredFieldCombinations": {}

},

{

"type": "enhanced-claim-status", "subtypeId": "SUMMARY", "payerId": "BCBSF", "payerName": "FLORIDA BLUE", "version": "SERVICE_DATE", "elements": {

"checkNumber": { "type": "Text",

"label": "Check Number", "order": 0,

"allowed": true,

"required": false,

"errorMessage": "Enter a valid Check Number (checkNumber) consisting of 1-16 alpha or numeric

characters.",


},


"pattern": "^[a-zA-Z0-9]{1,16}$", "maxLength": 16

"requestedStatus": { "type": "Enumeration",

"label": "Requested Status", "order": 1,

"allowed": true, "required": true,

"errorMessage": "Please select a valid request status.",

"mode": "DropDown", "values": [

{

"code": "ALL",

"value": "All"

},

{

"code": "DENIED",

"value": "Denied"

},

{

"code": "FINALIZED",

"value": "Finalized"

},

{

"code": "PAID",

"value": "Paid"

},

{

"code": "ALL_PENDING",

"value": "Pending"

}

]

},

"toDate": { "type": "Date",

"label": "Claim Service Date To", "order": 2,

"allowed": true,

"required": true,

"errorMessage": "Enter a valid date. The date must be within a 31 day span of the f rom date. It cannot be a future date. It must be after the f rom date.",

"min": "2002-01-01T05: 00:00.000+0000", "max": "2022-05-27T03:59:59.999+0000",

"dependentDateField": {

"f romDate": { "span": "31d",

"spanErrorMessage": "Enter a valid date. The date must be within a 31 day span of the f rom

date. It cannot be a future date. It must be after the f rom date."

}

}

},

"f romDate": { "type": "Date",

"label": "Claim Service Date From", "order": 3,

"allowed": true, "required": true,

"errorMessage": "Enter a valid date. The f rom date must be within the previous 39 months. It cannot be a future date. It must be after the patient's date of birth.",

"min": "2019-02-26T05: 00:00.000+0000",

"max": "2022-05-27T03:59:59.999+0000"

},

"payerAssignedProviderId": { "type": "Unsupported",

"label": "Provider Payer Assigned Provider ID", "order": 4,

"allowed": false,

"errorMessage": "This f ield is not supported."

},

"providerTaxId": { "type": "Text",

"label": "Provider Tax ID",

"order": 5, "allowed": true, "required": false,

"errorMessage": "Enter a valid Tax ID containing nine numeric digits and no dashes.", "pattern": "^[0-9]{9}$",

"maxLength": 9

},

"providerNpi": { "type": "Text",

"label": "Provider NPI", "order": 6,

"allowed": true, "required": true,

"errorMessage": "Enter a valid Requesting Provider National Provider Identifier (providerNpi)

containing 10 numeric digits and beginning with a 1, 2, 3, or 4.", "pattern": "^[1-4][0-9]{9}$",

"maxLength": 10

},

"traceId": { "type": "Text",

"label": "Trace ID", "order": 7, "allowed": true, "required": false,

"errorMessage": "Enter a valid Trace ID.", "pattern": "^[a-zA-Z0-9-]{1,35}$", "maxLength": 35

},

"payerId": { "type": "Text",

"label": "Payer ID", "order": 8, "allowed": true, "required": true,

"errorMessage": "Enter a valid Payer ID.", "pattern": "^[a-zA-Z0-9]{2,80}$", "maxLength": 80

},

"requestType": {

"type": "Enumeration", "label": "Request Type", "order": 9,

"allowed": true, "required": true,

"errorMessage": "Please select a valid request type.",

"mode": "DropDown", "values": [

{

"code": "BY_MEMBER_ID",

"value": "Search By Member ID"

},

{

"code": "BY_SUBSCRIBER_ID",

"value": "Search By Subscriber ID"

},

{

"code": "BY_PROVIDER_ID",

"value": "Search By Provider ID"

},

{

"code": "BY_PROCESSED_DATE",

"value": "Search By Processed Date"

},

{

"code": "BY_CHECK_NUMBER",

"value": "Search By Check Number"

},

{

"code": "BY_CLAIM_HISTORY",

"value": "Search By Claim History"

},

{

"code": "BY_CLAIM_NUMBER",

"value": "Search By Claim Number"

},

{

"code": "VALUE_ADDS_277",

"value": "Value Add Search"

}

]

}

},

"requiredFieldCombinations": {}

}

]

}


VALUE_ADDS_277 Request Fields

  • The configurations API should be used to identify the required f ields for each payerId

  • The parentTransactionId should be populated with the AVAILITY_TRACE_ID f rom the requestType: HIPAA_276 request made initially

  • The claimNumber index is a f requently required f ield on the VALUE_ADDS_277 request.

    • Health Plans can repeat a claimNumber across multiple unique claims. Due to this, we needed a way to differentiate which claim number is being requested during the value adds c all.

    • Each claim in the original searchBy276 response is assigned an index beginning at 0 and incrementing by 1 each time.


Steps for Anthem VALUE_ADDS_277 requestType:

  1. Perform SearchBy276 request

    1. POST 'https://api.availity.com/availity/clmsmgmt/claim-status/claim-status/v1/status/searchBy276'

  2. Use the id to get the SearchBy276 response

    1. GET 'https://api.availity.com/availity/clmsmgmt/claim-status/claim-

      status/v1/status/searchBy276’

  3. Perform the ValueAdds277 request using the id returned f rom the SearchBy276 as the parent transaction id.

    1. POST 'https://api.availity.com/availity/clmsmgmt/claim-status/claim-status/v1/status/valueAdds277'

    2. Claim Number should be pulled f rom the searchBy276 response

    3. claimIndex = 0 always maps to the f irst claim item in the results. claimIndex=1 will be the second claim item in the results, etc.

  4. Use the id f rom request to retrieve the claim

    1. GET 'https://api.availity.com/availity/clmsmgmt/claim-status/claim-status/v1/status/searchBy276?id=0020b41e-0165-24b9-000e-fa6448dc2335'


Fields for Anthem VALUE_ADDS_277 requestType:

{

"parentTransactionId": “<insert AVAILITY_TRACE_ID f rom SearchBy276 request>", "claimNumber":"<insert claim number>",

"claimIndex": 0, "payerId":"130",

"requestType":"VALUE_ADDS_277"

}


Example for Anthem VALUE_ADDS_277 requestType:

{

"parentTransactionId": “0010c95f-9c44-38e7-0010-ebb6a4461bd8", "claimNumber":"198365123456",

"claimIndex": 0,

"payerId":"130", "requestType":"VALUE_ADDS_277"

}


Helpful Notes:

  • To get the required elements for a ECS request, you must include the type, subtypeId and payerId in the request to the Config API

  • You can only call one subtype or one payerId at a time to the configurations call

  • You are not able to just search the configurations API for just a payerId

  • You are unable to search and f ilter based on version