--- swagger: "2.0" info: x-ibm-name: care-cost-estimator-institutional title: Care Cost Estimator - Institutional version: 1.0.0 description: "" schemes: - https basePath: /v1 consumes: - application/json produces: - application/json securityDefinitions: oauth2: type: oauth2 description: "" flow: application scopes: hipaa: Realtime - Live HIPAA API tokenUrl: https://api.availity.com/v1/token security: - oauth2: - hipaa x-ibm-configuration: enforced: true testable: false phase: realized paths: /institutional-claims: post: summary: Create a new institutional claims. operationId: createInstitutionalClaim consumes: - application/json - application/xml produces: - application/json - application/xml parameters: - in: body name: institutionalclaim schema: $ref: '#/definitions/InstitutionalClaim' responses: 202: description: Accepted headers: Location: type: string description: Location of the institutional claim. X-Status-Message: type: string description: Current status of the pending request. 400: description: Bad Request schema: $ref: '#/definitions/ErrorResponse' 401: description: Not Authorized schema: $ref: '#/definitions/ErrorResponse' 403: description: Forbidden schema: $ref: '#/definitions/ErrorResponse' 500: description: Internal Server Error schema: $ref: '#/definitions/ErrorResponse' /institutional-claims/{id}: get: summary: Get a institutional claim by its id. operationId: getInstitutionalClaim produces: - application/json - application/xml parameters: - in: path name: id required: true type: string responses: 200: description: OK schema: $ref: '#/definitions/InstitutionalClaim' 202: description: Accepted headers: Location: type: string description: Location of the institutional claim. X-Status-Message: type: string description: Current status of the pending request. 400: description: Bad Request schema: $ref: '#/definitions/ErrorResponse' 401: description: Not Authorized schema: $ref: '#/definitions/ErrorResponse' 403: description: Forbidden schema: $ref: '#/definitions/ErrorResponse' 404: description: Not Found schema: $ref: '#/definitions/ErrorResponse' 500: description: Internal Server Error schema: $ref: '#/definitions/ErrorResponse' 504: description: Gateway Timeout schema: $ref: '#/definitions/ErrorResponse' parameters: - name: id type: string required: true in: path description: A professional claim id definitions: InstitutionalClaim: type: object properties: id: type: string description: The id of the institutional claim. createdDate: type: string format: date-time description: The date and time that this institutional claim was created. updatedDate: type: string format: date-time description: The date and time that this institutional claim was last updated. expirationDate: type: string format: date-time description: The date and time that this institutional claim will expire from our system. customerId: type: string description: The id of the customer that owns this institutional claim. requestTypeCode: type: string description: The type of institutional claim. enum: - PRE_DETERMINATION submitter: type: object description: The submitter. properties: lastName: type: string description: The last name of the submitter. firstName: type: string description: The first name of the submitter. middleName: type: string description: The middle name of the submitter. id: type: string description: The id of the submitter. contactName: type: string description: The contact name of the submitter. phone: type: string description: The phone number of the submitter. extension: type: string description: The phone number extension of the submitter. fax: type: string description: The fax number of the submitter. email: type: string description: The email address of the submitter. payer: type: object description: The payer. properties: name: type: string description: The name of the payer. id: type: string description: The id of the payer. addressLine1: type: string description: The address of the payer. addressLine2: type: string description: The address of the payer. city: type: string description: The city of the payer. stateCode: type: string description: The state code of the payer. zipCode: type: string description: The ZIP code of the payer. countryCode: type: string description: The country code of the payer. enum: - US - CA ein: type: string description: The EIN of the payer. claimOfficeNumber: type: string description: The claim office number of the payer. naicCode: type: string description: The NAIC code of the payer. responsibilitySequenceCode: type: string description: The responsibility sequence code of the payer. enum: - P - S - T insuranceTypeCode: type: string description: The insurance type code of the payer. claimFilingIndicatorCode: type: string description: The claim filing indicator code of the payer. disclaimer: type: string description: A disclaimer from the payer. billingProvider: type: object description: The billing provider. properties: specialtyCode: type: string description: The specialty code of the billing provider. name: type: string description: The name of the billing provider. npi: type: string description: The national provider id of the billing provider. addressLine1: type: string description: The address of the billing provider. addressLine2: type: string description: The address of the billing provider. city: type: string description: The city of the billing provider. stateCode: type: string description: The state code of the billing provider. zipCode: type: string description: The ZIP code of the billing provider. countryCode: type: string description: The country code of the billing provider. enum: - US - CA ein: type: string description: The EIN of the billing provider. ssn: type: string description: The SSN of the billing provider. stateLicenseNumber: type: string description: The state license number of the billing provider. payerAssignedProviderId: type: string description: The payer assigned provider id of the billing provider. contactName: type: string description: The contact name of the billing provider. phone: type: string description: The phone number of the billing provider. extension: type: string description: The phone number extension of the billing provider. fax: type: string description: The fax number of the billing provider. email: type: string description: The email address of the billing provider. payToAddress: type: object description: The pay to address of the billing provider. properties: addressLine1: type: string description: The address of the pay to address. addressLine2: type: string description: The address of the pay to address. city: type: string description: The city of the pay to address. stateCode: type: string description: The state code of the pay to address. zipCode: type: string description: The ZIP code of the pay to address. subscriber: type: object description: The subscriber. properties: lastName: type: string description: The last name of the subscriber. firstName: type: string description: The first name of the subscriber. middleName: type: string description: The middle name of the subscriber. suffix: type: string description: The suffix of the subscriber. memberId: type: string description: The member id of the subscriber. groupNumber: type: string description: The group number of the subscriber. groupName: type: string description: The group name of the subscriber. ssn: type: string description: The SSN of the subscriber. totalFamilyDeductible: type: string description: The total family deductible of the subscriber. accumulatedFamilyDeductible: type: string description: The accumulated family deductible of the subscriber. remainingFamilyDeductible: type: string description: The remaining family deductible of the subscriber. totalDeductible: type: string description: The total deductible of the subscriber. accumulatedDeductible: type: string description: The accumulated deductible of the subscriber. remainingDeductible: type: string description: The remaining deductible of the subscriber. onHold: type: boolean description: The subscriber's on hold indicator. holdReasons: type: array description: A list of hold reasons. items: $ref: '#/definitions/ItemDescription' patient: type: object description: The patient. properties: lastName: type: string description: The last name of the patient. firstName: type: string description: The first name of the patient. middleName: type: string description: The middle name of the patient. suffix: type: string description: The suffix of the patient. ssn: type: string description: The SSN of the patient. addressLine1: type: string description: The address of the patient. addressLine2: type: string description: The address of the patient. city: type: string description: The city of the patient. stateCode: type: string description: The state code of the patient. zipCode: type: string description: The ZIP code of the patient. birthDate: type: string format: date description: The birth date of the patient. gender: type: string description: The gender of the patient. enum: - Female - Male - Unknown genderCode: type: string description: The gender code of the patient. enum: - F - M - U subscriberRelationship: type: string description: The relationship of the patient to the subscriber. enum: - Self - Spouse - Child - Employee - Unknown - Organ Donor - Cadaver Donor - Life Partner - Other Relationship - Other Adult subscriberRelationshipCode: type: string description: The relationship code of the patient to the subscriber. enum: - 18 - 1 - 19 - 20 - 21 - 39 - 40 - 53 - G8 - 34 claimInformation: type: object description: The claim information. properties: controlNumber: type: string description: The institutional claim's control number. facilityTypeCode: type: string description: The facility type code. frequencyTypeCode: type: string description: The frequency type code. providerAcceptAssignmentCode: type: string description: The provider accept assignment code. benefitsAssignmentCertification: type: boolean description: The benefits assignment certification indicator. informationReleaseCode: type: string description: The information release code. admissionTypeCode: type: string description: The admission type code. admissionSourceCode: type: string description: The admission source code. patientStatusCode: type: string description: The patient status code. bundled: type: boolean description: The bundled indicator. messages: type: array description: A list of messages from the payer. items: $ref: '#/definitions/ItemDescription' specialMessages: type: array description: A list of special messages from the payer. items: $ref: '#/definitions/ItemDescription' displayMessage: type: string description: A display message from the payer. serviceTypeCode: type: string description: The service type code. occurrenceCode: type: string description: The occurrence code. occurrenceCodeDate: type: string format: date description: The occurrence code date. valueCode: type: string description: The value code. valueCodeAmount: type: string description: The value code amount. conditionCode: type: string description: The condition code. claimIdentifier: type: string description: The claim identifier. principalDiagnosis: $ref: '#/definitions/Diagnosis' admittingDiagnosis: $ref: '#/definitions/Diagnosis' patientsReasonForVisit: $ref: '#/definitions/Diagnosis' principalProcedure: $ref: '#/definitions/Procedure' diagnosisRelatedGroupCode: type: string description: The diagnosis related group code. otherDiagnoses: type: array description: A list of other diagnoses. items: $ref: '#/definitions/Diagnosis' otherProcedures: type: array description: A list of other procedures. items: $ref: '#/definitions/Procedure' serviceLines: type: array description: A list of service lines. items: type: object properties: controlNumber: type: string description: The service line's control number. fromDate: type: string format: date description: The service from date. toDate: type: string format: date description: The service to date. revenue: type: string description: The revenue description. revenueCode: type: string description: The revenue code. procedure: type: string description: The procedure description. procedureCode: type: string description: The procedure code. alternateProcedure: type: string description: Alternate procedure. modifierCode1: type: string description: The first procedure modifier. modifierCode2: type: string description: The second procedure modifier. modifierCode3: type: string description: The third procedure modifier. modifierCode4: type: string description: The fourth procedure modifier. amount: type: string description: The service charge amount. quantity: type: string description: The service quantity. quantityTypeCode: type: string description: The service quantity type code. estimatedPatientResponsibility: type: string description: The estimated patient responsibility. bundlingDescription: type: string description: A bundling description. denyReason: type: string description: The deny reason. holdReasons: type: array description: A list of hold reasons for this service line. items: $ref: '#/definitions/ItemDescription' messages: type: array description: A list of messages for this service line. items: $ref: '#/definitions/ItemDescription' displayMessage: type: string description: A display message. allowed: $ref: '#/definitions/ItemDescription' estimated: $ref: '#/definitions/ItemDescription' notCovered: $ref: '#/definitions/ItemDescription' coPay: $ref: '#/definitions/ItemDescription' coInsurance: $ref: '#/definitions/ItemDescription' deductible: $ref: '#/definitions/ItemDescription' contractual: $ref: '#/definitions/ItemDescription' providerInitiated: $ref: '#/definitions/ItemDescription' providerResponsibility: $ref: '#/definitions/ItemDescription' remarks: type: array description: Remarks about this service line. items: type: object properties: remarkCode: type: string description: The remark code. description: type: string description: The description. totalCharges: $ref: '#/definitions/ItemDescription' totalAllowed: $ref: '#/definitions/ItemDescription' totalEstimated: $ref: '#/definitions/ItemDescription' totalNotCovered: $ref: '#/definitions/ItemDescription' totalCoPay: $ref: '#/definitions/ItemDescription' totalCoInsurance: $ref: '#/definitions/ItemDescription' totalDeductible: $ref: '#/definitions/ItemDescription' totalContractual: $ref: '#/definitions/ItemDescription' totalProviderInitiated: $ref: '#/definitions/ItemDescription' totalProviderResponsibility: $ref: '#/definitions/ItemDescription' totalPatientLiability: $ref: '#/definitions/ItemDescription' attendingProvider: type: object description: The attending provider. properties: lastName: type: string description: The attending provider's last name. firstName: type: string description: The attending provider's first name. npi: type: string description: The attending provider's national provider id. payerSpecificFlags: type: array description: A list of payer specific flags on this institutional claim. items: type: object properties: name: type: string description: A payer specific flag name. value: type: string description: A payer specific flag value. ItemDescription: type: object properties: amount: type: string description: An amount. code: type: string description: A code. codeType: type: string description: A code type. description: type: string description: A description. procedure: type: string description: The procedure. patientLiable: type: boolean description: Indicates whether the patient is liable for the item. Diagnosis: type: object properties: qualifier: type: string description: The qualifier description. qualifierCode: type: string description: The qualifier code. code: type: string description: The diagnosis code. description: type: string description: The diagnosis description. presentOnAdmissionIndicatorCode: type: string description: The present on admission indicator code. Procedure: type: object properties: qualifier: type: string description: The qualifier description. qualifierCode: type: string description: The qualifier code. code: type: string description: The procedure code. description: type: string description: The procedure description. codeDate: type: string format: date description: The code date. ErrorResponse: type: object properties: userMessage: type: string description: A high level error message. developerMessage: type: string description: A more technical error message. reasonCode: type: integer description: A reason code. statusCode: type: integer description: The status code. errors: type: array description: A list of detailed user friendly messages. items: $ref: '#/definitions/FieldError' FieldError: type: object properties: field: type: string description: The field or parameter associated with this error. code: type: string description: A code for the error. errorMessage: type: string description: The message associated with this error. index: type: integer description: The array index of the item associated with this error. tags: [] x-ibm-endpoints: - endpointUrl: https://api.availity.com/availity description: Custom API Endpoint type: - production ...