--- swagger: "2.0" info: version: 1.0.0 title: Care Cost Estimator - Professional x-ibm-name: care-cost-estimator-professional description: "" basePath: /v1 paths: /professional-claims: post: summary: Create a new professional claims. operationId: createProfessionalClaim consumes: - application/json - application/xml produces: - application/json - application/xml parameters: - in: body name: professionalclaim schema: $ref: '#/definitions/ProfessionalClaim' responses: 202: description: Accepted headers: Location: type: string description: Location of the professional 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' /professional-claims/{id}: get: summary: Get a professional claim by its id. operationId: getProfessionalClaim produces: - application/json - application/xml parameters: - in: path name: id required: true type: string responses: 200: description: OK schema: $ref: '#/definitions/ProfessionalClaim' 202: description: Accepted headers: Location: type: string description: Location of the professional 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: ProfessionalClaim: type: object properties: id: type: string description: The id of the professional claim. createdDate: type: string format: date-time description: The date and time when the professional claim was created. updatedDate: type: string format: date-time description: The date and time when the professional claim was last updated. expirationDate: type: string format: date-time description: The date and time when the professional claim will expire from our system. message: type: string description: A message about the claim. customerId: type: string description: The id of the customer that owns this professional claim. requestTypeCode: type: string enum: - PRE_DETERMINATION description: The type of professional claim. submitter: type: object properties: lastName: type: string description: The last or business 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. email: type: string description: The email address 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. payer: type: object 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 properties: specialtyCode: type: string description: The specialty code of the billing provider. lastName: type: string description: The last or business name of the billing provider. firstName: type: string description: The first name of the billing provider. middleName: type: string description: The middle name of the billing provider. suffix: type: string description: The suffix 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. upin: type: string description: The UPIN of the billing provider. payerAssignedProviderId: type: string description: The payer assigned provider id of the billing provider. locationNumber: type: string description: The location number 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. email: type: string description: The email address of the billing provider. fax: type: string description: The fax number 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. countryCode: type: string description: The country code of the pay to address. enum: - US - CA subscriber: $ref: '#/definitions/Subscriber' patient: type: object 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. 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. countryCode: type: string description: The country code of the patient. enum: - US - CA 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 ssn: type: string description: The SSN of the patient. agencyClaimNumber: type: string description: The agency claim number of the patient. deathDate: type: string format: date description: The death date of the patient. weight: type: string description: The weight of the patient. pregnancyIndicator: type: boolean description: Indicates whether or not the patient is pregnant. contactName: type: string description: The contact name of the patient. phone: type: string description: The phone number of the patient. extension: type: string description: The phone number extension of the patient. claimInformation: type: object properties: controlNumber: type: string description: The control number. placeOfServiceCode: type: string description: The place of service code. frequencyTypeCode: type: string description: The frequency type code. providerSignatureOnFile: type: boolean description: Indicates whether or not the provider signature is on file. providerAcceptAssignmentCode: type: string description: The provider accept assignment code. benefitsAssignmentCertification: type: string description: The benefits assignment certification indicator. informationReleaseCode: type: string description: The information release code. patientSignatureSourceCode: type: string description: The patient signature source code. specialProgramCode: type: string description: The special program code. delayReasonCode: type: string description: The delay reason code. serviceTypeCode: type: string description: The service type code. accidentCauseCode1: type: string description: The first accident cause code. accidentCauseCode2: type: string description: The second accident cause code. accidentStateCode: type: string description: The accident state code. accidentDate: type: string format: date description: The accident date. onsetOfCurrentIllnessOrSymptomDate: type: string format: date description: The onset of current illness or symptom date. initialTreatmentDate: type: string format: date description: The initial treatment date. lastSeenDate: type: string format: date description: The last seen date. acuteManifestationDate: type: string format: date description: The acute manifestation date. lastMenstrualPeriodDate: type: string format: date description: The last menstrual period date. lastXrayDate: type: string format: date description: The last x-ray date. hearingAndVisionPrescriptionDate: type: string format: date description: The hearing and vision prescription date. disabilityPeriodStartDate: type: string format: date description: The disability period start date. disabilityPeriodEndDate: type: string format: date description: The disability period end date. lastWorkedDate: type: string format: date description: The last worked date. authorizedReturnToWorkDate: type: string format: date description: The authorized to return to work date. admissionDate: type: string format: date description: The admission date. dischargeDate: type: string format: date description: The discharge date. assumedCareDate: type: string format: date description: The assumed care date. relinquishedCareDate: type: string format: date description: The relinquished care date. propertyAndCasualtyFirstContactDate: type: string format: date description: The property and casualty first contact date. repricerReceivedDate: type: string format: date description: The repricer received date. supplementalInformation: type: array description: A list of supplemental information (attachments) for the claim. items: $ref: '#/definitions/SupplementalInformation' contractTypeCode: type: string description: The contract type code. contractAmount: type: string description: The contract amount. contractPercentage: type: string description: The contract percentage. contractCode: type: string description: The contract code. contractTermsDiscountPercentage: type: string description: The contract terms discount percentage. contractVersionIdentifier: type: string description: The contract version identifier. patientPaidAmount: type: string description: The patient paid amount. serviceAuthorizationExceptionCode: type: string description: The service authorization exception code. medicareCrossoverIndicator: type: boolean description: The medicare crossover indicator. mammographyCertificationNumber: type: string description: The mammography certification number. referralNumber: type: string description: The referral number. priorAuthorizationNumber: type: string description: The prior authorization number. payerClaimControlNumber: type: string description: The payer claim control number. clinicalLaboratoryImprovementAmendmentNumber: type: string description: The clinical laboratory improvement amendment number. repricedClaimReferenceNumber: type: string description: The repriced claim reference number. adjustedRepricedClaimReferenceNumber: type: string description: The adjusted repriced claim reference number. investigationalDeviceExemptionIdentifier: type: string description: The investigational device exemption identifier. claimIdentifier: type: string description: The claim identifier. medicalRecordNumber: type: string description: The medical record number for the claim. demonstrationProjectIdentifier: type: string description: The demonstration project identifier for the claim. carePlanOversightNumber: type: string description: The care plan oversight number. claimNoteReferenceCode: type: string description: The claim note reference code. claimNoteText: type: string description: The claim not text. ambulanceTransportReasonCode: type: string description: The ambulance transport reason code. ambulanceTransportDistance: type: string description: The ambulance transport distance. ambulanceTransportRoundTripPurposeDescription: type: string description: The ambulance transport round trip purpose description. ambulanceTransportStretcherPurposeDescription: type: string description: The ambulance transport stretcher purpose description. spinalManipulationServicePatientConditionCode: type: string description: The splinal manipulation service patient condition code. spinalManipulationServicePatientConditionDescription1: type: string description: The first spinal manipulation service patient condition description. spinalManipulationServicePatientConditionDescription2: type: string description: The second spinal manipulation service patient condition description. ambulanceCertifications: type: array description: A list of ambulance certifications. items: $ref: '#/definitions/AmbulanceCertification' visionConditions: type: array description: A list of vision conditions. items: type: object properties: codeCategory: type: string description: The code category. certificationConditionIndicator: type: boolean description: The certification condition indicator. conditionCode1: type: string description: The first condition code. conditionCode2: type: string description: The second condition code. conditionCode3: type: string description: The third condition code. conditionCode4: type: string description: The fourth condition code. conditionCode5: type: string description: The fifth condition code. homeboundIndicator: type: boolean description: The homebound indicator. epsdtReferralCertificationConditionCodeAppliesIndicator: type: boolean description: The EPSDT referral certification condition code applies indicator. epsdtReferralConditionCode1: type: string description: The first EPSDT referral condition code. epsdtReferralConditionCode2: type: string description: The second EPSDT referral condition code. epsdtReferralConditionCode3: type: string description: The third EPSDT referral condition code. diagnoses: type: array description: A list of diagnoses. items: type: object properties: qualifier: type: string description: A description of the diagnosis qualifier code. qualifierCode: type: string description: The diagnosis qualifier code. code: type: string description: The diagnosis code anesthesiaRelatedSurgicalPrincipalProcedure: type: string description: The principal anesthesia related surgical procedure. anesthesiaRelatedSurgicalOtherProcedure: type: string description: The other anesthesia related surgical procedure. conditionInformation: type: array description: A list of condition codes. items: type: object properties: conditionCode: type: string description: The condition code. referringProvider: $ref: '#/definitions/Provider' primaryCareProvider: $ref: '#/definitions/Provider' renderingProvider: $ref: '#/definitions/Provider' serviceFacility: $ref: '#/definitions/Provider' supervisingProvider: $ref: '#/definitions/Provider' ambulancePickUpLocation: $ref: '#/definitions/PhysicalLocation' ambulanceDropOffLocation: $ref: '#/definitions/PhysicalLocation' otherPayers: type: array description: A list of other payers involved in this claim. items: type: object properties: responsibilitySequenceCode: type: string description: The responsibility sequence code of the other payer. enum: - P - S - T insuranceTypeCode: type: string description: The insurance type code of the other payer. claimFileIndicatorCode: type: string description: The claim file indicator code of the other payer. name: type: string description: The name of the payer. id: type: string description: The id of the other payer. addressLine1: type: string description: The address of the other payer. addressLine2: type: string description: The address of the other payer. city: type: string description: The city of the other payer. stateCode: type: string description: The state code of the other payer. zipCode: type: string description: The ZIP code of the other payer. countryCode: type: string description: The country code of the other payer. enum: - US - CA claimPaidDate: type: string format: date description: The date the other payer paid the claim. secondaryPayerIdentificationNumber: type: string description: The secondary payer identification number. ein: type: string description: The EIN of the other payer. claimOfficeNumber: type: string description: The claim office number. naicCode: type: string description: The NAIC code. priorAuthorizationNumber: type: string description: The prior authorization number for the other payer. referralNumber: type: string description: The referral number for the other payer. claimAdjustmentIndicator: type: boolean description: The claim adjustment indicator. claimControlNumber: type: string description: The claim control number. paidAmount: type: string description: The amount paid by the other payer. remainingPatientLiabilityAmount: type: string description: The remaining patient liability. nonCoveredAmount: type: string description: The non-covered amount. benefitsAssignmentCertification: type: boolean description: The benefit assignment certification indicator. patientSignatureSourceCode: type: string description: The patient signature source code. informationReleaseCode: type: string description: The information release code. subscriberRelationshipCode: type: string description: The relationship to the patient code. enum: - 18 - 1 - 19 - 20 - 21 - 39 - 40 - 53 - G8 - 34 subscriber: $ref: '#/definitions/Subscriber' medicareOutpatientAdjudicationInformation: type: object description: Medicare outpatient adjudication information. properties: reimburseRate: type: string description: The reimbursement rate. payableAmount: type: string description: The payable amount. claimPaymentRemarkCode1: type: string description: The first claim payment remark code. claimPaymentRemarkCode2: type: string description: The second claim payment remark code. claimPaymentRemarkCode3: type: string description: The third claim payment remark code. claimPaymentRemarkCode4: type: string description: The fourth claim payment remark code. claimPaymentRemarkCode5: type: string description: The fifth claim payment remark code. endStageRenalDiseasePaymentAmount: type: string description: The end stage renal disease payment amount. nonPayableProfessionalComponentBilledAmount: type: string description: The non payable professional component billed amount. claimAdjustmentGroups: type: array description: A list of claim adjustment groups. items: $ref: '#/definitions/ClaimAdjustmentGroup' serviceLines: type: array description: A list of service lines. items: type: object description: A service line. properties: controlNumber: type: string description: The control number for the service line. procedureCode: type: string description: The procedure that this service line describes. modifierCode1: type: string description: The first modifier code for the procedure. modifierCode2: type: string description: The second modifier code for the procedure. modifierCode3: type: string description: The third modifier code for the procedure. modifierCode4: type: string description: The fourth modifier code for the procedure. procedureDescription: type: string description: A description of the procedure. amount: type: string description: The amount for the service. quantityTypeCode: type: string description: The type code of the quantity of the service. quantity: type: string description: The quantity of the service. placeOfServiceCode: type: string description: The place of service for this service line if different than the overall claim place of service. diagnosisCodePointer1: type: string description: A pointer (number) to a diagnosis that this service line was related to. diagnosisCodePointer2: type: string description: A pointer (number) to a diagnosis that this service line was related to. diagnosisCodePointer3: type: string description: A pointer (number) to a diagnosis that this service line was related to. diagnosisCodePointer4: type: string description: A pointer (number) to a diagnosis that this service line was related to. emergencyIndicator: type: boolean description: Indicates whether or not that was an emergency. epsdtIndicator: type: boolean description: EPSDT indicator. familyPlanningIndicator: type: boolean description: Family planning indicator. copayStatusCode: type: string description: The co-pay status code. dmeProcedureCode: type: string description: The DME procedure code. dmeLengthOfMedicalNecessity: type: string description: The DME length of medical necessity. dmeRentalPrice: type: string description: The DME rental price. dmePurchasePrice: type: string description: The DME purchase price. dmeFrequencyCode: type: string description: The DME frequency code. supplementalInformation: type: array description: A list of supplemental information (attachments) for this service line items: $ref: '#/definitions/SupplementalInformation' dmeCertificateOfMedicalNecessityAttachmentTransmissionCode: type: string description: The DME certficate of medical necessity attachment transmission code. ambulanceTransportReasonCode: type: string description: The ambulance transport reason code. ambulanceTransportDistance: type: string description: The ambulance transport distance. ambulanceTransportRoundTripPurposeDescription: type: string description: The ambulance transport round trip purpose description. ambulanceTransportStretcherPurposeDescription: type: string description: The ambulance transport stretcher purpose description. dmeCertificationTypeCode: type: string description: The DME certification type code. dmeDuration: type: string description: The DME duration. ambulanceCertifications: type: array description: A list of ambulance certifications. items: $ref: '#/definitions/AmbulanceCertification' hospiceEmployeeIndicator: type: boolean description: The hospice employee indicator. dmeCertificationConditionIndicator: type: boolean description: The DME certification condition indicator. dmeCertificationConditionCode1: type: string description: The first DME certification condition code. dmeCertificationConditionCode2: type: string description: The second DME certification condition code. fromDate: type: string format: date description: The service from date. toDate: type: string format: date description: The service to date. prescriptionDate: type: string format: date description: The prescription date. certificationRevisionDate: type: string format: date description: The certification revision date. beginTherapyDate: type: string format: date description: The begin therapy date. lastCertificationDate: type: string format: date description: The last certification date. latestVisitOrConsultationDate: type: string format: date description: The latest visit or consultation date. mostRecentHemoglobinOrHematocritTestPerformedDate: type: string format: date description: The most recent hemoglobin or hematocrit test performed date. mostRecentSerumCreatineTestPerformedDate: type: string format: date description: The most recent serum creatine test performed date. shippedDate: type: string format: date description: The shipped date. lastXrayDate: type: string format: date description: The last x-ray date. initialTreatmentDate: type: string format: date description: The initial treatment date. ambulancePatientCount: type: string description: The ambulance patient count. obstetricAdditionalUnits: type: string description: Obstetric additional units. testResults: type: array description: A list of test results. items: type: object properties: referenceIdCode: type: string description: The reference id code. qualifier: type: string description: The qualifier. value: type: string description: The value. contractTypeCode: type: string description: The contract type code. contractAmount: type: string description: The contract amount. contractPercentage: type: string description: The contract percentage. contractCode: type: string description: The contract code. contractTermsDiscountPercentage: type: string description: The contract terms discount percentage. contractVersionIdentifier: type: string description: The contract version identifier. repricedLineItemReferenceNumber: type: string description: The repriced line item reference number. adjustedRepricedLineItemReferenceNumber: type: string description: The adjusted repriced line item reference number. priorAuthorizationNumber: type: string description: The prior authorization number. mammographyCertificationNumber: type: string description: The mammography certification number. clinicalLaboratoryImprovementAmendmentNumber: type: string description: The clinical laboratory improvement amendment number. referringClinicalLaboratoryImprovementAmendmentNumber: type: string description: The referring clinical laboratory improvement amendment number. immunizationBatchNumber: type: string description: The immunization batch number. referralNumber: type: string description: The referral number. salesTaxAmount: type: string description: The sales tax amount. postageClaimedAmount: type: string description: The postage claimed amount. additionalInformationLineNote: type: string description: An additional information line note. goalsRehabilitationPotentialDischargePlansLineNote: type: string description: A goals rehabilitation potential discharge plans line note. thirdPartyOrganizationNote: type: string description: A third party organization note. purchasedServiceProviderIdentifier: type: string description: The purchased service provider identifier. purchasedServiceChargeAmount: type: string description: The purchases service charge amount. nationalDrugCode: type: string description: The national drug code. nationalDrugUnitCount: type: string description: The national drug unit count. nationalDrugUnitCodeQualifer: type: string description: The national drug unit code qualifier. linkSequenceNumber: type: string description: The link sequence number. pharmacyPrescriptionNumber: type: string description: The pharmacy prescription number. renderingProvider: $ref: '#/definitions/Provider' purchasedServiceProvider: $ref: '#/definitions/Provider' serviceFacility: $ref: '#/definitions/Provider' supervisingProvider: $ref: '#/definitions/Provider' orderingProvider: $ref: '#/definitions/Provider' referringProvider: $ref: '#/definitions/Provider' primaryCareProvider: $ref: '#/definitions/Provider' ambulancePickUpLocation: $ref: '#/definitions/PhysicalLocation' ambulanceDropOffLocation: $ref: '#/definitions/PhysicalLocation' adjudicationInformation: type: array description: Service line adjudication information. items: type: object properties: payerId: type: string description: The id of the payer. paidAmount: type: string description: The amount paid. procedureCode: type: string description: The procedure code. modifierCode1: type: string description: The first modifier code. modifierCode2: type: string description: The second modifier code. modifierCode3: type: string description: The third modifier code. modifierCode4: type: string description: The fourth modifier code. procedureDescription: type: string description: The description of the procedure. quantity: type: string description: The quantity. lineNumber: type: string description: The line numbers. claimPaidDate: type: string format: date description: The date the claim was paid. remainingPatientLiabilityAmount: type: string description: The remaining patient liability amount. claimAdjustmentGroups: type: array description: A list of claim adjustment groups. items: $ref: '#/definitions/ClaimAdjustmentGroup' formIdentificationCodes: type: array description: A list of form identification codes. items: type: object properties: codeListQualifierCode: type: string description: The code list qualifier code. formIdentifier: type: string description: The form identifier. supportingDocumentation: type: array description: A list of supporting documentation. items: type: object properties: questionNumber: type: string description: The question number. yesNoResponse: type: boolean description: Yes or no response indicator. textResponse: type: string description: The text response. percentResponse: type: string description: The percentage response. dateResponse: type: string format: date description: The date response procedure: type: string description: The procedure. estimatedPatientResponsibility: type: string description: The estimated patient responsibility for this line. bundlingDescription: type: string description: The bundling description for this line. denyReason: type: string description: The deny reason for this line. holdReasons: type: array description: A list of hold reasons for this line. items: $ref: '#/definitions/ItemDescription' messages: type: string description: A list of messages for this line. items: $ref: '#/definitions/ItemDescription' displayMessage: type: string description: A display message for this line. allowed: $ref: '#/definitions/ItemDescription' notCovered: $ref: '#/definitions/ItemDescription' coPay: $ref: '#/definitions/ItemDescription' coInsurance: $ref: '#/definitions/ItemDescription' deductible: $ref: '#/definitions/ItemDescription' estimated: $ref: '#/definitions/ItemDescription' contractual: $ref: '#/definitions/ItemDescription' providerInitiated: $ref: '#/definitions/ItemDescription' providerResponsibility: $ref: '#/definitions/ItemDescription' remarks: type: array description: A list of remarks for this line. items: type: object properties: remarkCode: type: string description: The remark code. description: type: string description: The description. bundled: type: boolean description: Bundled indicator. messages: type: array description: Messages from the payer. items: $ref: '#/definitions/ItemDescription' displayMessage: type: string description: A display message from the payer. 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' payerSpecificFlags: type: array items: type: object properties: name: type: string description: A payer specific flag name. value: type: string description: A payer specific flag value. Subscriber: type: object properties: groupNumber: type: string description: The group number of the subscriber. groupName: type: string description: The group name of the subscriber. 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. addressLine1: type: string description: The address of the subscriber. addressLine2: type: string description: The address of the subscriber. city: type: string description: The city of the subscriber. stateCode: type: string description: The state code of the subscriber. zipCode: type: string description: The ZIP code of the subscriber. countryCode: type: string description: The country code of the subscriber. enum: - US - CA ssn: type: string description: The SSN 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: Indicates whether or not the subscriber is on hold. holdReasons: type: array description: Subscriber hold reasons. items: $ref: '#/definitions/ItemDescription' 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. Provider: type: object properties: lastName: type: string description: The provider's last or business name. firstName: type: string description: The provider's first name. middleName: type: string description: The provider's middle name. suffix: type: string description: The provider's suffix. npi: type: string description: The provider's national provider id. specialtyCode: type: string description: The provider's specialty code. stateLicenseNumber: type: string description: The provider's state license number. upin: type: string description: The provider's UPIN. payerAssignedProviderId: type: string description: The provider's payer assigned provider id. locationNumber: type: string description: The provider's location number. addressLine1: type: string description: The provider's address. addressLine2: type: string description: The provider's address. city: type: string description: The provider's city. stateCode: type: string description: The provider's state code. zipCode: type: string description: The provider's ZIP code. countryCode: type: string description: The provider's country code. enum: - US - CA contactName: type: string description: The provider's contact name. phone: type: string description: The provider's phone number. extension: type: string description: The provider's phone number extension. email: type: string description: The provider's email address. fax: type: string description: The provider's fax number. PhysicalLocation: type: object properties: locationName: type: string description: The name of the physical location. addressLine1: type: string description: The address of the physical location. addressLine2: type: string description: The address of the physical location. city: type: string description: The city of the physical location. stateCode: type: string description: The state code of the physical location. zipCode: type: string description: The ZIP code of the physical location. countryCode: type: string description: The country code of the physical location. enum: - US - CA ClaimAdjustmentGroup: type: object properties: groupCode: type: string description: The group code of the claim adjustment group. adjustments: type: array description: A list of adjustments associated with this claim adjustment group. items: type: object properties: reasonCode: type: string description: The claim adjustment reason code. amount: type: string description: The amount of the adjustment. quantity: type: string description: The quantity of the adjustment. SupplementalInformation: type: object properties: reportTypeCode: type: string description: The report type code of the supplemental information. reportTransmissionCode: type: string description: The report transmission code of the supplemental information. controlNumber: type: string description: The control number of the supplemental information. AmbulanceCertification: type: object properties: certificationConditionIndicator: type: boolean description: The certification condition indicator. conditionCode1: type: string description: The first condition code. conditionCode2: type: string description: The second condition code. conditionCode3: type: string description: The third condition code. conditionCode4: type: string description: The fourth condition code. conditionCode5: type: string description: The fifth condition code. 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. 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 schemes: - https x-ibm-endpoints: - endpointUrl: https://api.availity.com/availity description: Custom API Endpoint type: - production ...