--- swagger: "2.0" info: x-ibm-name: dental-claims title: Dental Claims version: 1.0.0 description: "" schemes: - https basePath: /v1 consumes: - 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: /dental-claims: post: summary: Create a new dental claim. operationId: createDentalClaim consumes: - application/json - application/xml produces: - application/json - application/xml parameters: - in: body name: dentalclaim schema: $ref: '#/definitions/DentalClaim' responses: 202: description: Accepted headers: Location: type: string description: Location of the dental 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' /dental-claims/{id}: get: summary: Get a dental claim by its id. operationId: getDentalClaim produces: - application/json - application/xml parameters: - in: path name: id required: true type: string responses: 200: description: OK schema: $ref: '#/definitions/DentalClaim' 202: description: Accepted headers: Location: type: string description: Location of the dental 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 dental claim id definitions: DentalClaim: type: object properties: id: type: string description: The id of the dental claim. createdDate: type: string format: date-time description: The date and time when this dental claim was created in our system. updatedDate: type: string format: date-time description: The date and time when this dental claim was last updated in our system. expirationDate: type: string format: date-time description: The date and time when this dental claim will expire from our system. message: type: string description: A message. customerId: type: string description: The id of the customer that owns this dental claim. requestTypeCode: type: string description: The requested type of claim. CLAIM, ENCOUNTER, etc. submitter: $ref: '#/definitions/Submitter' payer: $ref: '#/definitions/Payer' billingProvider: $ref: '#/definitions/BillingProvider' subscriber: $ref: '#/definitions/Subscriber' patient: $ref: '#/definitions/Patient' claimInformation: $ref: '#/definitions/ClaimInformation' Submitter: type: object properties: lastName: type: string description: The submitter's last name or organization name. firstName: type: string description: The submitter's first name. middleName: type: string description: The submitter's middle name. id: type: string description: The submitter's ETIN. contactName: type: string description: The submitter's contact name, email: type: string description: The submitter's email address. phone: type: string description: The submitter's phone number. extension: type: string description: The submitter's phone number extension. fax: type: string description: The submitter's fax number. Payer: type: object properties: name: type: string description: The payer's name. id: type: string description: The payer's id. addressLine1: type: string description: The payer's address (line one). addressLine2: type: string description: The payer's address (line two). city: type: string description: The payer's city. stateCode: type: string description: The payer's state (two character code). zipCode: type: string description: The payer's ZIP code. countryCode: type: string description: The payer's country code (US or CA). ein: type: string description: The payer's EIN. claimOfficeNumber: type: string description: The payer's claim office number. naicCode: type: string description: The payer's NAIC. responsibilitySequenceCode: type: string description: The responsibility sequence of the payer (P, S, or T). insuranceTypeCode: type: string description: The insurance type code of the payer. claimFilingIndicatorCode: type: string description: The claim filing indicator code of the payer. BillingProvider: type: object properties: specialtyCode: type: string description: The billing provider's specialty type code. lastName: type: string description: The billing provider's last name or organization name. firstName: type: string description: The billing provider's first name. middleName: type: string description: The billing provider's middle name. suffix: type: string description: The billing provider's suffix. npi: type: string description: The billing provider's NPI. addressLine1: type: string description: The billing provider's address (line one). addressLine2: type: string description: The billing provider's address (line two). city: type: string description: The billing provider's city. stateCode: type: string description: The billing provider's state (two character code). zipCode: type: string description: The billing provider's ZIP code. countryCode: type: string description: The billing provider's country code (US or CA). ein: type: string description: The billing provider's EIN. ssn: type: string description: The billing provider's SSN. stateLicenseNumber: type: string description: The billing provider's state license number. upin: type: string description: The billing provider's UPIN. payerAssignedProviderId: type: string description: The billing provider's payer assigned provider id. locationNumber: type: string description: The billing provider's location number. contactName: type: string description: The billing provider's contact name. phone: type: string description: The billing provider's phone number. extension: type: string description: The billing provider's phone extension. email: type: string description: The billing provider's email address. fax: type: string description: The billing provider's fax number. payTo: type: object description: The billing provider's pay-to address (if different from their physical address). properties: addressLine1: type: string description: The billing provider's pay-to address (line one). addressLine2: type: string description: The billing provider's pay-to address (line two). city: type: string description: The billing provider's pay-to city. stateCode: type: string description: The billing provider's pay-to state (two character code). zipCode: type: string description: The billing provider's ZIP code. countryCode: type: string description: The billing provider's country code (US or CA). Subscriber: type: object properties: groupNumber: type: string description: The subscriber's group number. groupName: type: string description: The subscriber's group name. lastName: type: string description: The subscriber's last name. firstName: type: string description: The subscriber's first name. middleName: type: string description: The subscriber's middle name. suffix: type: string description: The subscriber's suffix. memberId: type: string description: The subscriber's member id. addressLine1: type: string description: The subscriber's address (line one). addressLine2: type: string description: The subscriber's address (line two). city: type: string description: The subscriber's city. stateCode: type: string description: The subscriber's state (two character code). zipCode: type: string description: The subscriber's ZIP code. countryCode: type: string description: The subscriber's country (US or CA). ssn: type: string description: The subscriber's SSN. Patient: type: object properties: lastName: type: string description: The patient's last name. firstName: type: string description: The patient's first name. middleName: type: string description: The patient's middle name. suffix: type: string description: The patient's suffix. addressLine1: type: string description: The patient's address (line one). addressLine2: type: string description: The patient's address (line two). city: type: string description: The patient's city. stateCode: type: string description: The patient's state (two character code). zipCode: type: string description: The patient's ZIP code. countryCode: type: string description: The patient's country (US or CA). birthDate: type: string format: date description: The patient's birth date. genderCode: type: string description: The patient's gender. subscriberRelationshipCode: type: string description: The patient's relationship to the subscriber. agencyClaimNumber: type: string description: The patient's agency claim number. ClaimInformation: type: object properties: controlNumber: type: string description: A control number of patient account number to use on this claim. placeOfServiceCode: type: string description: The place of service type. frequencyTypeCode: type: string description: The claim frequency type. providerSignatureOnFile: type: boolean description: Indicate whether or not the provider's signature is on file. providerAcceptAssignmentCode: type: string description: Assignment or plan participation code. benefitsAssignmentCertification: type: boolean description: The benefits assignment certification indicator. informationReleaseCode: type: string description: The release of information code. specialProgramCode: type: string description: The special dental program. delayReasonCode: type: string description: The delay reason. appliancePlacementDate: type: string description: The date the appliance was placed. serviceFromDate: type: string format: date description: The service date (begin). serviceToDate: type: string format: date description: The service date (end). orthodonticClaim: type: boolean description: Indicate whether or not this was an orthodontic claim. orthodonticTreatmentMonths: type: string description: The estimated number of orthodontic treatment months. orthodonticTreatmentRemainingMonths: type: string description: The number of orthodontic treatment months remaining. patientPaidAmount: type: string description: The amount the patient has paid. serviceAuthorizationExceptionCode: type: string description: The service authorization exception code for this claim. payerClaimControlNumber: type: string description: The payer claim control number for this claim. priorAuthorizationNumber: type: string description: The prior authorization number for this claim. claimIdentifier: type: string description: Trace number for this claim. accidentCauseCode1: type: string description: Related/accident cause code. accidentCauseCode2: type: string description: Related/accident cause code. accidentStateCode: type: string description: The state the accident happened in. accidentDate: type: string format: date description: The date the accident occurred on. toothStatuses: type: array description: Status information about teeth. items: $ref: '#/definitions/ToothStatus' supplementalInformation: type: array description: Supplemental information (additional paperwork). items: $ref: '#/definitions/SupplementalInformation' contractTypeCode: type: string description: The type of contract. contractAmount: type: string description: The contracted amount. contractPercentage: type: string description: The contracted percentage. contractCode: type: string description: The contract code. contractTermsDiscountPercentage: type: string description: The contract terms discount percentage. contractVersion: type: string description: The contract version. notes: type: array description: Notes about this claim. items: $ref: '#/definitions/Note' diagnoses: type: array description: Diagnoses related to this claim. items: $ref: '#/definitions/Diagnosis' referringProvider: $ref: '#/definitions/Provider' primaryCareProvider: $ref: '#/definitions/Provider' renderingProvider: $ref: '#/definitions/Provider' serviceFacility: $ref: '#/definitions/Provider' assistantSurgeon: $ref: '#/definitions/Provider' supervisingProvider: $ref: '#/definitions/Provider' otherPayers: type: array description: Information about other payers. items: $ref: '#/definitions/OtherPayer' serviceLines: type: array description: Information about the services performed. items: $ref: '#/definitions/ServiceLine' ToothStatus: type: object properties: toothCode: type: string description: A tooth. toothStatusCode: type: string description: A tooth status. SupplementalInformation: type: object properties: reportTypeCode: type: string description: The report type. reportTransmissionCode: type: string description: The report transmission method. controlNumber: type: string description: The control number. Note: type: object properties: message: type: string description: A message about this claim. Diagnosis: type: object properties: qualifierCode: type: string description: The qualifier for this diagnosis. code: type: string description: The code for this diagnosis. Provider: type: object properties: lastName: type: string description: This provider's last name or organization name. firstName: type: string description: This provider's first name. middleName: type: string description: This provider's middle name. suffix: type: string description: This provider's suffix. npi: type: string description: This provider's NPI. specialtyCode: type: string description: This provider's specialty code. stateLicenseNumber: type: string description: This provider's state license number. upin: type: string description: This provider's UPIN. payerAssignedProviderId: type: string description: This provider's payer assigned provider id. locationNumber: type: string description: This provider's location number. addressLine1: type: string description: This provider's address (line one). addressLine2: type: string description: This provider's address (line two). city: type: string description: This provider's city. stateCode: type: string description: This provider's state (two character code). zipCode: type: string description: This provider's ZIP code. countryCode: type: string description: This provider's country (US or CA). referralNumber: type: string description: The referral number. OtherPayer: type: object properties: responsibilitySequenceCode: type: string description: The responsibility sequence of this payer (P, S, or T). insuranceTypeCode: type: string description: The insurance type of this payer. claimFilingIndicatorCode: type: string description: The claim filing indicator code of this payer. name: type: string description: The name of this payer. id: type: string description: The id of this payer. addressLine1: type: string description: This payer's address (line one). addressLine2: type: string description: This payer's address (line two). city: type: string description: This payer's city. stateCode: type: string description: This payer's state (two character code). zipCode: type: string description: This payer's ZIP code. countryCode: type: string description: This payer's country (US or CA). claimPaidDate: type: string format: date description: The date this payer paid the claim. ein: type: string description: This payer's EIN. claimOfficeNumber: type: string description: This payer's claim office number. naicCode: type: string description: This payer's NAIC. priorAuthorizationNumber: type: string description: The prior authorization number assigned by this payer. referralNumber: type: string description: The referral number assigned by this payer. claimControlNumber: type: string description: This payer's claim control number. paidAmount: type: string description: The amount paid by this payer. remainingPatientLiabilityAmount: type: string description: The remaining patient liability. nonCoveredAmount: type: string description: The amount that this payer did not cover. benefitsAssignmentCertification: type: boolean description: The benefits assignment certification indicator for this payer. informationReleaseCode: type: string description: The information release code for this payer. subscriberRelationshipCode: type: string description: The patient's relationship to this payer's subscriber. subscriber: $ref: '#/definitions/Subscriber' medicareOutpatientAdjudicationInformation: type: object description: Information about medicare outpatient adjudication. properties: reimburseRate: type: string description: The medicare outpatient adjudication reimburse rate. payableAmount: type: string description: The medicare outpatient adjudication payable amount. claimPaymentRemarkCode1: type: string description: A medicare outpatient adjudication claim remark code. claimPaymentRemarkCode2: type: string description: A medicare outpatient adjudication claim remark code. claimPaymentRemarkCode3: type: string description: A medicare outpatient adjudication claim remark code. claimPaymentRemarkCode4: type: string description: A medicare outpatient adjudication claim remark code. claimPaymentRemarkCode5: type: string description: A medicare outpatient adjudication claim remark code. nonPayableProfessionalComponentBilledAmount: type: string description: The medicare outpatient adjudication non-payable professional component billed amount. claimAdjustmentGroups: type: array description: Claim level adjustments for this payer. items: $ref: '#/definitions/AdjustmentGroup' ServiceLine: type: object properties: controlNumber: type: string description: The control number for this service line. procedureCode: type: string description: The procedure performed. modifierCode1: type: string description: A procedure modifier. modifierCode2: type: string description: A procedure modifier. modifierCode3: type: string description: A procedure modifier. modifierCode4: type: string description: A procedure modifier. procedureDescription: type: string description: A procedure description. amount: type: string description: The charge amount for this service. placeOfServiceCode: type: string description: The place where this service was performed. cavityDesignationCode1: type: string description: A cavity designation code. cavityDesignationCode2: type: string description: A cavity designation code. cavityDesignationCode3: type: string description: A cavity designation code. cavityDesignationCode4: type: string description: A cavity designation code. cavityDesignationCode5: type: string description: A cavity designation code. prostheticCode: type: string description: The presthetic code. quantity: type: string description: The quantity. diagnosisCodePointer1: type: string description: A diagnosis code pointer. diagnosisCodePointer2: type: string description: A diagnosis code pointer. diagnosisCodePointer3: type: string description: A diagnosis code pointer. diagnosisCodePointer4: type: string description: A diagnosis code pointer. serviceDate: type: string format: date description: The date that this service was performed. priorPlacementDate: type: string format: date description: The prior placement date. appliancePlacementDate: type: string format: date description: The appliance placement date. replacementDate: type: string format: date description: The replacement date. treatmentStartDate: type: string format: date description: The date treatment started. treatmentEndDate: type: string format: date description: The date treatment ended. toothInformation: type: array description: Information about the teeth involved in this service. items: $ref: '#/definitions/ToothInformation' contractTypeCode: type: string description: The contract type. 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. contractVersion: type: string description: The contract version. priorAuthorizationNumber: type: string description: The prior authorization number for this service. referralNumber: type: string description: The referral number for this service.. salesTax: type: string description: The sales tax for this service. renderingProvider: $ref: '#/definitions/Provider' assistantSurgeon: $ref: '#/definitions/Provider' supervisingProvider: $ref: '#/definitions/Provider' serviceFacility: $ref: '#/definitions/Provider' adjudicationInformation: type: array description: Adjudication information for this service line. items: $ref: '#/definitions/AdjudicationInformation' AdjustmentGroup: type: object properties: groupCode: type: string description: The adjustment group. adjustments: type: array description: A list of adjustments to this claim. items: $ref: '#/definitions/Adjustment' Adjustment: type: object properties: reasonCode: type: string description: The adjustment reason code. amount: type: string description: The adjustment amount. quantity: type: string description: The adjustment quantity. ToothInformation: type: object properties: toothCode: type: string description: The tooth. toothSurfaceCode1: type: string description: A tooth surface. toothSurfaceCode2: type: string description: A tooth surface. toothSurfaceCode3: type: string description: A tooth surface. toothSurfaceCode4: type: string description: A tooth surface. toothSurfaceCode5: type: string description: A tooth surface. AdjudicationInformation: type: object properties: payerId: type: string description: The payer id for this adjudication information. paidAmount: type: string description: The amount this payer paid. procedureCode: type: string description: The procedure performed. modifierCode1: type: string description: A procedure modifier. modifierCode2: type: string description: A procedure modifier. modifierCode3: type: string description: A procedure modifier. modifierCode4: type: string description: A procedure modifier. procedureDescription: type: string description: A procedure description. quantity: type: string description: The quantity. lineNumber: type: string description: The line number. claimPaidDate: type: string format: date description: The claim paid date. remainingPatientLiabilityAmount: type: string description: The remaining patient liability amount. claimAdjustmentGroups: type: array description: Claim line adjustments. items: $ref: '#/definitions/AdjustmentGroup' 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: [] produces: - application/json x-ibm-endpoints: - endpointUrl: https://api.availity.com/availity description: Custom API Endpoint type: - production ...