production
https://api.availity.com/availity
Custom API Endpoint
Paths
/professional-claims
post /professional-claims
Create a new professional claims.
oauth2
oauth2
(oauth2 application)
Token URL
https://api.availity.com/v1/token
Scopes
hipaa
Realtime - Live HIPAA API
professionalclaim
Optional in body
object
Content-Type
Optional in header
string
application/json
application/xml
application/xml
Accept
Optional in header
string
application/json
application/xml
application/xml
202
Accepted
400
Bad Request
401
Not Authorized
403
Forbidden
500
Internal Server Error
Example Request
Example Response
POST https://api.availity.com/availity/v1/professional-claims
/professional-claims/{id}
get /professional-claims/{id}
Get a professional claim by its id.
oauth2
oauth2
(oauth2 application)
Token URL
https://api.availity.com/v1/token
Scopes
hipaa
Realtime - Live HIPAA API
id
Required in path
string
Accept
Optional in header
string
application/json
application/xml
application/xml
200
202
Accepted
400
Bad Request
401
Not Authorized
403
Forbidden
404
Not Found
500
Internal Server Error
504
Gateway Timeout
Example Request
Example Response
GET https://api.availity.com/availity/v1/professional-claims/{id}
Definitions
{
"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."
}
}
}
}
}
}
{
"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"
}
}
}
}
{
"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."
}
}
}
{
"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."
}
}
}
{
"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"
]
}
}
}
{
"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."
}
}
}
}
}
}
{
"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."
}
}
}
{
"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."
}
}
}
{
"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"
}
}
}
}
{
"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."
}
}
}