{
    "type": "object",
    "properties": {
        "id": {
            "type": "string",
            "description": "The id of the institutional claim."
        },
        "createdDate": {
            "type": "string",
            "format": "date-time",
            "description": "The date and time that this institutional claim was created."
        },
        "updatedDate": {
            "type": "string",
            "format": "date-time",
            "description": "The date and time that this institutional claim was last updated."
        },
        "expirationDate": {
            "type": "string",
            "format": "date-time",
            "description": "The date and time that this institutional claim will expire from our system."
        },
        "customerId": {
            "type": "string",
            "description": "The id of the customer that owns this institutional claim."
        },
        "requestTypeCode": {
            "type": "string",
            "description": "The type of institutional claim.",
            "enum": [
                "PRE_DETERMINATION"
            ]
        },
        "submitter": {
            "type": "object",
            "description": "The submitter.",
            "properties": {
                "lastName": {
                    "type": "string",
                    "description": "The last name of the submitter."
                },
                "firstName": {
                    "type": "string",
                    "description": "The first name of the submitter."
                },
                "middleName": {
                    "type": "string",
                    "description": "The middle name of the submitter."
                },
                "id": {
                    "type": "string",
                    "description": "The id of the submitter."
                },
                "contactName": {
                    "type": "string",
                    "description": "The contact name of the submitter."
                },
                "phone": {
                    "type": "string",
                    "description": "The phone number of the submitter."
                },
                "extension": {
                    "type": "string",
                    "description": "The phone number extension of the submitter."
                },
                "fax": {
                    "type": "string",
                    "description": "The fax number of the submitter."
                },
                "email": {
                    "type": "string",
                    "description": "The email address of the submitter."
                }
            }
        },
        "payer": {
            "type": "object",
            "description": "The payer.",
            "properties": {
                "name": {
                    "type": "string",
                    "description": "The name of the payer."
                },
                "id": {
                    "type": "string",
                    "description": "The id of the payer."
                },
                "addressLine1": {
                    "type": "string",
                    "description": "The address of the payer."
                },
                "addressLine2": {
                    "type": "string",
                    "description": "The address of the payer."
                },
                "city": {
                    "type": "string",
                    "description": "The city of the payer."
                },
                "stateCode": {
                    "type": "string",
                    "description": "The state code of the payer."
                },
                "zipCode": {
                    "type": "string",
                    "description": "The ZIP code of the payer."
                },
                "countryCode": {
                    "type": "string",
                    "description": "The country code of the payer.",
                    "enum": [
                        "US",
                        "CA"
                    ]
                },
                "ein": {
                    "type": "string",
                    "description": "The EIN of the payer."
                },
                "claimOfficeNumber": {
                    "type": "string",
                    "description": "The claim office number of the payer."
                },
                "naicCode": {
                    "type": "string",
                    "description": "The NAIC code of the payer."
                },
                "responsibilitySequenceCode": {
                    "type": "string",
                    "description": "The responsibility sequence code of the payer.",
                    "enum": [
                        "P",
                        "S",
                        "T"
                    ]
                },
                "insuranceTypeCode": {
                    "type": "string",
                    "description": "The insurance type code of the payer."
                },
                "claimFilingIndicatorCode": {
                    "type": "string",
                    "description": "The claim filing indicator code of the payer."
                },
                "disclaimer": {
                    "type": "string",
                    "description": "A disclaimer from the payer."
                }
            }
        },
        "billingProvider": {
            "type": "object",
            "description": "The billing provider.",
            "properties": {
                "specialtyCode": {
                    "type": "string",
                    "description": "The specialty code of the billing provider."
                },
                "name": {
                    "type": "string",
                    "description": "The name of the billing provider."
                },
                "npi": {
                    "type": "string",
                    "description": "The national provider id of the billing provider."
                },
                "addressLine1": {
                    "type": "string",
                    "description": "The address of the billing provider."
                },
                "addressLine2": {
                    "type": "string",
                    "description": "The address of the billing provider."
                },
                "city": {
                    "type": "string",
                    "description": "The city of the billing provider."
                },
                "stateCode": {
                    "type": "string",
                    "description": "The state code of the billing provider."
                },
                "zipCode": {
                    "type": "string",
                    "description": "The ZIP code of the billing provider."
                },
                "countryCode": {
                    "type": "string",
                    "description": "The country code of the billing provider.",
                    "enum": [
                        "US",
                        "CA"
                    ]
                },
                "ein": {
                    "type": "string",
                    "description": "The EIN of the billing provider."
                },
                "ssn": {
                    "type": "string",
                    "description": "The SSN of the billing provider."
                },
                "stateLicenseNumber": {
                    "type": "string",
                    "description": "The state license number of the billing provider."
                },
                "payerAssignedProviderId": {
                    "type": "string",
                    "description": "The payer assigned provider id of the billing provider."
                },
                "contactName": {
                    "type": "string",
                    "description": "The contact name of the billing provider."
                },
                "phone": {
                    "type": "string",
                    "description": "The phone number of the billing provider."
                },
                "extension": {
                    "type": "string",
                    "description": "The phone number extension of the billing provider."
                },
                "fax": {
                    "type": "string",
                    "description": "The fax number of the billing provider."
                },
                "email": {
                    "type": "string",
                    "description": "The email address of the billing provider."
                },
                "payToAddress": {
                    "type": "object",
                    "description": "The pay to address of the billing provider.",
                    "properties": {
                        "addressLine1": {
                            "type": "string",
                            "description": "The address of the pay to address."
                        },
                        "addressLine2": {
                            "type": "string",
                            "description": "The address of the pay to address."
                        },
                        "city": {
                            "type": "string",
                            "description": "The city of the pay to address."
                        },
                        "stateCode": {
                            "type": "string",
                            "description": "The state code of the pay to address."
                        },
                        "zipCode": {
                            "type": "string",
                            "description": "The ZIP code of the pay to address."
                        }
                    }
                }
            }
        },
        "subscriber": {
            "type": "object",
            "description": "The subscriber.",
            "properties": {
                "lastName": {
                    "type": "string",
                    "description": "The last name of the subscriber."
                },
                "firstName": {
                    "type": "string",
                    "description": "The first name of the subscriber."
                },
                "middleName": {
                    "type": "string",
                    "description": "The middle name of the subscriber."
                },
                "suffix": {
                    "type": "string",
                    "description": "The suffix of the subscriber."
                },
                "memberId": {
                    "type": "string",
                    "description": "The member id of the subscriber."
                },
                "groupNumber": {
                    "type": "string",
                    "description": "The group number of the subscriber."
                },
                "groupName": {
                    "type": "string",
                    "description": "The group name of the subscriber."
                },
                "ssn": {
                    "type": "string",
                    "description": "The SSN of the subscriber."
                },
                "totalFamilyDeductible": {
                    "type": "string",
                    "description": "The total family deductible of the subscriber."
                },
                "accumulatedFamilyDeductible": {
                    "type": "string",
                    "description": "The accumulated family deductible of the subscriber."
                },
                "remainingFamilyDeductible": {
                    "type": "string",
                    "description": "The remaining family deductible of the subscriber."
                },
                "totalDeductible": {
                    "type": "string",
                    "description": "The total deductible of the subscriber."
                },
                "accumulatedDeductible": {
                    "type": "string",
                    "description": "The accumulated deductible of the subscriber."
                },
                "remainingDeductible": {
                    "type": "string",
                    "description": "The remaining deductible of the subscriber."
                },
                "onHold": {
                    "type": "boolean",
                    "description": "The subscriber's on hold indicator."
                },
                "holdReasons": {
                    "type": "array",
                    "description": "A list of hold reasons.",
                    "items": {
                        "$ref": "#/definitions/ItemDescription"
                    }
                }
            }
        },
        "patient": {
            "type": "object",
            "description": "The patient.",
            "properties": {
                "lastName": {
                    "type": "string",
                    "description": "The last name of the patient."
                },
                "firstName": {
                    "type": "string",
                    "description": "The first name of the patient."
                },
                "middleName": {
                    "type": "string",
                    "description": "The middle name of the patient."
                },
                "suffix": {
                    "type": "string",
                    "description": "The suffix of the patient."
                },
                "ssn": {
                    "type": "string",
                    "description": "The SSN of the patient."
                },
                "addressLine1": {
                    "type": "string",
                    "description": "The address of the patient."
                },
                "addressLine2": {
                    "type": "string",
                    "description": "The address of the patient."
                },
                "city": {
                    "type": "string",
                    "description": "The city of the patient."
                },
                "stateCode": {
                    "type": "string",
                    "description": "The state code of the patient."
                },
                "zipCode": {
                    "type": "string",
                    "description": "The ZIP code of the patient."
                },
                "birthDate": {
                    "type": "string",
                    "format": "date",
                    "description": "The birth date of the patient."
                },
                "gender": {
                    "type": "string",
                    "description": "The gender of the patient.",
                    "enum": [
                        "Female",
                        "Male",
                        "Unknown"
                    ]
                },
                "genderCode": {
                    "type": "string",
                    "description": "The gender code of the patient.",
                    "enum": [
                        "F",
                        "M",
                        "U"
                    ]
                },
                "subscriberRelationship": {
                    "type": "string",
                    "description": "The relationship of the patient to the subscriber.",
                    "enum": [
                        "Self",
                        "Spouse",
                        "Child",
                        "Employee",
                        "Unknown",
                        "Organ Donor",
                        "Cadaver Donor",
                        "Life Partner",
                        "Other Relationship",
                        "Other Adult"
                    ]
                },
                "subscriberRelationshipCode": {
                    "type": "string",
                    "description": "The relationship code of the patient to the subscriber.",
                    "enum": [
                        18,
                        1,
                        19,
                        20,
                        21,
                        39,
                        40,
                        53,
                        "G8",
                        34
                    ]
                }
            }
        },
        "claimInformation": {
            "type": "object",
            "description": "The claim information.",
            "properties": {
                "controlNumber": {
                    "type": "string",
                    "description": "The institutional claim's control number."
                },
                "facilityTypeCode": {
                    "type": "string",
                    "description": "The facility type code."
                },
                "frequencyTypeCode": {
                    "type": "string",
                    "description": "The frequency type code."
                },
                "providerAcceptAssignmentCode": {
                    "type": "string",
                    "description": "The provider accept assignment code."
                },
                "benefitsAssignmentCertification": {
                    "type": "boolean",
                    "description": "The benefits assignment certification indicator."
                },
                "informationReleaseCode": {
                    "type": "string",
                    "description": "The information release code."
                },
                "admissionTypeCode": {
                    "type": "string",
                    "description": "The admission type code."
                },
                "admissionSourceCode": {
                    "type": "string",
                    "description": "The admission source code."
                },
                "patientStatusCode": {
                    "type": "string",
                    "description": "The patient status code."
                },
                "bundled": {
                    "type": "boolean",
                    "description": "The bundled indicator."
                },
                "messages": {
                    "type": "array",
                    "description": "A list of messages from the payer.",
                    "items": {
                        "$ref": "#/definitions/ItemDescription"
                    }
                },
                "specialMessages": {
                    "type": "array",
                    "description": "A list of special messages from the payer.",
                    "items": {
                        "$ref": "#/definitions/ItemDescription"
                    }
                },
                "displayMessage": {
                    "type": "string",
                    "description": "A display message from the payer."
                },
                "serviceTypeCode": {
                    "type": "string",
                    "description": "The service type code."
                },
                "occurrenceCode": {
                    "type": "string",
                    "description": "The occurrence code."
                },
                "occurrenceCodeDate": {
                    "type": "string",
                    "format": "date",
                    "description": "The occurrence code date."
                },
                "valueCode": {
                    "type": "string",
                    "description": "The value code."
                },
                "valueCodeAmount": {
                    "type": "string",
                    "description": "The value code amount."
                },
                "conditionCode": {
                    "type": "string",
                    "description": "The condition code."
                },
                "claimIdentifier": {
                    "type": "string",
                    "description": "The claim identifier."
                },
                "principalDiagnosis": {
                    "$ref": "#/definitions/Diagnosis"
                },
                "admittingDiagnosis": {
                    "$ref": "#/definitions/Diagnosis"
                },
                "patientsReasonForVisit": {
                    "$ref": "#/definitions/Diagnosis"
                },
                "principalProcedure": {
                    "$ref": "#/definitions/Procedure"
                },
                "diagnosisRelatedGroupCode": {
                    "type": "string",
                    "description": "The diagnosis related group code."
                },
                "otherDiagnoses": {
                    "type": "array",
                    "description": "A list of other diagnoses.",
                    "items": {
                        "$ref": "#/definitions/Diagnosis"
                    }
                },
                "otherProcedures": {
                    "type": "array",
                    "description": "A list of other procedures.",
                    "items": {
                        "$ref": "#/definitions/Procedure"
                    }
                },
                "serviceLines": {
                    "type": "array",
                    "description": "A list of service lines.",
                    "items": {
                        "type": "object",
                        "properties": {
                            "controlNumber": {
                                "type": "string",
                                "description": "The service line's control number."
                            },
                            "fromDate": {
                                "type": "string",
                                "format": "date",
                                "description": "The service from date."
                            },
                            "toDate": {
                                "type": "string",
                                "format": "date",
                                "description": "The service to date."
                            },
                            "revenue": {
                                "type": "string",
                                "description": "The revenue description."
                            },
                            "revenueCode": {
                                "type": "string",
                                "description": "The revenue code."
                            },
                            "procedure": {
                                "type": "string",
                                "description": "The procedure description."
                            },
                            "procedureCode": {
                                "type": "string",
                                "description": "The procedure code."
                            },
                            "alternateProcedure": {
                                "type": "string",
                                "description": "Alternate procedure."
                            },
                            "modifierCode1": {
                                "type": "string",
                                "description": "The first procedure modifier."
                            },
                            "modifierCode2": {
                                "type": "string",
                                "description": "The second procedure modifier."
                            },
                            "modifierCode3": {
                                "type": "string",
                                "description": "The third procedure modifier."
                            },
                            "modifierCode4": {
                                "type": "string",
                                "description": "The fourth procedure modifier."
                            },
                            "amount": {
                                "type": "string",
                                "description": "The service charge amount."
                            },
                            "quantity": {
                                "type": "string",
                                "description": "The service quantity."
                            },
                            "quantityTypeCode": {
                                "type": "string",
                                "description": "The service quantity type code."
                            },
                            "estimatedPatientResponsibility": {
                                "type": "string",
                                "description": "The estimated patient responsibility."
                            },
                            "bundlingDescription": {
                                "type": "string",
                                "description": "A bundling description."
                            },
                            "denyReason": {
                                "type": "string",
                                "description": "The deny reason."
                            },
                            "holdReasons": {
                                "type": "array",
                                "description": "A list of hold reasons for this service line.",
                                "items": {
                                    "$ref": "#/definitions/ItemDescription"
                                }
                            },
                            "messages": {
                                "type": "array",
                                "description": "A list of messages for this service line.",
                                "items": {
                                    "$ref": "#/definitions/ItemDescription"
                                }
                            },
                            "displayMessage": {
                                "type": "string",
                                "description": "A display message."
                            },
                            "allowed": {
                                "$ref": "#/definitions/ItemDescription"
                            },
                            "estimated": {
                                "$ref": "#/definitions/ItemDescription"
                            },
                            "notCovered": {
                                "$ref": "#/definitions/ItemDescription"
                            },
                            "coPay": {
                                "$ref": "#/definitions/ItemDescription"
                            },
                            "coInsurance": {
                                "$ref": "#/definitions/ItemDescription"
                            },
                            "deductible": {
                                "$ref": "#/definitions/ItemDescription"
                            },
                            "contractual": {
                                "$ref": "#/definitions/ItemDescription"
                            },
                            "providerInitiated": {
                                "$ref": "#/definitions/ItemDescription"
                            },
                            "providerResponsibility": {
                                "$ref": "#/definitions/ItemDescription"
                            },
                            "remarks": {
                                "type": "array",
                                "description": "Remarks about this service line.",
                                "items": {
                                    "type": "object",
                                    "properties": {
                                        "remarkCode": {
                                            "type": "string",
                                            "description": "The remark code."
                                        },
                                        "description": {
                                            "type": "string",
                                            "description": "The description."
                                        }
                                    }
                                }
                            }
                        }
                    }
                },
                "totalCharges": {
                    "$ref": "#/definitions/ItemDescription"
                },
                "totalAllowed": {
                    "$ref": "#/definitions/ItemDescription"
                },
                "totalEstimated": {
                    "$ref": "#/definitions/ItemDescription"
                },
                "totalNotCovered": {
                    "$ref": "#/definitions/ItemDescription"
                },
                "totalCoPay": {
                    "$ref": "#/definitions/ItemDescription"
                },
                "totalCoInsurance": {
                    "$ref": "#/definitions/ItemDescription"
                },
                "totalDeductible": {
                    "$ref": "#/definitions/ItemDescription"
                },
                "totalContractual": {
                    "$ref": "#/definitions/ItemDescription"
                },
                "totalProviderInitiated": {
                    "$ref": "#/definitions/ItemDescription"
                },
                "totalProviderResponsibility": {
                    "$ref": "#/definitions/ItemDescription"
                },
                "totalPatientLiability": {
                    "$ref": "#/definitions/ItemDescription"
                },
                "attendingProvider": {
                    "type": "object",
                    "description": "The attending provider.",
                    "properties": {
                        "lastName": {
                            "type": "string",
                            "description": "The attending provider's last name."
                        },
                        "firstName": {
                            "type": "string",
                            "description": "The attending provider's first name."
                        },
                        "npi": {
                            "type": "string",
                            "description": "The attending provider's national provider id."
                        }
                    }
                }
            }
        },
        "payerSpecificFlags": {
            "type": "array",
            "description": "A list of payer specific flags on this institutional claim.",
            "items": {
                "type": "object",
                "properties": {
                    "name": {
                        "type": "string",
                        "description": "A payer specific flag name."
                    },
                    "value": {
                        "type": "string",
                        "description": "A payer specific flag value."
                    }
                }
            }
        }
    }
}
              

{
    "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": {
        "qualifier": {
            "type": "string",
            "description": "The qualifier description."
        },
        "qualifierCode": {
            "type": "string",
            "description": "The qualifier code."
        },
        "code": {
            "type": "string",
            "description": "The diagnosis code."
        },
        "description": {
            "type": "string",
            "description": "The diagnosis description."
        },
        "presentOnAdmissionIndicatorCode": {
            "type": "string",
            "description": "The present on admission indicator code."
        }
    }
}
              

{
    "type": "object",
    "properties": {
        "qualifier": {
            "type": "string",
            "description": "The qualifier description."
        },
        "qualifierCode": {
            "type": "string",
            "description": "The qualifier code."
        },
        "code": {
            "type": "string",
            "description": "The procedure code."
        },
        "description": {
            "type": "string",
            "description": "The procedure description."
        },
        "codeDate": {
            "type": "string",
            "format": "date",
            "description": "The code date."
        }
    }
}
              

{
    "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."
        }
    }
}