{
  "payerId": "BCBS001",
  "requestType": "SERVICE_DATE",
  "memberId": "MEM123456",
  "fromDate": "2025-01-01",
  "toDate": "2025-12-31",
  "providerNpi": "1234567890",
  "checkNumber": "CHK-001234",
  "requestedStatus": "PAID"
}