openapi: 3.2.0 info: title: Reference Charge Capture Claim Creation API version: 1.0.0 servers: - url: https://pre-api.joincandidhealth.com description: Production - url: https://pre-api-staging.joincandidhealth.com description: Staging - url: https://sandbox-pre-api.joincandidhealth.com description: CandidSandbox - url: https://staging-pre-api.joincandidhealth.com description: CandidStaging - url: http://localhost:4000 description: Local - url: https://api.joincandidhealth.com description: Production - url: https://api-staging.joincandidhealth.com description: Staging - url: https://sandbox-api.joincandidhealth.com description: CandidSandbox - url: https://staging-api.joincandidhealth.com description: CandidStaging - url: http://localhost:5050 description: Local tags: - name: Charge Capture Claim Creation paths: /api/charge_capture_claim_creation/v1/{charge_capture_claim_creation_id}: get: operationId: get summary: Get Charge Capture Claim Creation tags: - Charge Capture Claim Creation parameters: - name: charge_capture_claim_creation_id in: path required: true schema: $ref: '#/components/schemas/type_commons_ChargeCaptureClaimCreationId' - name: Authorization in: header description: OAuth authentication required: true schema: type: string responses: '200': description: Response with status 200 content: application/json: schema: $ref: '#/components/schemas/type_charge-capture-bundles_v1_ChargeCaptureClaimCreation' /api/charge_capture_claim_creation/v1/all/summary: get: operationId: getSummary summary: Get Charge Capture Claim Creation Summary tags: - Charge Capture Claim Creation parameters: - name: Authorization in: header description: OAuth authentication required: true schema: type: string responses: '200': description: Response with status 200 content: application/json: schema: $ref: '#/components/schemas/type_charge-capture-bundles_v1_ChargeCaptureClaimCreationSummary' /api/charge_capture_claim_creation/v1/error/{charge_capture_bundle_error_id}: patch: operationId: resolveChargeCreationError summary: Mark a ClaimCreationAttempt error as resolved tags: - Charge Capture Claim Creation parameters: - name: charge_capture_bundle_error_id in: path required: true schema: type: string format: uuid - name: Authorization in: header description: OAuth authentication required: true schema: type: string responses: '200': description: Successful response '403': description: Error response with status 403 content: application/json: schema: type: object properties: errorName: type: string enum: - UnauthorizedError content: $ref: '#/components/schemas/type_commons_UnauthorizedErrorMessage' required: - errorName - content '404': description: Error response with status 404 content: application/json: schema: type: object properties: errorName: type: string enum: - EntityNotFoundError content: $ref: '#/components/schemas/type_commons_EntityNotFoundErrorMessage' required: - errorName - content requestBody: content: application/json: schema: type: object properties: resolved_by: type: string description: A string, denoting who resolved the error for audit trail purposes. resolution_reason: type: string description: A string denoting why or how the error was dealt with for audit trail purposes. /api/charge_capture_claim_creation/v1: get: operationId: getAll summary: Get all Charge Capture Claim Creations tags: - Charge Capture Claim Creation parameters: - name: limit in: query description: Maximum number of entities per page, defaults to 100. required: false schema: type: integer - name: sort in: query description: Defaults to created_at required: false schema: $ref: '#/components/schemas/type_charge-capture-bundles_v1_ChargeCaptureClaimCreationSortField' - name: sort_direction in: query description: Sort direction. Defaults to descending order if not provided. required: false schema: $ref: '#/components/schemas/type_commons_SortDirection' - name: page_token in: query required: false schema: $ref: '#/components/schemas/type_commons_PageToken' - name: patient_external_id in: query description: The patient ID from the external EMR platform for the patient required: false schema: type: string - name: claim_creation_status in: query description: the status of the charge capture Claim Creation, refers to whether it was able to create a claim. required: false schema: $ref: '#/components/schemas/type_charge-capture-bundles_v1_ChargeCaptureClaimCreationStatus' - name: charge_status in: query description: the status of the charge captures required: false schema: $ref: '#/components/schemas/type_charge-capture_v1_ChargeCaptureStatus' - name: charge_external_id in: query description: 'A client-specified unique ID to associate with this encounter; for example, your internal encounter ID or a Dr. Chrono encounter ID. This field should not contain PHI.' required: false schema: type: string - name: date_of_service_min in: query description: 'Date formatted as YYYY-MM-DD; eg: 2019-08-24. This date must be the local date in the timezone where the service occurred.' required: false schema: type: string format: date - name: date_of_service_max in: query description: 'Date formatted as YYYY-MM-DD; eg: 2019-08-24. This date must be the local date in the timezone where the service occurred.' required: false schema: type: string format: date - name: claim_ids in: query description: A list of claim IDs to filter by. This will return all charge capture claim_creations that have a resulting claim with one of the IDs in this list. required: false schema: $ref: '#/components/schemas/type_commons_EncounterId' - name: claim_creation_ids in: query description: A list of Claim Creation IDs to filter by. required: false schema: $ref: '#/components/schemas/type_commons_ChargeCaptureClaimCreationId' - name: billing_provider_npis in: query description: A list of billing provider NPIs to filter by. This will return all charge capture claim_creations which include one or more charges with one of the NPIs in this list. required: false schema: type: string - name: service_facility_name in: query description: A string to filter by. This will return all charge capture claim_creations which include one or more charges with this service facility name. required: false schema: type: string - name: primary_payer_ids in: query description: A list of primary payer IDs to filter by. This will return all charge capture claim_creations which include one or more charges with one of the primary payer IDs in this list. required: false schema: type: string - name: rendering_provider_npis in: query description: A list of rendering provider NPIs to filter by. This will return all charge capture claim_creations which include one or more charges with one of the NPIs in this list. required: false schema: type: string - name: rendering_provider_names in: query description: A list of rendering provider names to filter by. This will return all charge capture claim_creations which include one or more charges with one of the names in this list. required: false schema: type: string - name: supervising_provider_npis in: query description: A list of supervising provider NPIs to filter by. This will return all charge capture claim_creations which include one or more charges with one of the NPIs in this list. required: false schema: type: string - name: supervising_provider_names in: query description: A list of supervising provider names to filter by. This will return all charge capture claim_creations which include one or more charges with one of the names in this list. required: false schema: type: string - name: claim_status in: query description: the status of the claim to filter by created from charge capture bundle. required: false schema: $ref: '#/components/schemas/type_claims_ClaimStatus' - name: claim_creation_category in: query description: A list of claim creation categories to filter by. This will return all charge capture claim_creations which include one or more charges with one of the names in this list. required: false schema: type: string - name: tags in: query description: A list of tags to filter by. This will return all charge captures with one of the tags. required: false schema: type: string - name: primary_payer_names in: query description: A list of primary payer names to filter by. This will return all charge captures with one of the names. required: false schema: type: string - name: patient_names in: query description: A list of patient names to filter by. This will return all charge captures with one of the names. required: false schema: type: string - name: has_charge_capture_updates in: query description: If true, only return claim_creations that have charge captures that have been updated since the Claim Creation has had a status of BILLED. See the updates property on ChargeCapture for more details. required: false schema: type: boolean - name: Authorization in: header description: OAuth authentication required: true schema: type: string responses: '200': description: Response with status 200 content: application/json: schema: $ref: '#/components/schemas/type_charge-capture-bundles_v1_ChargeCaptureClaimCreationPage' components: schemas: type_property-and-casualty_v1_PropertyCasualtyPatientIdentifierCreateOptional: type: object properties: property_casualty_patient_identifier_qualifier: $ref: '#/components/schemas/type_property-and-casualty_v1_PropertyCasualtyPatientIdentifierQualifier' description: 'Represents REF01 on the EDI 837 Loop 2010CA Property and Casualty Patient Identifier segment. Valid values include 1W (Member Identification Number) and SY (Social Security Number).' property_casualty_patient_identifier: type: string description: Represents REF02 on the EDI 837 Loop 2010CA Property and Casualty Patient Identifier segment. Value cannot exceed 50 characters title: PropertyCasualtyPatientIdentifierCreateOptional type_yes-no-indicator_YesNoIndicator: type: string enum: - 'YES' - 'NO' - UNKNOWN - NOT_APPLICABLE title: YesNoIndicator type_commons_EmrPayerCrosswalk: type: string enum: - HEALTHIE - CANVAS - WAYSTAR - PAYER_PLAN_GROUP title: EmrPayerCrosswalk type_encounters_v4_PriorAuthorizationNumber: type: string title: PriorAuthorizationNumber type_commons_State: type: string enum: - AA - AE - AP - AL - AK - AS - AZ - AR - CA - CO - CT - DC - DE - FL - FM - GA - GU - HI - ID - IL - IN - IA - KS - KY - LA - ME - MD - MA - MH - MI - MN - MP - MS - MO - MT - NE - NV - NH - NJ - NM - NY - NC - ND - OH - OK - OR - PA - PR - PW - RI - SC - SD - TN - TX - UT - VI - VT - VA - WA - WV - WI - WY title: State type_x12_v1_TypeOfBillFrequencyCode: type: string enum: - '0' - '1' - '2' - '3' - '4' - '5' - '7' - '8' - '9' - A - B - C - D - E - F - G - H - I - J - K - M - O - P - Q - X - Y - Z title: TypeOfBillFrequencyCode type_commons_DelayReasonCode: type: string enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - '9' - '10' - '11' - '15' - '16' - '17' description: Code indicating the reason why a request was delayed title: DelayReasonCode type_encounters_v4_ClinicalNoteCategoryCreateOptional: type: object properties: category: $ref: '#/components/schemas/type_encounters_v4_NoteCategory' notes: type: array items: $ref: '#/components/schemas/type_encounters_v4_ClinicalNoteOptional' title: ClinicalNoteCategoryCreateOptional type_commons_EncounterId: type: string format: uuid title: EncounterId type_individual_PatientNonInsurancePayerInfoCreateOptional: type: object properties: non_insurance_payer_id: $ref: '#/components/schemas/type_non-insurance-payers_v1_NonInsurancePayerId' member_id: type: string clinical_trial_info: type: array items: $ref: '#/components/schemas/type_individual_PatientClinicalTrialInfoCreateOptional' title: PatientNonInsurancePayerInfoCreateOptional type_non-insurance-payers_v1_NonInsurancePayerId: type: string format: uuid title: NonInsurancePayerId type_service-lines_v2_TestResultType: type: string enum: - HEMATOCRIT - HEMOGLOBIN - LDL - VITAMIN_D title: TestResultType type_encounter-providers_v2_SupervisingProviderUpdateWithOptionalAddress: type: object properties: first_name: type: string description: If the provider is an individual, this should be set instead of organization name last_name: type: string description: If the provider is an individual, this should be set instead of organization name organization_name: type: string description: If the provider is an organization, this should be set instead of first + last name npi: type: string description: 'A National Provider Identifier is a unique 10-digit identification number issued to health care providers in the United States' taxonomy_code: type: string address: $ref: '#/components/schemas/type_commons_StreetAddressShortZipOptional' secondary_identification: $ref: '#/components/schemas/type_encounter-providers_v2_SupervisingProviderSecondaryIdentificationOptional' title: SupervisingProviderUpdateWithOptionalAddress type_organization-service-facilities_v2_OrganizationServiceFacilityId: type: string format: uuid title: OrganizationServiceFacilityId type_commons_PageToken: type: string title: PageToken type_encounters_v4_LabCodeType: type: string enum: - quest - labcorp title: LabCodeType type_commons_ProcedureModifier: type: string enum: - AV - AU - AW - AY - '07' - 08 - 09 - '10' - '11' - '12' - '13' - '14' - '15' - '16' - '22' - '23' - '24' - '25' - '26' - '27' - '28' - '32' - '33' - '47' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '59' - '62' - '63' - '66' - '73' - '74' - '76' - '77' - '78' - '79' - '80' - '81' - '82' - '90' - '91' - '92' - '93' - '95' - '96' - '97' - '99' - A1 - A2 - A3 - A4 - A5 - A6 - A7 - A8 - A9 - AA - AB - AD - AE - AF - AG - AH - AI - AJ - AK - AM - AO - AP - AQ - AR - AS - AT - AZ - BA - BL - BO - BP - BR - BU - CA - CB - CC - CD - CE - CF - CG - CH - CI - CJ - CK - CL - CM - CN - CR - CS - CT - CO - CQ - DA - E1 - E2 - E3 - E4 - EA - EB - EC - ED - EE - EJ - EM - EP - ER - ET - EV - EX - EY - F1 - F2 - F3 - F4 - F5 - F6 - F7 - F8 - F9 - FA - FB - FC - FP - FQ - FR - FS - FT - FX - FY - G0 - G1 - G2 - G3 - G4 - G5 - G6 - G7 - G8 - G9 - GA - GB - GC - GE - GF - GG - GH - GJ - GK - GL - GM - GN - GO - GP - GQ - GR - GS - GT - GU - GV - GW - GX - GY - GZ - HA - HB - HC - HD - HE - HF - HG - HH - HI - HJ - HK - HL - HM - HN - HO - HP - HQ - HR - HS - HT - HU - HV - HW - HX - HY - HZ - J1 - J2 - J3 - J4 - J5 - JA - JB - JC - JD - JE - JG - JW - JZ - K0 - K1 - K2 - K3 - K4 - KA - KB - KC - KD - KE - KF - KG - KH - KI - KJ - KK - KL - KM - KN - KO - KP - KQ - KR - KS - KT - KU - KV - KW - KX - KY - KZ - LC - LD - LL - LM - LR - LS - LT - LU - M2 - MA - MB - MC - MD - ME - MF - MG - MH - MS - N1 - N2 - N3 - NB - NR - NU - P1 - P2 - P3 - P4 - P5 - P6 - PA - PB - PC - PD - PI - PL - PM - PN - PO - PS - PT - Q0 - Q1 - Q2 - Q3 - Q4 - Q5 - Q6 - Q7 - Q8 - Q9 - QA - QB - QC - QD - QE - QF - QG - QH - QJ - QK - QL - QM - QN - QP - QQ - QR - QS - QT - QW - QX - QY - QZ - RA - RB - RC - RD - RE - RI - RR - RT - SA - SB - SC - SD - SE - SF - SG - SH - SJ - SL - SM - SN - SQ - SS - ST - SU - SV - SW - SY - T1 - T2 - T3 - T4 - T5 - T6 - T7 - T8 - T9 - TA - TB - TC - TD - TE - TF - TG - TH - TJ - TK - TL - TM - TN - TP - TQ - TR - TS - TT - TU - TV - TW - U1 - U2 - U3 - U4 - U5 - U6 - U7 - U8 - U9 - UA - UB - UC - UD - UE - UF - UG - UH - UJ - UK - UN - UP - UQ - UR - US - V1 - V2 - V3 - W1 - W2 - W3 - X4 - XE - XP - XS - XU - XY - ZZ title: ProcedureModifier type_encounters_v4_ServiceAuthorizationExceptionCode: type: string enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' description: 'Required when mandated by government law or regulation to obtain authorization for specific service(s) but, for the reasons listed in one of the enum values, the service was performed without obtaining the authorization.' title: ServiceAuthorizationExceptionCode type_organization-providers_v2_LicenseType: type: string enum: - MD - NP - PA - LMFT - LCPC - LCSW - PMHNP - FNP - LPCC - DO - RD - SLP - APRN - LPC - PHD - PSYD - LMSW - LMHC - OTHER_MASTERS - BCBA - UNKNOWN - RPH - PHT - LAC - LMT - DC - ND - MA - PT - IBCLC - RN - DPT - LCMHC - CNM - RNFA - ACSW - APC - BCABA - BHA - OD - DPM - DA - DDS - DEH - DMD - PTA - LCADC - LCAT - LCMHCS - LCMHCA - LCSWA - LICSW - LISW - LMFTS - LMFTA - LPCI - LSCSW - MHCA - MHT - RBT - RCSWI - RHMCI - LPN - OTD - OMS - MFTA - APCC - DNP - AGNPBC - ANP - FNPPP - LCSWR - ALC - RMFTI - LAMFT - LPCA - LSWI - CSW - CPC - LGMFT - LLPC - PLPC - PLMFT - LMHCA - CIT - CT - MFT - LSW - PLMHP - PCMSW - LMHP - OTR/L - RPA - COTA - CRNP - SLP-CF - NP-C - PA-C - AMFT - CDN - CGC - CNS - MDPHD - AuD - ATC - LAT - OTA - LSSP - SLPA title: LicenseType type_tags_TagId: type: string title: TagId type_encounters_v4_IntakeFollowUpId: type: string title: IntakeFollowUpId type_individual_PatientUpdateWithOptionalAddress: type: object properties: first_name: type: string last_name: type: string gender: $ref: '#/components/schemas/type_individual_Gender' external_id: type: string description: The ID used to identify this individual in your system. For example, your internal patient ID or an EHR patient ID. date_of_birth: type: string format: date description: Box 3 on the CMS-1500 claim form or Form Locator 10 on a UB-04 claim form. The date format should be in ISO 8601 date; formatted YYYY-MM-DD (i.e. 2012-02-01) address: $ref: '#/components/schemas/type_commons_StreetAddressShortZipOptional' description: Box 5 on the CMS-1500 claim form or Form Locator 9 on a UB-04 claim form. phone_numbers: type: array items: $ref: '#/components/schemas/type_commons_PhoneNumberOptional' phone_consent: type: boolean email: $ref: '#/components/schemas/type_commons_Email' email_consent: type: boolean auto_charge_consent: type: boolean non_insurance_payers: type: array items: $ref: '#/components/schemas/type_non-insurance-payers_v1_NonInsurancePayerId' description: On update, we will replace the existing list of non-insurance payers with the new list if populated. non_insurance_payers_info: type: array items: $ref: '#/components/schemas/type_individual_PatientNonInsurancePayerInfoCreateOptional' description: On update, we will replace the existing list of non-insurance payers with the new list if populated. title: PatientUpdateWithOptionalAddress type_encounters_v4_IntakeResponseAndFollowUpsOptional: type: object properties: response: type: string follow_ups: type: array items: $ref: '#/components/schemas/type_encounters_v4_IntakeFollowUpOptional' title: IntakeResponseAndFollowUpsOptional type_encounters_v4_RxCui: type: string title: RxCui type_commons_ChargeCaptureClaimCreationId: type: string format: uuid title: ChargeCaptureClaimCreationId type_claim-submission_v1_ExternalClaimSubmissionCreateOptional: type: object properties: claim_created_at: type: string format: date-time description: When the claim was created in the external system. patient_control_number: type: string description: 'The Patient Control Number sent on the claim to the payer. To guarantee compatibility with all payers, this field must consist only of uppercase letters and numbers and be no more than 14 characters long.' submission_records: type: array items: $ref: '#/components/schemas/type_claim-submission_v1_ClaimSubmissionRecordCreateOptional' description: 'A successful claim submission record will be created for each value provided. An empty list may be provided for cases where the claim originated in an external system but was never submitted to a payer.' title: ExternalClaimSubmissionCreateOptional type_commons_IntendedSubmissionMedium: type: string enum: - paper - electronic description: The medium (paper or electronic) via which we intended to submit the claim. The clearinghouse to which we sent the claim may use a different medium in certain cases, e.g., if the payer does not support electronic claims. title: IntendedSubmissionMedium type_property-and-casualty_v1_PropertyCasualtyPatientIdentifierQualifier: type: string enum: - 1W - SY title: PropertyCasualtyPatientIdentifierQualifier type_charge-capture_v1_ChargeCaptureData: type: object properties: benefits_assigned_to_provider: type: boolean description: Whether this patient has authorized insurance payments to be made to you, not them. If false, patient may receive reimbursement. Box 13 on the CMS-1500 claim form or Form Locator 53 on a UB-04 claim form. prior_authorization_number: $ref: '#/components/schemas/type_encounters_v4_PriorAuthorizationNumber' description: Box 23 on the CMS-1500 claim form or Form Locator 63 on a UB-04 claim form. external_id: $ref: '#/components/schemas/type_commons_EncounterExternalId' description: 'A client-specified unique ID to associate with this encounter; for example, your internal encounter ID or a Dr. Chrono encounter ID. This field should not contain PHI.' date_of_service: type: string format: date description: 'Date formatted as YYYY-MM-DD; eg: 2019-08-24. This date must be the local date in the timezone where the service occurred. Box 24a on the CMS-1500 claim form or Form Locator 45 on the UB-04 claim form. If service occurred over a range of dates, this should be the start date. If service lines have distinct date_of_service values, updating the encounter''s date_of_service will fail. If all service line date_of_service values are the same, updating the encounter''s date_of_service will update all service line date_of_service values.' tag_ids: type: array items: $ref: '#/components/schemas/type_tags_TagId' description: Names of tags that should be on the encounter. Note all tags on encounter will be overridden with this list. billable_status: $ref: '#/components/schemas/type_encounters_v4_BillableStatusType' description: Defines if the Encounter is to be billed by Candid to the responsible_party. Examples for when this should be set to NOT_BILLABLE include if the Encounter has not occurred yet or if there is no intention of ever billing the responsible_party. responsible_party: $ref: '#/components/schemas/type_encounters_v4_ResponsiblePartyType' description: Defines the party to be billed with the initial balance owed on the claim. Use SELF_PAY if you intend to bill self pay/cash pay. provider_accepts_assignment: type: boolean description: Whether you have accepted the patient's authorization for insurance payments to be made to you, not them. Box 27 on the CMS-1500 claim form. There is no exact equivalent of this field on a UB-04 claim, however contributes to the concept of Form Locator 53. synchronicity: $ref: '#/components/schemas/type_encounters_v4_SynchronicityType' description: Whether or not this was a synchronous or asynchronous encounter. Asynchronous encounters occur when providers and patients communicate online using forms, instant messaging, or other pre-recorded digital mediums. Synchronous encounters occur in live, real-time settings where the patient interacts directly with the provider, such as over video or a phone call. place_of_service_code: $ref: '#/components/schemas/type_commons_FacilityTypeCode' description: Box 24B on the CMS-1500 claim form. 837p Loop2300, CLM-05-1. 02 for telemedicine, 11 for in-person. Full list [here](https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set). appointment_type: type: string description: 'Human-readable description of the appointment type (ex: "Acupuncture - Headaches").' end_date_of_service: type: string format: date description: 'Date formatted as YYYY-MM-DD; eg: 2019-08-25. This date must be the local date in the timezone where the service occurred. If omitted, the Encounter is assumed to be for a single day. Must not be temporally before the date_of_service field. If service lines have distinct end_date_of_service values, updating the encounter''s end_date_of_service will fail. If all service line end_date_of_service values are the same, updating the encounter''s end_date_of_service will update all service line date_of_service values.' additional_information: type: string description: 'Defines additional information on the claim needed by the payer. Box 19 on the CMS-1500 claim form or Form Locator 80 on a UB-04 claim form.' service_authorization_exception_code: $ref: '#/components/schemas/type_encounters_v4_ServiceAuthorizationExceptionCode' description: '837p Loop2300 REF*4N Required when mandated by government law or regulation to obtain authorization for specific service(s) but, for the reasons listed in one of the enum values of ServiceAuthorizationExceptionCode, the service was performed without obtaining the authorization.' admission_date: type: string format: date description: '837p Loop2300 DTP*435, CMS-1500 Box 18 or UB-04 Form Locator 12. Required on all ambulance claims when the patient was known to be admitted to the hospital. OR Required on all claims involving inpatient medical visits.' discharge_date: type: string format: date description: 837p Loop2300 DTP*096, CMS-1500 Box 18 Required for inpatient claims when the patient was discharged from the facility and the discharge date is known. Not used on an institutional claim. onset_of_current_illness_or_symptom_date: type: string format: date description: "837p Loop2300 DTP*431, CMS-1500 Box 14\nRequired for the initial medical service or visit performed in response to a medical emergency when the date is available and is different than the date of service.\nOR\nThis date is the onset of acute symptoms for the current illness or condition.\n For UB-04 claims, this is populated separately via occurrence codes." last_menstrual_period_date: type: string format: date description: '837p Loop2300 DTP*484, CMS-1500 Box 14 Required when, in the judgment of the provider, the services on this claim are related to the patient''s pregnancy.de This field is populated separately via occurrence codes for UB-04 claim forms.' delay_reason_code: $ref: '#/components/schemas/type_commons_DelayReasonCode' description: 'Code indicating the reason why a claim submission was delayed. Corresponds to CLM-20 in the 837 specification (both professional and institutional).' patient_authorized_release: type: boolean description: 'Whether this patient has authorized the release of medical information for billing purpose. Box 12 on the CMS-1500 claim form or Form Locator 52 on a UB-04 claim form.' referral_number: type: string description: Refers to REF*9F on the 837p. Value cannot be greater than 50 characters. secondary_payer_carrier_code: type: string description: When Medicaid is billed as the secondary payer the Carrier Code is used to identify the primary payer. This is required for certain states. vitals: $ref: '#/components/schemas/type_encounters_v4_VitalsUpdate' description: 'If a vitals entity already exists for the encounter, then all values will be updated to the provided values. Otherwise, a new vitals object will be created for the encounter.' diagnoses: type: array items: $ref: '#/components/schemas/type_diagnoses_DiagnosisCreateOptional' description: 'Ideally, this field should contain no more than 12 diagnoses. However, more diagnoses may be submitted at this time, and coders will later prioritize the 12 that will be submitted to the payor.' clinical_notes: type: array items: $ref: '#/components/schemas/type_encounters_v4_ClinicalNoteCategoryCreateOptional' description: Holds a collection of clinical observations made by healthcare providers during patient encounters. Please note that medical records for appeals should be sent using the Encounter Attachments API. claim_supplemental_information: type: array items: $ref: '#/components/schemas/type_encounters_v4_ClaimSupplementalInformationOptional' description: Refers to Loop 2300 - Segment PWK on the 837P and 837i form. No more than 10 entries are permitted. epsdt_referral: $ref: '#/components/schemas/type_encounters_v4_EPSDTReferralOptional' description: Refers to Box 24H on the CMS1500 form and Loop 2300 CRC - EPSDT Referral on the 837P and 837i form existing_medications: type: array items: $ref: '#/components/schemas/type_encounters_v4_MedicationOptional' description: 'Existing medications that should be on the encounter. Note all current existing medications on encounter will be overridden with this list.' guarantor: $ref: '#/components/schemas/type_guarantor_v1_GuarantorOptional' description: Personal and contact info for the guarantor of the patient responsibility. subscriber_primary: $ref: '#/components/schemas/type_individual_SubscriberCreateOptional' description: Contains details of the primary insurance subscriber. subscriber_secondary: $ref: '#/components/schemas/type_individual_SubscriberCreateOptional' description: Contains details of the secondary insurance subscriber. subscriber_tertiary: $ref: '#/components/schemas/type_individual_SubscriberCreateOptional' description: Contains details of the tertiary insurance subscriber. interventions: type: array items: $ref: '#/components/schemas/type_encounters_v4_InterventionOptional' schema_instances: type: array items: $ref: '#/components/schemas/type_custom-schemas_v1_SchemaInstanceOptional' description: 'Key-value pairs that must adhere to a schema created via the Custom Schema API. Multiple schema instances cannot be created for the same schema on an encounter. Updating schema instances utilizes PUT semantics, so the schema instances on the encounter will be set to whatever inputs are provided. If null is provided as an input, then the encounter''s schema instances will be cleared.' external_claim_submission: $ref: '#/components/schemas/type_claim-submission_v1_ExternalClaimSubmissionCreateOptional' description: '***This field is in beta.*** To be included for claims that have been submitted outside of Candid. Candid supports posting remits and payments to these claims and working them in-platform (e.g. editing, resubmitting).' service_lines: type: array items: $ref: '#/components/schemas/type_service-lines_v2_ServiceLineCreateOptional' description: 'Each service line must be linked to a diagnosis. Concretely, `service_line.diagnosis_pointers`must contain at least one entry which should be in bounds of the diagnoses list field.' patient_histories: type: array items: $ref: '#/components/schemas/type_encounters_v4_PatientHistoryCategoryOptional' billing_notes: type: array items: $ref: '#/components/schemas/type_billing-notes_v2_BillingNoteBaseOptional' description: 'Spot to store misc, human-readable, notes about this encounter to be used in the billing process.' patient: $ref: '#/components/schemas/type_individual_PatientUpdateWithOptionalAddress' description: Contains the identification information of the individual receiving medical services. service_facility: $ref: '#/components/schemas/type_service-facility_EncounterServiceFacilityUpdateWithOptionalAddress' description: Encounter Service facility is typically the location a medical service was rendered, such as a provider office or hospital. For telehealth, service facility can represent the provider's location when the service was delivered (e.g., home), or the location where an in-person visit would have taken place, whichever is easier to identify. If the provider is in-network, service facility may be defined in payer contracts. Box 32 on the CMS-1500 claim form. There is no equivalent on the paper UB-04 claim form, but this field is equivalent to Loop 2310E Service Facility Location details on an 837i form, and is used when this is different to the entity identified as the Billing Provider. Note that for an in-network claim to be successfully adjudicated, the service facility address listed service_facility_id: $ref: '#/components/schemas/type_organization-service-facilities_v2_OrganizationServiceFacilityId' description: The ID of an existing Organization Service Facility to use for this encounter. The service facility's canonical data (name, address, NPI, etc.) will be populated automatically. If the value does not match an existing Organization Service Facility, the request will fail with a 422 error. This field is mutually exclusive with service_facility — providing both will result in a 422 error. rendering_provider: $ref: '#/components/schemas/type_encounter-providers_v2_RenderingProviderUpdateWithOptionalAddress' description: The rendering provider is the practitioner -- physician, nurse practitioner, etc. -- performing the service. For telehealth services, the rendering provider performs the visit, asynchronous communication, or other service. The rendering provider address should generally be the same as the service facility address. initial_referring_provider: $ref: '#/components/schemas/type_encounter-providers_v2_InitialReferringProviderUpdateWithOptionalAddress' description: 'The second iteration of Loop ID-2310. Use code "P3 - Primary Care Provider" in this loop to indicate the initial referral from the primary care provider or whatever provider wrote the initial referral for this patient''s episode of care being billed/reported in this transaction.' referring_provider: $ref: '#/components/schemas/type_encounter-providers_v2_ReferringProviderUpdateWithOptionalAddress' description: 'The final provider who referred the services that were rendered. All physicians who order services or refer Medicare beneficiaries must report this data.' supervising_provider: $ref: '#/components/schemas/type_encounter-providers_v2_SupervisingProviderUpdateWithOptionalAddress' description: Required when the rendering provider is supervised by a physician. If not required by this implementation guide, do not send. treating_provider: $ref: '#/components/schemas/type_encounter-providers_v2_TreatingProviderUpdateWithOptionalAddress' description: The treating provider is the provider who treats the patient. This is supported for professional and institutional encounters. billing_provider: $ref: '#/components/schemas/type_encounter-providers_v2_BillingProviderUpdateWithOptionalAddress' description: The billing provider is the provider or business entity submitting the claim. Billing provider may be, but is not necessarily, the same person/NPI as the rendering provider. From a payer's perspective, this represents the person or entity being reimbursed. When a contract exists with the target payer, the billing provider should be the entity contracted with the payer. In some circumstances, this will be an individual provider. In that case, submit that provider's NPI and the tax ID (TIN) that the provider gave to the payer during contracting. In other cases, the billing entity will be a medical group. If so, submit the group NPI and the group's tax ID. Box 33 on the CMS-1500 claim form or Form Locator 1 on a UB-04 claim form. pay_to_address: $ref: '#/components/schemas/type_commons_StreetAddressShortZipOptional' description: Specifies the address to which payments for the claim should be sent. related_causes_information: $ref: '#/components/schemas/type_related-causes_v1_RelatedCausesInformationCreateOptional' description: Corresponds to box 10a on the CMS-1500 (Loop 2300 on 837) property_casualty_claim_number: type: string description: 837p Loop2010 REF02, CMS1500 Box 11b accident_date: type: string format: date description: 837p Loop2300 DTP*439, CMS1500 Box 15 property_casualty_patient_identifier: $ref: '#/components/schemas/type_property-and-casualty_v1_PropertyCasualtyPatientIdentifierCreateOptional' description: 'Patient identifier for Property and Casualty claims. 837p Loop2010CA' title: ChargeCaptureData type_commons_ClinicalTrialId: type: string format: uuid title: ClinicalTrialId type_service-facility_EncounterServiceFacilityUpdateWithOptionalAddress: type: object properties: organization_name: type: string npi: type: string description: 'An NPI specific to the service facility if applicable, i.e. if it has one and is not under the billing provider''s NPI. Box 32 section (a) of the CMS-1500 claim form.' address: $ref: '#/components/schemas/type_commons_StreetAddressShortZipOptional' description: zip_plus_four_code is required for service facility address. When the zip_plus_four_code is not available use "9998" as per CMS documentation. secondary_identification: type: string description: 'An additional identifier for the service facility other than the facility''s NPI. Some payers may require this field. Potential examples: state license number, provider commercial number, or location number. Box 32 section (b) of the CMS-1500 claim form.' mammography_certification_number: type: string description: The associated mammography certification number for this service facility. This is a 6 digit code assigned by the FDA. title: EncounterServiceFacilityUpdateWithOptionalAddress type_commons_QualifierCode: type: string enum: - DQ - DN - DK - P3 title: QualifierCode type_encounters_v4_PatientHistoryCategoryOptional: type: object properties: category: $ref: '#/components/schemas/type_encounters_v4_PatientHistoryCategoryEnum' questions: type: array items: $ref: '#/components/schemas/type_encounters_v4_IntakeQuestionOptional' description: Must contain at least one item. title: PatientHistoryCategoryOptional type_encounters_v4_MedicationOptional: type: object properties: name: type: string rx_cui: $ref: '#/components/schemas/type_encounters_v4_RxCui' dosage: type: string dosage_form: type: string frequency: type: string as_needed: type: boolean title: MedicationOptional type_claims_ClaimStatus: type: string enum: - biller_received - coded - submitted_to_payer - missing_information - not_billable - waiting_for_provider - era_received - rejected - denied - paid - paid_incorrectly - finalized_paid - finalized_denied - held_by_customer - era_requires_review title: ClaimStatus type_encounters_v4_VitalsUpdate: type: object properties: height_in: type: integer weight_lbs: type: integer blood_pressure_systolic_mmhg: type: integer blood_pressure_diastolic_mmhg: type: integer body_temperature_f: type: number format: double hemoglobin_gdl: type: number format: double hematocrit_pct: type: number format: double title: VitalsUpdate type_encounters_v4_BillableStatusType: type: string enum: - BILLABLE - NOT_BILLABLE title: BillableStatusType type_individual_Gender: type: string enum: - male - female - other - not_given - unknown title: Gender type_commons_PhoneNumberType: type: string enum: - Home - Mobile - Work title: PhoneNumberType type_encounter-providers_v2_InitialReferringProviderUpdateWithOptionalAddress: type: object properties: first_name: type: string description: If the provider is an individual, this should be set instead of organization name last_name: type: string description: If the provider is an individual, this should be set instead of organization name organization_name: type: string description: If the provider is an organization, this should be set instead of first + last name npi: type: string description: 'A National Provider Identifier is a unique 10-digit identification number issued to health care providers in the United States' taxonomy_code: type: string address: $ref: '#/components/schemas/type_commons_StreetAddressShortZipOptional' qualifier: $ref: '#/components/schemas/type_commons_QualifierCode' secondary_identification: $ref: '#/components/schemas/type_encounter-providers_v2_ReferringProviderSecondaryIdentificationOptional' title: InitialReferringProviderUpdateWithOptionalAddress type_encounters_v4_ClaimSupplementalInformationOptional: type: object properties: attachment_report_type_code: $ref: '#/components/schemas/type_commons_ReportTypeCode' attachment_transmission_code: $ref: '#/components/schemas/type_commons_ReportTransmissionCode' attachment_control_number: type: string title: ClaimSupplementalInformationOptional type_encounters_v4_NoteCategory: type: string enum: - clinical - care_plan - diagnoses - vitals - physical_exam - review_of_systems - medical_decisions - history_of_present_illness - patient_info - chief_complaint - health_record - consent - procedure - time_in_appointment title: NoteCategory type_commons_PhoneNumberOptional: type: object properties: number: type: string type: $ref: '#/components/schemas/type_commons_PhoneNumberType' title: PhoneNumberOptional type_individual_PatientClinicalTrialInfoCreateOptional: type: object properties: clinical_trial_arm: type: string clinical_trial_id: $ref: '#/components/schemas/type_commons_ClinicalTrialId' title: PatientClinicalTrialInfoCreateOptional type_charge-capture_v1_ChargeCaptureStatus: type: string enum: - planned - not-billable - billable - aborted - entered-in-error title: ChargeCaptureStatus type_encounter-providers_v2_BillingProviderUpdateWithOptionalAddress: type: object properties: first_name: type: string description: If the provider is an individual, this should be set instead of organization name last_name: type: string description: If the provider is an individual, this should be set instead of organization name organization_name: type: string description: If the provider is an organization, this should be set instead of first + last name address: $ref: '#/components/schemas/type_commons_StreetAddressShortZipOptional' tax_id: type: string description: If the provider has a contract with insurance, this must be the same tax ID given to the payer on an IRS W-9 form completed during contracting. npi: type: string taxonomy_code: type: string provider_commercial_license_type: $ref: '#/components/schemas/type_commons_BillingProviderCommercialLicenseType' description: '837i Loop2010BB G2 Provider Commercial Number' secondary_identification: $ref: '#/components/schemas/type_encounter-providers_v2_BillingProviderSecondaryIdentificationOptional' description: 'Only one of provider_commercial_license_type or secondary_identification may be provided 837i Loop2010BB G2 Secondary Identification' description: 'The billing provider is the provider or business entity submitting the claim. Billing provider may be, but is not necessarily, the same person/NPI as the rendering provider. From a payer''s perspective, this represents the person or entity being reimbursed. When a contract exists with the target payer, the billing provider should be the entity contracted with the payer. In some circumstances, this will be an individual provider. In that case, submit that provider''s NPI and the tax ID (TIN) that the provider gave to the payer during contracting. In other cases, the billing entity will be a medical group. If so, submit the group NPI and the group''s tax ID. Box 33 on the CMS-1500 claim or Form Locator 1 on a UB-04 claim form. The address fields here are optional.' title: BillingProviderUpdateWithOptionalAddress type_commons_PatientRelationshipToInsuredCodeAll: type: string enum: - '01' - '04' - '05' - '07' - '10' - '15' - '17' - '18' - '19' - '20' - '21' - '22' - '23' - '24' - '29' - '32' - '33' - '36' - '39' - '40' - '41' - '43' - '53' - G8 title: PatientRelationshipToInsuredCodeAll type_charge-capture-bundles_v1_ChargeCaptureClaimCreationStatus: type: string enum: - not-started - in-error - successful - successful-dry-run - aborted - held title: ChargeCaptureClaimCreationStatus type_commons_PayerPlanGroupId: type: string format: uuid title: PayerPlanGroupId type_charge-capture-bundles_v1_ChargeCaptureClaimCreationSortField: type: string enum: - created_at title: ChargeCaptureClaimCreationSortField type_encounters_v4_IntakeQuestionId: type: string title: IntakeQuestionId type_encounters_v4_ClinicalNoteOptional: type: object properties: text: type: string author_name: type: string author_npi: $ref: '#/components/schemas/type_commons_Npi' timestamp: type: string format: date-time title: ClinicalNoteOptional type_service-lines_v2_MeasurementUnitCode: type: string enum: - ML - UN - GR - F2 - ME title: MeasurementUnitCode type_commons_BillingProviderCommercialLicenseType: type: string enum: - '0' - A - B - C - D - E - F - G - H - I title: BillingProviderCommercialLicenseType type_diagnoses_DiagnosisCreateOptional: type: object properties: name: type: string description: Empty string not allowed. code_type: $ref: '#/components/schemas/type_diagnoses_DiagnosisTypeCode' description: Typically, providers submitting claims to Candid are using ICD-10 diagnosis codes. If you are using ICD-10 codes, the primary diagnosis code listed on the claim should use the ABK code_type. If more than one diagnosis is being submitted on a claim, please use ABF for the rest of the listed diagnoses. If you are using ICD-9 diagnosis codes, use BK and BF for the principal and following diagnosis code(s) respectively. code: type: string description: "Empty string not allowed.\nShould be of the appropriate format for the provided `code_type`.\nMust obey the ICD-10 format if an ICD-10 code_type is provided, specifically:\n - Letter\n - Digit\n - Digit or the letter `A` or `B`\n - (Optional) Period `.`\n - Up to 4 (or as few as 0) letters and digits" present_on_admission_indicator: $ref: '#/components/schemas/type_yes-no-indicator_YesNoIndicator' description: 'For Institutional claims only. A "Y" indicates that the onset occurred prior to admission to the hospital. An "N" indicates that the onset did NOT occur prior to admission to the hospital. A "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not.' title: DiagnosisCreateOptional type_commons_EntityNotFoundErrorMessage: type: object properties: id: type: string required: - id title: EntityNotFoundErrorMessage type_commons_InsuranceTypeCode: type: string enum: - '01' - '12' - '13' - '14' - '15' - '16' - '17' - '18' - '19' - '41' - '42' - '43' - '47' - AP - C1 - CO - CP - D - DB - E - EP - FF - GP - HA - HB - HD - HG - HM - HN - HP - HS - IN - IP - LC - LD - LI - LT - M - MA - MB - MC - MD - ME - MF - MH - MI - MJ - MK - ML - MM - MN - MO - MP - MR - MT - MV - OA - OT - PE - PL - PP - PR - PS - QM - RP - SP - TF - U - WC - WU description: Code identifying the type of insurance policy within a specific insurance program (X12 008020 Element 1336) title: InsuranceTypeCode type_service-lines_v2_TestResultOptional: type: object properties: value: type: number format: double result_type: $ref: '#/components/schemas/type_service-lines_v2_TestResultType' title: TestResultOptional type_billing-notes_v2_BillingNoteBaseOptional: type: object properties: text: type: string description: Empty string not allowed. title: BillingNoteBaseOptional type_encounters_v4_IntakeQuestionOptional: type: object properties: id: $ref: '#/components/schemas/type_encounters_v4_IntakeQuestionId' text: type: string responses: type: array items: $ref: '#/components/schemas/type_encounters_v4_IntakeResponseAndFollowUpsOptional' title: IntakeQuestionOptional type_encounter-providers_v2_SupervisingProviderSecondaryIdentificationOptional: type: object properties: reference_identification: type: string reference_identification_qualifier: $ref: '#/components/schemas/type_encounter-providers_v2_ProviderSecondaryIdentificationQualifier' title: SupervisingProviderSecondaryIdentificationOptional type_related-causes_v1_RelatedCausesInformationCreateOptional: type: object properties: related_causes_code_1: $ref: '#/components/schemas/type_related-causes_v1_RelatedCausesCode' related_causes_code_2: $ref: '#/components/schemas/type_related-causes_v1_RelatedCausesCode' state_or_province_code: type: string title: RelatedCausesInformationCreateOptional type_encounter-providers_v2_ReferringProviderSecondaryIdentificationOptional: type: object properties: reference_identification: type: string reference_identification_qualifier: $ref: '#/components/schemas/type_encounter-providers_v2_ReferringProviderSecondaryIdentificationQualifier' title: ReferringProviderSecondaryIdentificationOptional type_individual_SubscriberCreateOptional: type: object properties: first_name: type: string last_name: type: string gender: $ref: '#/components/schemas/type_individual_Gender' patient_relationship_to_subscriber_code: $ref: '#/components/schemas/type_commons_PatientRelationshipToInsuredCodeAll' date_of_birth: type: string format: date address: $ref: '#/components/schemas/type_commons_StreetAddressShortZipOptional' insurance_card: $ref: '#/components/schemas/type_insurance-cards_v2_InsuranceCardCreateOptional' description: Please reference our [Payer Information](https://docs.joincandidhealth.com/introduction/payer-information) documentation for more details on how to populate the `insurance_card` fields. title: SubscriberCreateOptional type_commons_EncounterExternalId: type: string title: EncounterExternalId type_encounters_v4_IntakeFollowUpOptional: type: object properties: id: $ref: '#/components/schemas/type_encounters_v4_IntakeFollowUpId' text: type: string response: type: string title: IntakeFollowUpOptional type_charge-capture-bundles_v1_ChargeCaptureClaimCreationSummary: type: object properties: charge_capture_charges_not_linked_to_claims_count: type: integer description: The count of charge captures which are not part of a Claim Creation. charge_capture_claim_creations_not_started_count: type: integer description: The count of charge capture claim_creations that have a Claim Creation status of NOT_STARTED. charge_capture_held_claim_creations_count: type: integer description: The count of charge capture claim_creations that have a Claim Creation status of HELD. charge_capture_claim_creations_in_error_count: type: integer description: The count of charge capture claim_creations that have a Claim Creation status of IN_ERROR. charge_capture_unresolved_change_count: type: integer description: The number of ChargeCapturePostBilledChange items that are unresolved. required: - charge_capture_charges_not_linked_to_claims_count - charge_capture_claim_creations_not_started_count - charge_capture_held_claim_creations_count - charge_capture_claim_creations_in_error_count - charge_capture_unresolved_change_count title: ChargeCaptureClaimCreationSummary type_encounters_v4_PatientHistoryCategoryEnum: type: string enum: - present_illness - medical - family - social title: PatientHistoryCategoryEnum type_commons_ReportTransmissionCode: type: string enum: - AA - BM - EL - FX title: ReportTransmissionCode type_encounter-providers_v2_ProviderSecondaryIdentificationOptional: type: object properties: reference_identification: type: string description: Represents REF02 on the EDI 837 Loop 2010BB Billing Provider Secondary Identification segment. Value cannot exceed 50 characters reference_identification_qualifier: $ref: '#/components/schemas/type_encounter-providers_v2_ProviderSecondaryIdentificationQualifier' description: Represents REF01 on the EDI 837 Loop 2010BB Provider Secondary Identification segment. title: ProviderSecondaryIdentificationOptional type_service-lines_v2_ServiceIdQualifier: type: string enum: - EN - EO - HI - N4 - 'ON' - UK - UP title: ServiceIdQualifier type_encounters_v4_EPSDTReferralOptional: type: object properties: condition_indicator1: $ref: '#/components/schemas/type_commons_EPSDTReferralConditionIndicatorCode' condition_indicator2: $ref: '#/components/schemas/type_commons_EPSDTReferralConditionIndicatorCode' condition_indicator3: $ref: '#/components/schemas/type_commons_EPSDTReferralConditionIndicatorCode' title: EPSDTReferralOptional type_encounter-providers_v2_ReferringProviderUpdateWithOptionalAddress: type: object properties: first_name: type: string description: If the provider is an individual, this should be set instead of organization name last_name: type: string description: If the provider is an individual, this should be set instead of organization name organization_name: type: string description: If the provider is an organization, this should be set instead of first + last name npi: type: string description: 'A National Provider Identifier is a unique 10-digit identification number issued to health care providers in the United States' taxonomy_code: type: string address: $ref: '#/components/schemas/type_commons_StreetAddressShortZipOptional' secondary_identification: $ref: '#/components/schemas/type_encounter-providers_v2_ReferringProviderSecondaryIdentificationOptional' title: ReferringProviderUpdateWithOptionalAddress type_custom-schemas_v1_SchemaInstanceOptional: type: object properties: schema_id: $ref: '#/components/schemas/type_commons_SchemaId' description: The schema to which the content must adhere. content: type: object additionalProperties: description: Any type description: A set of key-value pairs that adhere to the naming and type convention of the schema. Not all keys in the schema must be included, but attaching any key that does not exist in the schema or attaching a key with the incorrect value type will result in errors. title: SchemaInstanceOptional type_commons_Npi: type: string title: Npi type_diagnoses_DiagnosisTypeCode: type: string enum: - ABF - ABJ - ABK - APR - BF - BJ - BK - PR - DR - LOI title: DiagnosisTypeCode type_encounters_v4_LabOptional: type: object properties: name: type: string code: type: string code_type: $ref: '#/components/schemas/type_encounters_v4_LabCodeType' title: LabOptional type_service-lines_v2_ServiceLineCreateOptional: type: object properties: modifiers: type: array items: $ref: '#/components/schemas/type_commons_ProcedureModifier' has_epsdt_indicator: type: boolean description: 'Maps to SV1-11 on the 837-P and Box 24H on the CMS-1500. If the value is true, the box will be populated with "Y". Otherwise, the box will not be populated.' has_family_planning_indicator: type: boolean description: 'Maps to SV1-12 on the 837-P and Box 24I on the CMS-1500. If the value is true, the box will be populated with "Y". Otherwise, the box will not be populated.' procedure_code: type: string quantity: $ref: '#/components/schemas/type_commons_Decimal' description: 'String representation of a Decimal that can be parsed by most libraries. For professional claims, a ServiceLine quantity cannot contain more than one digit of precision (Example: 1.1 is valid, 1.11 is not). For institutional claims, a ServiceLine quantity cannot contain more than three decimal digits of precision.' units: $ref: '#/components/schemas/type_commons_ServiceLineUnits' charge_amount_cents: type: integer description: The total amount charged for this service line, factoring in quantity. If procedure_code is updated and this is not, the system will attempt to set it based on chargemasters entries and the service line’s quantity. For example, if a single unit has an entry of 100 cents and 2 units were rendered, the charge_amount_cents will be set to 200, if there is no chargemaster entry, it will default to the amount set in this field. diagnosis_pointers: type: array items: type: integer description: Indices (zero-indexed) of all the diagnoses this service line references drug_identification: $ref: '#/components/schemas/type_service-lines_v2_DrugIdentificationOptional' place_of_service_code: $ref: '#/components/schemas/type_commons_FacilityTypeCode' description: 837p Loop2300, SV105. This enum is not used or required in 837i claims. If your organization does not intend to submit claims with a different place of service at the service line level, this field should not be populated. 02 for telemedicine, 11 for in-person. Full list [here](https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set). description: type: string description: A free-form description to clarify the related data elements and their content. Maps to SV1-01, C003-07 on a 837-P and SV2-02, C003-07 on a 837-I form. date_of_service: type: string format: date end_date_of_service: type: string format: date ordering_provider: $ref: '#/components/schemas/type_encounter-providers_v2_OrderingProviderOptional' description: 'Required when the service or supply was ordered by a provider who is different than the rendering provider for this service line. If not required by this implementation guide, do not send.' test_results: type: array items: $ref: '#/components/schemas/type_service-lines_v2_TestResultOptional' description: 'Contains a list of test results. Test result types may map to MEA-02 on the 837-P (ex: Hemoglobin, Hematocrit). This is unused by 837-i and ignored for institutional service lines. No more than 5 MEA-02 test results may be submitted per service line.' note: type: string description: Maps to NTE02 loop 2400 on the EDI 837. revenue_code: type: string description: A 4 digit code that specifies facility department or type of service arrangement for institutional service line items (837i). This code is not required for professional claim billing (837p). prior_authorization_number: type: string description: Prior authorization number for this service line. Maps to the appropriate REF segment on Loop 2400 of the EDI 837p. This is not used for institutional claims (EDI 837i). external_id: type: string description: 'An external identifier for this service line. This is not used in the EDI 837, but can be used to identify the service line in external systems. This field should not contain PHI. Must be unique on a given claim.' title: ServiceLineCreateOptional type_commons_StreetAddressLongZipOptional: type: object properties: address1: type: string address2: type: string city: type: string state: $ref: '#/components/schemas/type_commons_State' zip_code: type: string description: 5-digit zip code zip_plus_four_code: type: string description: 4-digit zip add-on code https://en.wikipedia.org/wiki/ZIP_Code#ZIP+4 title: StreetAddressLongZipOptional type_insurance-cards_v2_InsuranceCardCreateOptional: type: object properties: group_number: type: string description: Box 11 on the CMS-1500 claim form. plan_name: type: string description: Box 11c on the CMS-1500 claim form. plan_type: $ref: '#/components/schemas/type_commons_SourceOfPaymentCode' insurance_type: $ref: '#/components/schemas/type_commons_InsuranceTypeCode' payer_plan_group_id: $ref: '#/components/schemas/type_commons_PayerPlanGroupId' payer_address: $ref: '#/components/schemas/type_commons_StreetAddressLongZipOptional' member_id: type: string payer_name: type: string payer_id: type: string rx_bin: type: string rx_pcn: type: string image_url_front: type: string image_url_back: type: string emr_payer_crosswalk: $ref: '#/components/schemas/type_commons_EmrPayerCrosswalk' description: Set to PAYER_PLAN_GROUP to use Payer Plans for automatic payer resolution. See Payer Information documentation for details. payer_plan_group_name: type: string description: When using emr_payer_crosswalk set to PAYER_PLAN_GROUP, specify the payer plan name here. See Payer Information documentation for details. title: InsuranceCardCreateOptional type_claim-submission_v1_ClaimSubmissionRecordCreateOptional: type: object properties: submitted_at: type: string format: date-time description: When the claim was submitted to the payer. claim_frequency_code: $ref: '#/components/schemas/type_x12_v1_TypeOfBillFrequencyCode' payer_responsibility: $ref: '#/components/schemas/type_commons_ClaimSubmissionPayerResponsibilityType' intended_submission_medium: $ref: '#/components/schemas/type_commons_IntendedSubmissionMedium' description: 'The medium by which the claim was submitted to the payer: paper or electronic. If omitted, defaults to electronic.' description: Data about each external submission. title: ClaimSubmissionRecordCreateOptional type_commons_ChargeCaptureId: type: string format: uuid title: ChargeCaptureId type_commons_StreetAddressShortZipOptional: type: object properties: address1: type: string address2: type: string city: type: string state: $ref: '#/components/schemas/type_commons_State' zip_code: type: string description: 5-digit zip code zip_plus_four_code: type: string description: 4-digit zip add-on code https://en.wikipedia.org/wiki/ZIP_Code#ZIP+4 title: StreetAddressShortZipOptional type_charge-capture-bundles_v1_ChargeCaptureClaimCreationPage: type: object properties: prev_page_token: $ref: '#/components/schemas/type_commons_PageToken' next_page_token: $ref: '#/components/schemas/type_commons_PageToken' items: type: array items: $ref: '#/components/schemas/type_charge-capture-bundles_v1_ChargeCaptureClaimCreation' required: - items title: ChargeCaptureClaimCreationPage type_commons_ClaimSubmissionPayerResponsibilityType: type: string enum: - primary - secondary title: ClaimSubmissionPayerResponsibilityType type_commons_EPSDTReferralConditionIndicatorCode: type: string enum: - AV - NU - S2 - ST title: EPSDTReferralConditionIndicatorCode type_encounters_v4_SynchronicityType: type: string enum: - Synchronous - Asynchronous title: SynchronicityType type_encounters_v4_InterventionOptional: type: object properties: name: type: string category: $ref: '#/components/schemas/type_encounters_v4_InterventionCategory' description: type: string description: '"Examples: ''Birth Control LAC'', ''Tracking'', ''Stress Management'', ''Supplement'', ''Labs''"' medication: $ref: '#/components/schemas/type_encounters_v4_MedicationOptional' description: Required when `type` is `allopathic`. labs: type: array items: $ref: '#/components/schemas/type_encounters_v4_LabOptional' description: Required when `type` is `tests`. title: InterventionOptional type_encounter-providers_v2_RenderingProviderUpdateWithOptionalAddress: type: object properties: first_name: type: string description: If the provider is an individual, this should be set instead of organization name last_name: type: string description: If the provider is an individual, this should be set instead of organization name organization_name: type: string description: If the provider is an organization, this should be set instead of first + last name npi: type: string description: 'A National Provider Identifier is a unique 10-digit identification number issued to health care providers in the United States' taxonomy_code: type: string address: $ref: '#/components/schemas/type_commons_StreetAddressShortZipOptional' secondary_identification: $ref: '#/components/schemas/type_encounter-providers_v2_ProviderSecondaryIdentificationOptional' description: 'Only one of provider_commercial_license_type or secondary_identification may be provided 837i Loop2310BB G2 Secondary Identification' title: RenderingProviderUpdateWithOptionalAddress type_commons_UnauthorizedErrorMessage: type: object properties: message: type: string title: UnauthorizedErrorMessage type_related-causes_v1_RelatedCausesCode: type: string enum: - AA - AB - AP - EM - OA - ZZ title: RelatedCausesCode type_encounter-providers_v2_ReferringProviderSecondaryIdentificationQualifier: type: string enum: - 0B - 1G - G2 title: ReferringProviderSecondaryIdentificationQualifier type_commons_SchemaId: type: string format: uuid title: SchemaId type_charge-capture-bundles_v1_ChargeCaptureClaimCreation: type: object properties: id: $ref: '#/components/schemas/type_commons_ChargeCaptureClaimCreationId' created_encounter_id: $ref: '#/components/schemas/type_commons_EncounterId' status: $ref: '#/components/schemas/type_charge-capture-bundles_v1_ChargeCaptureClaimCreationStatus' description: Status of the Claim Creation, Successful means that the Claim Creation created a corresponding Claim characteristics: type: object additionalProperties: description: Any type description: 'A dictionary of characteristics that are used to group charge captures together based on the bundling configuration. Example: {"service_facility.npi": "99999999", "date_of_service": "2023-01-01"}' errors: type: array items: $ref: '#/components/schemas/type_charge-capture_v1_ChargeCaptureError' description: 'All errors that were found when the Claim was attempted to be created. Errors can correspond to the Claim Creation as a whole or specific underlying Charge Captures.' encounter_creation_input: $ref: '#/components/schemas/type_charge-capture_v1_ChargeCaptureData' description: If a ChargeCaptureBundle attempts creation, this is the input that was created from the underlying charges and used to attempt encounter creation. required: - id - status - characteristics - errors title: ChargeCaptureClaimCreation type_encounter-providers_v2_OrderingProviderOptional: type: object properties: first_name: type: string description: If the provider is an individual, this should be set instead of organization name last_name: type: string description: If the provider is an individual, this should be set instead of organization name organization_name: type: string description: If the provider is an organization, this should be set instead of first + last name npi: type: string description: 'A National Provider Identifier is a unique 10-digit identification number issued to health care providers in the United States' taxonomy_code: type: string address: $ref: '#/components/schemas/type_commons_StreetAddressLongZipOptional' title: OrderingProviderOptional type_commons_Email: type: string title: Email type_commons_ReportTypeCode: type: string enum: - '03' - '04' - '05' - '06' - '07' - 08 - 09 - '10' - '11' - '13' - '15' - '21' - A3 - A4 - AM - AS - B2 - B3 - B4 - BR - BS - BT - CB - CK - CT - D2 - DA - DB - DG - DJ - DS - EB - HC - HR - I5 - IR - LA - M1 - MT - NN - OB - OC - OD - OE - OX - OZ - P4 - P5 - PE - PN - PO - PQ - PY - PZ - RB - RR - RT - RX - SG - V5 - XP title: ReportTypeCode type_service-lines_v2_DrugIdentificationOptional: type: object properties: service_id_qualifier: $ref: '#/components/schemas/type_service-lines_v2_ServiceIdQualifier' national_drug_code: type: string national_drug_unit_count: type: string measurement_unit_code: $ref: '#/components/schemas/type_service-lines_v2_MeasurementUnitCode' link_sequence_number: type: string pharmacy_prescription_number: type: string conversion_formula: type: string drug_description: type: string title: DrugIdentificationOptional type_encounters_v4_InterventionCategory: type: string enum: - allopathic - naturopathic - tests - lifestyle title: InterventionCategory type_encounters_v4_ResponsiblePartyType: type: string enum: - INSURANCE_PAY - SELF_PAY - UNKNOWN title: ResponsiblePartyType type_charge-capture_v1_ChargeCaptureError: type: object properties: id: type: string format: uuid charge_capture_id: $ref: '#/components/schemas/type_commons_ChargeCaptureId' description: 'The underlying Charge Capture that this error object references. The Charge Capture referenced will be a part of the Claim Creation tied to this error. Errors may also refer to all charge_captures present in a Claim Creation, in which case this field will be null.' message: type: string description: A human readable error explaining why this charge capture Claim Creation failed to create a claim. resolved: type: boolean description: Whether or not the error has been resolved as part of user workflows resolved_by: type: string description: A string denoting who resolved the error within candid's system. resolution_reason: type: string description: A string denoting how or why an error was resolved. field_in_error: type: string description: 'The field of the corresponding underlying ChargeCapture that has a field that is failing validations, is not present but marked as required, or otherwise in error.' claim_creation_id: $ref: '#/components/schemas/type_commons_ChargeCaptureClaimCreationId' description: The ID of the ChargeCaptureClaimCreation associated with this Error. required: - id - message - claim_creation_id title: ChargeCaptureError type_commons_SortDirection: type: string enum: - asc - desc title: SortDirection type_encounter-providers_v2_TreatingProviderUpdateWithOptionalAddress: type: object properties: first_name: type: string last_name: type: string npi: type: string description: 'A National Provider Identifier is a unique 10-digit identification number issued to health care providers in the United States' taxonomy_code: type: string address: $ref: '#/components/schemas/type_commons_StreetAddressLongZipOptional' license_type: $ref: '#/components/schemas/type_organization-providers_v2_LicenseType' description: The license type of the treating provider (e.g., MD, NP, PA, LCSW). description: Update type for the treating provider with optional address fields. Used in contexts where address fields may be partially provided. title: TreatingProviderUpdateWithOptionalAddress type_guarantor_v1_GuarantorOptional: type: object properties: first_name: type: string last_name: type: string external_id: type: string description: A unique identifier for the guarantor assigned by an external system. date_of_birth: type: string format: date description: 'Date formatted as YYYY-MM-DD; eg: 2019-08-25.' address: $ref: '#/components/schemas/type_commons_StreetAddressShortZipOptional' phone_numbers: type: array items: $ref: '#/components/schemas/type_commons_PhoneNumberOptional' phone_consent: type: boolean email: $ref: '#/components/schemas/type_commons_Email' email_consent: type: boolean auto_charge_consent: type: boolean title: GuarantorOptional type_commons_ServiceLineUnits: type: string enum: - MJ - UN title: ServiceLineUnits type_encounter-providers_v2_BillingProviderSecondaryIdentificationQualifier: type: string enum: - G2 - LU title: BillingProviderSecondaryIdentificationQualifier type_encounter-providers_v2_BillingProviderSecondaryIdentificationOptional: type: object properties: reference_identification: type: string description: Represents REF02 on the EDI 837 Loop 2010BB Billing Provider Secondary Identification segment. Value cannot exceed 50 characters reference_identification_qualifier: $ref: '#/components/schemas/type_encounter-providers_v2_BillingProviderSecondaryIdentificationQualifier' description: 'Represents REF01 on the EDI 837 Loop 2010BB Billing Provider Secondary Identification segment. Valid values include G2 (Provider Commercial Number) and LU (Location Number). Defaults to G2 if not set.' title: BillingProviderSecondaryIdentificationOptional type_commons_SourceOfPaymentCode: type: string enum: - 09 - '11' - '12' - '13' - '14' - '15' - '16' - '17' - AM - BL - CH - CI - DS - FI - HM - LM - MA - MB - MC - OF - TV - VA - WC - ZZ title: SourceOfPaymentCode type_encounter-providers_v2_ProviderSecondaryIdentificationQualifier: type: string enum: - 0B - 1G - G2 - LU title: ProviderSecondaryIdentificationQualifier type_commons_FacilityTypeCode: type: string enum: - '01' - '02' - '03' - '04' - '05' - '06' - '07' - 08 - 09 - '10' - '11' - '12' - '13' - '14' - '15' - '16' - '17' - '18' - '19' - '20' - '21' - '22' - '23' - '24' - '25' - '26' - '31' - '32' - '33' - '34' - '41' - '42' - '49' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '60' - '61' - '62' - '65' - '71' - '72' - '81' - '99' description: 'Box 24B on the CMS-1500 claim form. Line-level place of service is not currently supported. 02 for telemedicine, 11 for in-person. Full list here: https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set' title: FacilityTypeCode type_commons_Decimal: type: string description: String representation of a Decimal that can be parsed by most libraries. title: Decimal securitySchemes: OAuthScheme: type: http scheme: bearer description: OAuth 2.0 authentication