openapi: 3.1.0
info:
title: API Reference
version: 1.0.0
paths:
/eligibility-checks/v1:
post:
operationId: post
summary: Post
description: Sends real-time eligibility checks to payers through Stedi.
tags:
- >-
subpackage_pre-encounter.subpackage_pre-encounter/eligibilityChecks.subpackage_pre-encounter/eligibilityChecks/v1
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_pre-encounter/eligibilityChecks/v1:EligibilityResponse'
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityRequest'
/eligibility-checks/v1/batch:
post:
operationId: batch
summary: Batch
description: Sends a batch of eligibility checks to payers through Stedi.
tags:
- >-
subpackage_pre-encounter.subpackage_pre-encounter/eligibilityChecks.subpackage_pre-encounter/eligibilityChecks/v1
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_pre-encounter/eligibilityChecks/v1:BatchEligibilityResponse'
requestBody:
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityRequest'
/eligibility-checks/v1/batch/{batch_id}:
get:
operationId: poll-batch
summary: Poll Batch
description: Polls the status of a batch eligibility check.
tags:
- >-
subpackage_pre-encounter.subpackage_pre-encounter/eligibilityChecks.subpackage_pre-encounter/eligibilityChecks/v1
parameters:
- name: batch_id
in: path
required: true
schema:
type: string
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
- 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_pre-encounter/eligibilityChecks/v1:EligibilityCheckPage'
/eligibility-checks/v1/payer/search:
get:
operationId: payer-search
summary: Payer Search
description: Searches for payers that match the query parameters.
tags:
- >-
subpackage_pre-encounter.subpackage_pre-encounter/eligibilityChecks.subpackage_pre-encounter/eligibilityChecks/v1
parameters:
- name: page_size
in: query
required: false
schema:
type: integer
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
- name: query
in: query
required: false
schema:
type: string
- 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_pre-encounter/eligibilityChecks/v1:PayerSearchResponse'
/eligibility-checks/v1/recommendation:
get:
operationId: recommendation
summary: Recommendation
description: >-
Gets recommendation for eligibility checks based on filters. This endpoint will retrieve all the latest
eligibility recommendations for each
eligibility recommendation type for the given filters. If you want to get a specific recommendation type, you
can use the `type` query parameter.
tags:
- >-
subpackage_pre-encounter.subpackage_pre-encounter/eligibilityChecks.subpackage_pre-encounter/eligibilityChecks/v1
parameters:
- name: filters
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:FilterQueryString'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityRecommendation'
post:
operationId: create-recommendation
summary: Create Recommendation
description: Create an eligibiilty recommendation based on the request.
tags:
- >-
subpackage_pre-encounter.subpackage_pre-encounter/eligibilityChecks.subpackage_pre-encounter/eligibilityChecks/v1
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_pre-encounter/eligibilityChecks/v1:EligibilityRecommendation'
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:PostEligibilityRecommendationRequest'
/eligibility-checks/v1/recommendation/{recommendation_id}/{version}/vote:
put:
operationId: vote-recommendation
summary: Vote Recommendation
description: >-
Submit user feedback on an eligibility recommendation. The path must contain the next version number to prevent
race conditions. For example, if the current version of the recommendation is n, you will need to send a request
to this endpoint with `/{recommendation_id}/{n+1}/vote` to update the vote.
tags:
- >-
subpackage_pre-encounter.subpackage_pre-encounter/eligibilityChecks.subpackage_pre-encounter/eligibilityChecks/v1
parameters:
- name: recommendation_id
in: path
required: true
schema:
type: string
- name: version
in: path
required: true
schema:
type: string
- 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_pre-encounter/eligibilityChecks/v1:EligibilityRecommendation'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:Vote'
/eligibility-checks/v1/get-multi/:
get:
operationId: get-multi
summary: Get Multi
tags:
- >-
subpackage_pre-encounter.subpackage_pre-encounter/eligibilityChecks.subpackage_pre-encounter/eligibilityChecks/v1
parameters:
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
- name: limit
in: query
required: false
schema:
type: integer
- name: subscriber_member_id
in: query
required: false
schema:
type: string
- name: payer_id
in: query
required: false
schema:
type: string
- name: provider_npi
in: query
required: false
schema:
type: string
- name: date_of_service
in: query
required: false
schema:
type: string
- name: initiated_at_min
in: query
required: false
schema:
type: string
format: date-time
- name: initiated_at_max
in: query
required: false
schema:
type: string
format: date-time
- 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_pre-encounter/eligibilityChecks/v1:EligibilityCheckPage'
/appointments/v1:
post:
operationId: create
summary: Create
description: Adds an appointment. VersionConflictError is returned when the placer_appointment_id is already in use.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/appointments.subpackage_pre-encounter/appointments/v1
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_pre-encounter/appointments/v1:Appointment'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:MutableAppointment'
/appointments/v1/visits:
get:
operationId: get-visits
summary: Get Visits
description: >-
Gets all Visits within a given time range. The return list is ordered by start_time ascending.
**IMPORTANT:** This endpoint requires a date filter on `appointment.startTimestamp` to ensure acceptable query
performance.
Without date filtering, the query can take 50+ seconds on large datasets due to grouping and aggregation
operations.
Example filters:
- `appointment.startTimestamp|gt|2024-01-01` - appointments after January 1, 2024
- `appointment.startTimestamp|eq|2024-12-08` - appointments on December 8, 2024
- `appointment.startTimestamp|lt|2024-12-31` - appointments before December 31, 2024
You can combine the date filter with other filters using commas:
- `appointment.startTimestamp|gt|2024-01-01,appointment.status|eq|PENDING`
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/appointments.subpackage_pre-encounter/appointments/v1
parameters:
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
- name: limit
in: query
required: false
schema:
type: integer
- name: sort_field
in: query
description: Defaults to appointment.start_time.
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/lists/v1:SortFieldString'
- name: sort_direction
in: query
description: Defaults to ascending.
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:SortDirection'
- name: filters
in: query
description: |-
**Required:** Must include a date filter on appointment.startTimestamp (using gt, lt, or eq operators).
Example: appointment.startTimestamp|gt|2024-01-01
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:FilterQueryString'
- 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_pre-encounter/appointments/v1:VisitsPage'
'400':
description: Error response with status 400
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- BadRequestError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
/appointments/v1/{id}:
get:
operationId: get
summary: Get
description: Gets an appointment.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/appointments.subpackage_pre-encounter/appointments/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:AppointmentId'
- 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_pre-encounter/appointments/v1:Appointment'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
/appointments/v1/{id}/history:
get:
operationId: get-history
summary: Get History
description: Gets an appointment along with it's full history. The return list is ordered by version ascending.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/appointments.subpackage_pre-encounter/appointments/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:AppointmentId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:Appointment'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
/appointments/v1/{id}/{version}:
put:
operationId: update
summary: Update
description: >-
Updates an appointment. The path must contain the next version number to prevent race conditions. For example,
if the current version of the appointment is n, you will need to send a request to this endpoint with
`/{id}/n+1` to update the appointment. Updating historic versions is not supported.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/appointments.subpackage_pre-encounter/appointments/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:AppointmentId'
- name: version
in: path
required: true
schema:
type: string
- 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_pre-encounter/appointments/v1:Appointment'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:MutableAppointment'
delete:
operationId: deactivate
summary: Deactivate
description: >-
Sets an appointment as deactivated. The path must contain the most recent version to prevent race conditions.
Deactivating historic versions is not supported. Subsequent updates via PUT to the appointment will "reactivate"
the appointment and set the deactivated flag to false.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/appointments.subpackage_pre-encounter/appointments/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:AppointmentId'
- name: version
in: path
required: true
schema:
type: string
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
/appointments/v1/updates/scan:
get:
operationId: scan
summary: Scan
description: >-
Scans up to 100 appointment updates. The since query parameter is inclusive, and the result list is ordered by
updatedAt ascending.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/appointments.subpackage_pre-encounter/appointments/v1
parameters:
- name: since
in: query
required: true
schema:
type: string
format: date-time
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:Appointment'
/coverages/v1/:
post:
operationId: create
summary: Create
description: >-
Creates a new Coverage. A Coverage provides the high-level identifiers and descriptors of a specific insurance
plan for a specific individual - typically the information you can find on an insurance card. Additionally a
coverage will include detailed benefits information covered by the specific plan for the individual.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
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_pre-encounter/coverages/v1:Coverage'
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:MutableCoverage'
get:
operationId: get-multi
summary: Get Multi
description: Returns a list of Coverages based on the search criteria.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
parameters:
- name: patient_id
in: query
required: false
schema:
type: string
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:Coverage'
/coverages/v1//{id}/{version}:
put:
operationId: update
summary: Update
description: >-
Updates a Coverage. The path must contain the next version number to prevent race conditions. For example, if
the current version of the coverage is n, you will need to send a request to this endpoint with `/{id}/n+1` to
update the coverage. Updating historic versions is not supported.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
- name: version
in: path
required: true
schema:
type: string
- 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_pre-encounter/coverages/v1:Coverage'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:MutableCoverage'
/coverages/v1//get-multi-paginated:
get:
operationId: get-multi-paginated
summary: Get Multi Paginated
description: Returns a page of Coverages based on the search criteria.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
parameters:
- name: patient_id
in: query
required: false
schema:
type: string
- name: payer_plan_group_id
in: query
required: false
schema:
type: string
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
- name: limit
in: query
description: Must be between 0 and 1000. Defaults to 100
required: false
schema:
type: integer
- 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_pre-encounter/coverages/v1:CoveragesPage'
'400':
description: Error response with status 400
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- BadRequestError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
/coverages/v1//{id}:
get:
operationId: get
summary: Get
description: gets a specific Coverage
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
- 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_pre-encounter/coverages/v1:Coverage'
/coverages/v1//{id}/history:
get:
operationId: get-history
summary: Get History
description: |-
Gets a coverage's history. Full history is returned if no filters are
defined. The return list is ordered by version, defaulting to ascending.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
- name: start
in: query
required: false
schema:
type: string
format: date
- name: end
in: query
required: false
schema:
type: string
format: date
- name: non_auto_updated_coverages_only
in: query
description: If true, only returns coverages that have NOT been auto-updated by the system.
required: false
schema:
type: boolean
- name: sort_direction
in: query
description: Defaults to ascending. Sorts by version.
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:SortDirection'
- name: limit
in: query
description: Must be between 0 and 1000. No default.
required: false
schema:
type: integer
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:Coverage'
'400':
description: Error response with status 400
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- BadRequestError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
/coverages/v1//updates/scan:
get:
operationId: scan
summary: Scan
description: >-
Scans up to 100 coverage updates. The since query parameter is inclusive, and the result list is ordered by
updatedAt ascending.
**Polling Pattern:**
To continuously poll for updates without gaps:
1. Make your initial request with a `since` timestamp (e.g., `since=2020-01-01T13:00:00.000Z`)
2. The API returns up to 100 coverage records, sorted by `updated_at` ascending
3. Find the `updated_at` value from the last record in the response
4. Use that `updated_at` value as the `since` parameter in your next request
5. Repeat steps 2-4 to ingest updates until you receive an empty list
**Important Notes:**
- The `since` parameter is inclusive, so you may receive the last record from the previous batch again (you can
deduplicate by ID and version)
- All coverage records include `updated_at`, `id`, `version`, `deactivated`, and `updating_user` fields for
tracking changes
- Timestamps have millisecond resolution for precise ordering
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
parameters:
- name: since
in: query
required: true
schema:
type: string
format: date-time
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:Coverage'
/coverages/v1//batch-update-ppg/{ppg_id}:
post:
operationId: batch-update-ppg
summary: Batch Update Ppg
description: Finds all coverages associated with the given ppg_id and updates the ppg_fields for each coverage.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
parameters:
- name: ppg_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PayerPlanGroupId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:PayerPlanGroupFields'
/coverages/v1//{id}/eligibility:
post:
operationId: check-eligibility
summary: Check Eligibility
description: Initiates an eligibility check. Returns the metadata of the check if successfully initiated.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
- 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_pre-encounter/eligibilityChecks/v1:EligibilityCheckMetadata'
requestBody:
content:
application/json:
schema:
type: object
properties:
service_code:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:ServiceTypeCode'
date_of_service:
type: string
format: date
npi:
type: string
required:
- service_code
- date_of_service
- npi
/coverages/v1//{id}/eligibility/{check_id}:
get:
operationId: get-eligibility
summary: Get Eligibility
description: Gets the eligibility of a patient for a specific coverage if successful.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/coverages.subpackage_pre-encounter/coverages/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
- name: check_id
in: path
required: true
schema:
type: string
- 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_pre-encounter/coverages/v1:CoverageEligibilityCheckResponse'
/images/v1:
post:
operationId: create
summary: Create
description: Adds an image. VersionConflictError is returned if a front or back of this coverage already exists.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/images.subpackage_pre-encounter/images/v1
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_pre-encounter/images/v1:Image'
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/images/v1:MutableImage'
get:
operationId: get-multi
summary: Get Multi
description: Searches for images that match the query parameters.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/images.subpackage_pre-encounter/images/v1
parameters:
- name: patient_id
in: query
required: false
schema:
type: string
- name: coverage_id
in: query
required: false
schema:
type: string
- name: file_type
in: query
required: false
schema:
type: string
- name: patient_notes
in: query
required: false
schema:
type: string
- name: sort_field
in: query
description: The field to order by. Defaults to updatedAt.
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/images/v1:ImageSortField'
- name: sort_direction
in: query
description: The direction to order by. Defaults to desc.
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:SortDirection'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/images/v1:Image'
/images/v1/{id}:
get:
operationId: get
summary: Get
description: Gets an image by imageId.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/images.subpackage_pre-encounter/images/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/images/v1:ImageId'
- 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_pre-encounter/images/v1:Image'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
/images/v1/{id}/{version}:
put:
operationId: update
summary: Update
description: Updates an Image. The path must contain the most recent version to prevent races.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/images.subpackage_pre-encounter/images/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/images/v1:ImageId'
- name: version
in: path
required: true
schema:
type: string
- 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_pre-encounter/images/v1:Image'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/images/v1:MutableImage'
delete:
operationId: deactivate
summary: Deactivate
description: Sets an Image as deactivated. The path must contain the most recent version to prevent races.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/images.subpackage_pre-encounter/images/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/images/v1:ImageId'
- name: version
in: path
required: true
schema:
type: string
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
/lists/v1/patient:
get:
operationId: get-patient-list
summary: Get Patient List
description: Gets patients with dependent objects for patients that match the query parameters.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/lists.subpackage_pre-encounter/lists/v1
parameters:
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
- name: limit
in: query
required: false
schema:
type: integer
- name: sort_field
in: query
description: Defaults to patient.updatedAt.
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/lists/v1:SortFieldString'
- name: sort_direction
in: query
description: Defaults to ascending.
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:SortDirection'
- name: filters
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:FilterQueryString'
- name: include_deactivated
in: query
description: If true, includes deactivated patients in the results. Defaults to false.
required: false
schema:
type: boolean
- name: redirect_to_primary
in: query
description: If true, and filtering by mrn equals, then only return the primary version of the patient requested
required: false
schema:
type: boolean
- name: hide_alternatives
in: query
description: If true, then do not show alternative patients
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_pre-encounter/lists/v1:PatientListPage'
'400':
description: Error response with status 400
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- BadRequestError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
/lists/v1/appointment:
get:
operationId: get-appointment-list
summary: Get Appointment List
description: Searches for appointments that match the query parameters.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/lists.subpackage_pre-encounter/lists/v1
parameters:
- name: sort_field
in: query
description: Defaults to appointment.startTimestamp.
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/lists/v1:SortFieldString'
- name: sort_direction
in: query
description: Defaults to asc.
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:SortDirection'
- name: limit
in: query
description: Defaults to 100.
required: false
schema:
type: integer
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
- name: filters
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:FilterQueryString'
- name: include_deactivated
in: query
description: If true, includes deactivated appointments in the results. Defaults to false.
required: false
schema:
type: boolean
- name: include_merged_patient_data
in: query
description: >-
If true and a patient id is specified, then also include appointments from any alternative patients that are
merged into this patient. Defaults to false.
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_pre-encounter/lists/v1:AppointmentListPage'
/notes/v1/{id}:
get:
operationId: get
summary: Get
description: Gets a note by NoteId.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/notes.subpackage_pre-encounter/notes/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:NoteId'
- 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_pre-encounter/notes/v1:Note'
/notes/v1:
post:
operationId: create
summary: Create
description: Adds a new note.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/notes.subpackage_pre-encounter/notes/v1
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_pre-encounter/notes/v1:Note'
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/notes/v1:MutableNote'
/notes/v1/{id}/{version}:
put:
operationId: update
summary: Update
description: Updates a note. The path must contain the most recent version to prevent races.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/notes.subpackage_pre-encounter/notes/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:NoteId'
- name: version
in: path
required: true
schema:
type: string
- 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_pre-encounter/notes/v1:Note'
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/notes/v1:MutableNote'
delete:
operationId: deactivate
summary: Deactivate
description: Sets a note as deactivated. The path must contain the most recent version to prevent races.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/notes.subpackage_pre-encounter/notes/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:NoteId'
- name: version
in: path
required: true
schema:
type: string
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
/organization-external-providers/v1/{id}:
get:
operationId: get
summary: Get
description: Gets an organization external provider by ID.
tags:
- >-
subpackage_pre-encounter.subpackage_pre-encounter/organizationExternalProviders.subpackage_pre-encounter/organizationExternalProviders/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProviderId'
- 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_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProvider'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
/organization-external-providers/v1:
get:
operationId: get-multi
summary: Get Multi
description: Searches for organization external providers that match the query parameters.
tags:
- >-
subpackage_pre-encounter.subpackage_pre-encounter/organizationExternalProviders.subpackage_pre-encounter/organizationExternalProviders/v1
parameters:
- name: limit
in: query
required: false
schema:
type: integer
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
- name: sort_field
in: query
description: Defaults to name.family.
required: false
schema:
$ref: >-
#/components/schemas/type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProviderSortField
- name: sort_direction
in: query
description: Defaults to ascending.
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:SortDirection'
- name: npi
in: query
required: false
schema:
type: string
- name: type
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProviderType'
- name: first_name
in: query
required: false
schema:
type: string
- name: last_name
in: query
required: false
schema:
type: string
- 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_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProviderPage
post:
operationId: create
summary: Create
description: Creates a new organization external provider. BadRequestError is returned when the NPI is already in use.
tags:
- >-
subpackage_pre-encounter.subpackage_pre-encounter/organizationExternalProviders.subpackage_pre-encounter/organizationExternalProviders/v1
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_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProvider'
'400':
description: Error response with status 400
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- BadRequestError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: >-
#/components/schemas/type_pre-encounter/organizationExternalProviders/v1:MutableOrganizationExternalProvider
/organization-external-providers/v1/{id}/{version}:
put:
operationId: update
summary: Update
description: >-
Updates an organization external provider. The path must contain the next version number to prevent race
conditions. For example, if the current version of the provider is n, you will need to send a request to this
endpoint with `/{id}/n+1` to update the provider. Updating historic versions is not supported. BadRequestError
is returned when the NPI is already in use by another provider.
tags:
- >-
subpackage_pre-encounter.subpackage_pre-encounter/organizationExternalProviders.subpackage_pre-encounter/organizationExternalProviders/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProviderId'
- name: version
in: path
required: true
schema:
type: string
- 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_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProvider'
'400':
description: Error response with status 400
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- BadRequestError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: >-
#/components/schemas/type_pre-encounter/organizationExternalProviders/v1:MutableOrganizationExternalProvider
delete:
operationId: deactivate
summary: Deactivate
description: >-
Sets an organization external provider as deactivated. The path must contain the most recent version plus 1 to
prevent race conditions. Deactivating historic versions is not supported.
tags:
- >-
subpackage_pre-encounter.subpackage_pre-encounter/organizationExternalProviders.subpackage_pre-encounter/organizationExternalProviders/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProviderId'
- name: version
in: path
required: true
schema:
type: string
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
/organization-external-providers/v1/updates/scan:
get:
operationId: scan
summary: Scan
description: >-
Scans up to 1000 organization external provider updates. The since query parameter is inclusive, and the result
list is ordered by updatedAt ascending.
**Polling Pattern:**
To continuously poll for updates without gaps:
1. Make your initial request with a `since` timestamp (e.g., `since=2020-01-01T13:00:00.000Z`)
2. The API returns 100 by default and up to 1000 records, sorted by `updated_at` ascending
3. Find the `updated_at` value from the last record in the response
4. Use that `updated_at` value as the `since` parameter in your next request
5. Repeat steps 2-4 to ingest updates until you receive an empty list
**Important Notes:**
- The `since` parameter is inclusive, so you may receive the last record from the previous batch again (you can
deduplicate by ID and version)
- All records include `updated_at`, `id`, `version`, `deactivated`, and `updating_user` fields for tracking
changes
- Timestamps have millisecond resolution for precise ordering
tags:
- >-
subpackage_pre-encounter.subpackage_pre-encounter/organizationExternalProviders.subpackage_pre-encounter/organizationExternalProviders/v1
parameters:
- name: since
in: query
required: true
schema:
type: string
format: date-time
- name: maxResults
in: query
required: false
schema:
type: integer
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: >-
#/components/schemas/type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProvider
/patients/v1:
post:
operationId: create
summary: Create
description: Adds a patient. VersionConflictError is returned when the patient's external ID is already in use.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/patients.subpackage_pre-encounter/patients/v1
parameters:
- name: skip_duplicate_check
in: query
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_pre-encounter/patients/v1:Patient'
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:MutablePatient'
get:
operationId: search
summary: Search
description: Returns a list of Patients based on the search criteria.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/patients.subpackage_pre-encounter/patients/v1
parameters:
- name: mrn
in: query
required: false
schema:
type: string
- name: similar_name_ordering
in: query
description: A string that is used to order similar names in search results.
required: false
schema:
type: string
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Patient'
/patients/v1/with_mrn:
post:
operationId: create-with-mrn
summary: Create With Mrn
description: >-
Adds a patient and hydrates their MRN with a pre-existing MRN. Once this patient is created their MRN will not
be editable. BadRequestError is returned when the MRN is greater than 20 characters. VersionConflictError is
returned when the patient's external ID is already in use.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/patients.subpackage_pre-encounter/patients/v1
parameters:
- name: skip_duplicate_check
in: query
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_pre-encounter/patients/v1:Patient'
'400':
description: Error response with status 400
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- BadRequestError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:MutablePatientWithMrn'
/patients/v1/get_multi:
get:
operationId: get-multi
summary: Get Multi
description: Searches for patients that match the query parameters.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/patients.subpackage_pre-encounter/patients/v1
parameters:
- name: limit
in: query
required: false
schema:
type: integer
- name: mrn
in: query
required: false
schema:
type: string
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
- name: sort_field
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:PatientSortField'
- name: sort_direction
in: query
description: Defaults to ascending.
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:SortDirection'
- name: redirect_to_primary
in: query
description: If true, then only return the primary version of any patients requested
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_pre-encounter/patients/v1:PatientPage'
/patients/v1/search_providers:
get:
operationId: search-providers
summary: Search Providers
description: >-
Searches for referring providers that match the query parameters. The search is case-insensitive, supports
fuzzy matching, and matches against provider name and NPI. The search criteria must be an alphanumeric string,
and the search is limited to the first 20 results.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/patients.subpackage_pre-encounter/patients/v1
parameters:
- name: search_criteria
in: query
required: true
schema:
type: string
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:ExternalProvider'
/patients/v1/{id}:
get:
operationId: get
summary: Get
description: Gets a patient.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/patients.subpackage_pre-encounter/patients/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PatientId'
- 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_pre-encounter/patients/v1:Patient'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
/patients/v1/mrn/{mrn}:
get:
operationId: get-by-mrn
summary: Get By Mrn
description: Gets a patient by mrn.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/patients.subpackage_pre-encounter/patients/v1
parameters:
- name: mrn
in: path
required: true
schema:
type: string
- 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_pre-encounter/patients/v1:Patient'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
/patients/v1/{id}/history:
get:
operationId: get-history
summary: Get History
description: Gets a patient along with it's full history. The return list is ordered by version ascending.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/patients.subpackage_pre-encounter/patients/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PatientId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Patient'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
/patients/v1/{id}/snapshot:
get:
operationId: get-coverage-snapshot
summary: Get Coverage Snapshot
description: >-
Gets a patient along with their coverages at a specific point in time. Note that the date passed in is only used
to determine what the filing order was for that patient during that time. The actual data returned will always
be the latest version of the patient and coverages.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/patients.subpackage_pre-encounter/patients/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PatientId'
- name: date
in: query
required: false
schema:
type: string
format: date-time
- 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_pre-encounter/patients/v1:PatientCoverageSnapshot'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
/patients/v1/{id}/{version}:
put:
operationId: update
summary: Update
description: >-
Updates a patient. The path must contain the next version number to prevent race conditions. For example, if the
current version of the patient is n, you will need to send a request to this endpoint with `/{id}/n+1` to update
the patient. Updating historic versions is not supported.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/patients.subpackage_pre-encounter/patients/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PatientId'
- name: version
in: path
required: true
schema:
type: string
- 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_pre-encounter/patients/v1:Patient'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:MutablePatient'
delete:
operationId: deactivate
summary: Deactivate
description: >-
Sets a patient as deactivated. The path must contain the most recent version plus 1 to prevent race
conditions. Deactivating historic versions is not supported.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/patients.subpackage_pre-encounter/patients/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PatientId'
- name: version
in: path
required: true
schema:
type: string
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
patch:
operationId: reactivate
summary: Reactivate
description: >-
Removes the deactivated flag for a patient. The path must contain the most recent version plus 1 to prevent
race conditions. Reactivating historic versions is not supported.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/patients.subpackage_pre-encounter/patients/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PatientId'
- name: version
in: path
required: true
schema:
type: string
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- NotFoundError
content:
$ref: '#/components/schemas/type_pre-encounter/common:ErrorBase4xx'
required:
- errorName
- content
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- VersionConflictError
content:
$ref: '#/components/schemas/type_pre-encounter/common:VersionConflictErrorBody'
required:
- errorName
- content
/patients/v1/updates/scan:
get:
operationId: scan
summary: Scan
description: >-
Scans up to 1000 patient updates. The since query parameter is inclusive, and the result list is ordered by
updatedAt ascending.
**Polling Pattern:**
To continuously poll for updates without gaps:
1. Make your initial request with a `since` timestamp (e.g., `since=2020-01-01T13:00:00.000Z`)
2. The API returns 100 by default and up to 1000 patient records, sorted by `updated_at` ascending
3. Find the `updated_at` value from the last record in the response
4. Use that `updated_at` value as the `since` parameter in your next request
5. Repeat steps 2-4 to ingest updates until you receive an empty list
**Important Notes:**
- The `since` parameter is inclusive, so you may receive the last record from the previous batch again (you can
deduplicate by ID and version)
- All patient records include `updated_at`, `id`, `version`, `deactivated`, and `updating_user` fields for
tracking changes
- Timestamps have millisecond resolution for precise ordering
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/patients.subpackage_pre-encounter/patients/v1
parameters:
- name: since
in: query
required: true
schema:
type: string
format: date-time
- name: maxResults
in: query
required: false
schema:
type: integer
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Patient'
/tags/v1/{id}:
get:
operationId: get
summary: Get
description: Gets a tag by TagId.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/tags.subpackage_pre-encounter/tags/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:TagId'
- 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_pre-encounter/tags/v1:Tag'
/tags/v1:
get:
operationId: get-all
summary: Get All
description: Gets all tags. Defaults to page size of 1000.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/tags.subpackage_pre-encounter/tags/v1
parameters:
- name: limit
in: query
required: false
schema:
type: integer
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
- 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_pre-encounter/tags/v1:TagPage'
post:
operationId: create
summary: Create
description: Adds a new tag if it does not already exist, otherwise, returns the existing tag.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/tags.subpackage_pre-encounter/tags/v1
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_pre-encounter/tags/v1:Tag'
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/tags/v1:MutableTag'
/tags/v1/{id}/{version}:
put:
operationId: update
summary: Update
description: Updates a tag. The path must contain the most recent version to prevent races.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/tags.subpackage_pre-encounter/tags/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:TagId'
- name: version
in: path
required: true
schema:
type: string
- 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_pre-encounter/tags/v1:Tag'
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_pre-encounter/tags/v1:MutableTag'
delete:
operationId: deactivate
summary: Deactivate
description: Sets a tag as deactivated. The path must contain the most recent version to prevent races.
tags:
- subpackage_pre-encounter.subpackage_pre-encounter/tags.subpackage_pre-encounter/tags/v1
parameters:
- name: id
in: path
required: true
schema:
$ref: '#/components/schemas/type_pre-encounter/common:TagId'
- name: version
in: path
required: true
schema:
type: string
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
/api/auth/v2/token:
post:
operationId: get-token
summary: Get token
description: >-
Candid Health SDKs automatically handle authentication workflows after configuring them with the `client_id` and
`client_secret`.
Candid Health utilizes the [OAuth 2.0 bearer token authentication
scheme](https://developer.mozilla.org/en-US/docs/Web/HTTP/Authentication) in our auth flow. You obtain the
bearer token for all
subsequent API requests via the `/auth/v2/token` endpoint defined below, which requires you to provide your
`client_id` and `client_secret`. Your `client_id` and `client_secret` can be
[generated](https://support.joincandidhealth.com/hc/en-us/articles/23065219476244--Generating-Candid-API-Keys)
from the "Users & Credentials" tab by your org admin.
The `/auth/v2/token` endpoint accepts both `Content-Type: application/json` and `Content-Type:
application/x-www-form-urlencoded`. The request body should contain the `client_id` and `client_secret` as
follows:
```json
{
"client_id": "YOUR_CLIENT_ID",
"client_secret": "YOUR_CLIENT_SECRET"
}
```
or as URL-encoded form data:
```
client_id=YOUR_CLIENT_ID&client_secret=YOUR_CLIENT_SECRET
```
The bearer token is a signed [JWT](https://jwt.io/). The public key for the JWT can be found
[here](https://candidhealth.auth0.com/pem) for any verification workflows.
The bearer token should be provided in the `Authorization` header for all subsequent API calls.
The bearer token expires 5 hours after it has been created. After it has expired, the client will receive an
"HTTP 401
Unauthorized" error, at which point the client should generate a new token. It is important that tokens be
reused between
requests; if the client attempts to generate a token too often, it will be rate-limited and will receive an
`HTTP 429 Too Many Requests` error.
tags:
- subpackage_auth.subpackage_auth/default
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
$ref: '#/components/schemas/type_auth/default:AuthGetTokenResponse'
'415':
description: Error response with status 415
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- InvalidContentTypeError
content:
$ref: '#/components/schemas/type_auth/default:InvalidContentTypeErrorType'
required:
- errorName
- content
'429':
description: Error response with status 429
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- TooManyRequestsError
content:
$ref: '#/components/schemas/type_auth/default:TooManyRequestsErrorType'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
client_id:
type: string
description: Your application's Client ID.
client_secret:
type: string
description: Your application's Client Secret.
required:
- client_id
- client_secret
/api/import-invoice/v1:
post:
operationId: import-invoice
summary: Import Invoice
description: Import an existing invoice from a third party service to reflect state in Candid.
tags:
- subpackage_import-invoice.subpackage_import-invoice/v1
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_import-invoice/v1:ImportInvoice'
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EntityConflictError
content:
$ref: '#/components/schemas/type_commons:EntityConflictErrorMessage'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_import-invoice/v1:CreateImportInvoiceRequest'
get:
operationId: get-multi
summary: Get Multi
description: Returns all Invoices for the authenticated user's organziation with all filters applied.
tags:
- subpackage_import-invoice.subpackage_import-invoice/v1
parameters:
- name: patient_external_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PatientExternalId'
- name: encounter_external_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:EncounterExternalId'
- name: note
in: query
description: partial match supported
required: false
schema:
type: string
- name: due_date_before
in: query
description: all invoices whose due date is before this due date, not inclusive
required: false
schema:
type: string
format: date
- name: due_date_after
in: query
description: all invoices whose due date is after this due date, not inclusive
required: false
schema:
type: string
format: date
- name: status
in: query
description: all invoices that match any of the provided statuses
required: false
schema:
$ref: '#/components/schemas/type_invoices/v2:InvoiceStatus'
- name: limit
in: query
description: Defaults to 100
required: false
schema:
type: integer
- name: sort
in: query
description: Defaults to created_at
required: false
schema:
$ref: '#/components/schemas/type_invoices/v2:InvoiceSortField'
- name: sort_direction
in: query
description: Sort direction. Defaults to descending order
required: false
schema:
$ref: '#/components/schemas/type_commons:SortDirection'
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- 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_import-invoice/v1:ImportInvoicesPage'
/api/import-invoice/v1/{invoice_id}:
get:
operationId: get
summary: Get
description: Retrieve and view an import invoice
tags:
- subpackage_import-invoice.subpackage_import-invoice/v1
parameters:
- name: invoice_id
in: path
description: InvoiceId to be returned
required: true
schema:
$ref: '#/components/schemas/type_commons:InvoiceId'
- 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_import-invoice/v1:ImportInvoice'
'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
patch:
operationId: update
summary: Update
description: Update the information on the imported invoice
tags:
- subpackage_import-invoice.subpackage_import-invoice/v1
parameters:
- name: invoice_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:InvoiceId'
- 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_import-invoice/v1:ImportInvoice'
'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:
$ref: '#/components/schemas/type_import-invoice/v1:ImportInvoiceUpdateRequest'
/api/patient-ar/v1/inventory:
get:
operationId: list-inventory
summary: List Inventory Records
description: >-
Retrieve a list of inventory records based on the provided filters. Each inventory record provides the latest
invoiceable status of the associated claim.
The response is paginated, and the `page_token` can be used to retrieve subsequent pages. Initial requests
should not include `page_token`.
tags:
- subpackage_patient-ar.subpackage_patient-ar/v1
parameters:
- name: since
in: query
description: Timestamp to filter records since, inclusive
required: false
schema:
type: string
format: date-time
- name: limit
in: query
description: Maximum number of records to return, default is 100
required: false
schema:
type: integer
default: 100
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- 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_patient-ar/v1:ListInventoryPagedResponse'
'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
'422':
description: The provided filters are invalid or not supported.
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- InvalidFiltersError
description: The provided filters are invalid or not supported.
content:
$ref: '#/components/schemas/type_patient-ar/v1:InvalidFiltersErrorType'
description: The provided filters are invalid or not supported.
required:
- errorName
- content
/api/patient-ar/v1/invoice-itemization/{claim_id}:
get:
operationId: itemize
summary: Invoice Itemization
description: Provides detailed itemization of invoice data for a specific claim.
tags:
- subpackage_patient-ar.subpackage_patient-ar/v1
parameters:
- name: claim_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:ClaimId'
- 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_patient-ar/v1:InvoiceItemizationResponse'
'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
/api/patient-payments/v4:
get:
operationId: get-multi
summary: Get patient payments
description: |-
Returns all patient payments satisfying the search criteria AND whose organization_id matches
the current organization_id of the authenticated user.
tags:
- subpackage_patient-payments.subpackage_patient-payments/v4
parameters:
- name: limit
in: query
description: Defaults to 100. The value must be greater than 0 and less than 1000.
required: false
schema:
type: integer
- name: patient_external_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PatientExternalId'
- name: claim_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:ClaimId'
- name: service_line_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:ServiceLineId'
- name: billing_provider_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:ProviderId'
- name: unattributed
in: query
description: returns payments with unattributed allocations if set to true
required: false
schema:
type: boolean
- name: invoice_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:InvoiceId'
- name: sources
in: query
required: false
schema:
$ref: '#/components/schemas/type_financials:PatientTransactionSource'
- name: source_internal_id
in: query
required: false
schema:
type: string
- name: sort
in: query
description: Defaults to payment_timestamp
required: false
schema:
$ref: '#/components/schemas/type_patient-payments/v4:PatientPaymentSortField'
- 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: 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_patient-payments/v4:PatientPaymentsPage'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
post:
operationId: create
summary: Create patient payment
description: |-
Creates a new patient payment record and returns the newly created PatientPayment object.
The allocations can describe whether the payment is being applied toward a specific service line,
claim, or billing provider.
tags:
- subpackage_patient-payments.subpackage_patient-payments/v4
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_patient-payments/v4:PatientPayment'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
amount_cents:
type: integer
payment_timestamp:
type: string
format: date-time
payment_note:
type: string
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
allocations:
type: array
items:
$ref: '#/components/schemas/type_financials:AllocationCreate'
invoice:
$ref: '#/components/schemas/type_commons:InvoiceId'
payment_method_detail:
$ref: '#/components/schemas/type_patient-payments/v4:PaymentMethodDetailCreate'
payment_source:
$ref: '#/components/schemas/type_financials:PatientPaymentCreateSource'
source_internal_id:
type: string
required:
- amount_cents
- patient_external_id
- allocations
/api/patient-payments/v4/{patient_payment_id}:
get:
operationId: get
summary: Get patient payment
description: Retrieves a previously created patient payment by its `patient_payment_id`.
tags:
- subpackage_patient-payments.subpackage_patient-payments/v4
parameters:
- name: patient_payment_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_patient-payments/v4:PatientPaymentId'
- 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_patient-payments/v4:PatientPayment'
'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
patch:
operationId: update
summary: Update
description: Updates the patient payment record matching the provided patient_payment_id.
tags:
- subpackage_patient-payments.subpackage_patient-payments/v4
parameters:
- name: patient_payment_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_patient-payments/v4:PatientPaymentId'
- 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_patient-payments/v4:PatientPayment'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
payment_timestamp:
type: string
format: date-time
payment_note:
$ref: '#/components/schemas/type_financials:NoteUpdate'
invoice:
$ref: '#/components/schemas/type_financials:InvoiceUpdate'
delete:
operationId: delete
summary: Delete patient payment
description: Deletes the patient payment record matching the provided patient_payment_id.
tags:
- subpackage_patient-payments.subpackage_patient-payments/v4
parameters:
- name: patient_payment_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_patient-payments/v4:PatientPaymentId'
- 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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
/api/patient-refunds/v1:
get:
operationId: get-multi
summary: Get patient refunds
description: |-
Returns all patient refunds satisfying the search criteria AND whose organization_id matches
the current organization_id of the authenticated user.
tags:
- subpackage_patient-refunds.subpackage_patient-refunds/v1
parameters:
- name: limit
in: query
description: Defaults to 100. The value must be greater than 0 and less than 1000.
required: false
schema:
type: integer
- name: patient_external_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PatientExternalId'
- name: claim_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:ClaimId'
- name: service_line_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:ServiceLineId'
- name: billing_provider_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:ProviderId'
- name: unattributed
in: query
description: returns payments with unattributed allocations if set to true
required: false
schema:
type: boolean
- name: invoice_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:InvoiceId'
- name: sources
in: query
required: false
schema:
$ref: '#/components/schemas/type_financials:PatientTransactionSource'
- name: sort
in: query
description: Defaults to refund_timestamp
required: false
schema:
$ref: '#/components/schemas/type_patient-refunds/v1:PatientRefundSortField'
- 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: 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_patient-refunds/v1:PatientRefundsPage'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
post:
operationId: create
summary: Create patient refund
description: |-
Creates a new patient refund record and returns the newly created PatientRefund object.
The allocations can describe whether the refund is being applied toward a specific service line,
claim, or billing provider.
tags:
- subpackage_patient-refunds.subpackage_patient-refunds/v1
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_patient-refunds/v1:PatientRefund'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- ReallocationWouldOverdraftError
content:
$ref: '#/components/schemas/type_financials:ReallocationWouldOverdraftErrorContent'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
amount_cents:
type: integer
refund_timestamp:
type: string
format: date-time
refund_note:
type: string
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
allocations:
type: array
items:
$ref: '#/components/schemas/type_financials:AllocationCreate'
invoice:
$ref: '#/components/schemas/type_commons:InvoiceId'
refund_reason:
$ref: '#/components/schemas/type_financials:RefundReason'
raise_on_overdraft:
type: boolean
description: >-
If true, the refund will be rejected if it would cause any account to be overdrafted. Defaults to
false.
required:
- amount_cents
- patient_external_id
- allocations
/api/patient-refunds/v1/{patient_refund_id}:
get:
operationId: get
summary: Get patient refund
description: Retrieves a previously created patient refund by its `patient_refund_id`.
tags:
- subpackage_patient-refunds.subpackage_patient-refunds/v1
parameters:
- name: patient_refund_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_patient-refunds/v1:PatientRefundId'
- 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_patient-refunds/v1:PatientRefund'
'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
patch:
operationId: update
summary: Update
description: Updates the patient refund record matching the provided patient_refund_id.
tags:
- subpackage_patient-refunds.subpackage_patient-refunds/v1
parameters:
- name: patient_refund_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_patient-refunds/v1:PatientRefundId'
- 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_patient-refunds/v1:PatientRefund'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
refund_timestamp:
type: string
format: date-time
refund_note:
$ref: '#/components/schemas/type_financials:NoteUpdate'
invoice:
$ref: '#/components/schemas/type_financials:InvoiceUpdate'
refund_reason:
$ref: '#/components/schemas/type_financials:RefundReasonUpdate'
delete:
operationId: delete
summary: Delete patient refund
description: Deletes the patient refund record matching the provided patient_refund_id.
tags:
- subpackage_patient-refunds.subpackage_patient-refunds/v1
parameters:
- name: patient_refund_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_patient-refunds/v1:PatientRefundId'
- 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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
/api/billing_notes/v2:
post:
operationId: create
summary: Create billing note
tags:
- subpackage_billing-notes.subpackage_billing-notes/v2
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_billing-notes/v2:BillingNote'
requestBody:
content:
application/json:
schema:
type: object
properties:
text:
type: string
description: Empty string not allowed.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
required:
- text
- encounter_id
/api/billing_notes/v2/{billing_note_id}:
delete:
operationId: delete
summary: Delete billing note
tags:
- subpackage_billing-notes.subpackage_billing-notes/v2
parameters:
- name: billing_note_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_billing-notes/v2:BillingNoteId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'400':
description: Error response with status 400
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- OrganizationNotAuthorizedError
content:
$ref: '#/components/schemas/type_commons:OrganizationNotAuthorizedErrorMessage'
required:
- errorName
- content
'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
patch:
operationId: update
summary: Update
tags:
- subpackage_billing-notes.subpackage_billing-notes/v2
parameters:
- name: billing_note_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_billing-notes/v2:BillingNoteId'
- 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_billing-notes/v2:BillingNote'
'400':
description: Error response with status 400
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- OrganizationNotAuthorizedError
content:
$ref: '#/components/schemas/type_commons:OrganizationNotAuthorizedErrorMessage'
required:
- errorName
- content
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationsError
content:
type: array
items:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
text:
type: string
description: Empty string not allowed.
required:
- text
/api/charge_capture_claim_creation/v1/{charge_capture_claim_creation_id}:
get:
operationId: get
summary: Get Charge Capture Claim Creation
tags:
- subpackage_charge-capture-bundles.subpackage_charge-capture-bundles/v1
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: get-summary
summary: Get Charge Capture Claim Creation Summary
tags:
- subpackage_charge-capture-bundles.subpackage_charge-capture-bundles/v1
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: resolve-charge-creation-error
summary: Mark a ClaimCreationAttempt error as resolved
tags:
- subpackage_charge-capture-bundles.subpackage_charge-capture-bundles/v1
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: get-all
summary: Get all Charge Capture Claim Creations
tags:
- subpackage_charge-capture-bundles.subpackage_charge-capture-bundles/v1
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'
/api/charge_captures/v1:
post:
operationId: create
summary: Create a Charge Capture
tags:
- subpackage_charge-capture.subpackage_charge-capture/v1
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/v1:ChargeCapture'
'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
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- ChargeExternalIdConflictError
content:
$ref: '#/components/schemas/type_charge-capture/v1:ChargeExternalIdConflictErrorMessage'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
data:
$ref: '#/components/schemas/type_charge-capture/v1:ChargeCaptureData'
description: >-
Charge Capture data contains all the fields needed to create an encounter, but listed as optional.
Candid will use this data when attempting to bundle multiple Charge Captures into a single
encounter.
charge_external_id:
type: string
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.
originating_system:
type: string
description: An optional string field denoting the originating system of the charge.
claim_creation_category:
type: string
description: An optional string field denoting the user defined category of the claim creation.
ehr_source_url:
type: string
description: >-
External URL reference that links to Charge Capture details within the external system (e.g. the EHR
visit page). Send full URL format for the external link (e.g.
https://emr_charge_capture_url.com/123).
patient_external_id:
type: string
description: The patient ID from the external EMR platform for the patient
status:
$ref: '#/components/schemas/type_charge-capture/v1:ChargeCaptureStatus'
description: the status of the charge capture
attachment_external_document_ids:
type: array
items:
type: string
description: >-
Provide external attachment IDs which have been uploaded to Candid. They will be associated with the
Encounter at Encounter creation time.
metadata:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaInstance'
description: |-
Key-value pairs that adhere to metadata schemas.
Multiple metadata instances can be associated with a charge capture.
hl7_message_type:
$ref: '#/components/schemas/type_charge-capture/v1:Hl7MessageType'
description: >-
The HL7 message type that produced this write. Used to differentiate post-submission update
behavior. Sent by HL7 producers (conduit); null for manual / script writes.
required:
- data
- charge_external_id
- patient_external_id
- status
get:
operationId: get-all
summary: Get all Charge Captures
tags:
- subpackage_charge-capture.subpackage_charge-capture/v1
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/v1:ChargeCaptureSortField'
- 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: 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 captures 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 captures 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 captures 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 captures 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 captures 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 captures 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 captures 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 captures with one of the
names in this list.
required: false
schema:
type: string
- 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: exclude_charges_linked_to_claims
in: query
description: Whether to exclude charge captures which are part of a claim creation.
required: false
schema:
type: boolean
- name: patient_external_id_ranked_sort
in: query
description: The patient ID from the external EMR platform for the patient
required: false
schema:
type: string
- name: status_ranked_sort
in: query
description: The charge capture status to show first
required: false
schema:
$ref: '#/components/schemas/type_charge-capture/v1:ChargeCaptureStatus'
- name: charge_external_id_ranked_sort
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_ranked_sort
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_ranked_sort
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: search_term
in: query
description: |-
Filter by any of the following fields: charge_id, claim_id, patient external_id,
patient date of birth, patient first name, patient last name,
or charge external id.
required: false
schema:
type: string
- name: billable_status
in: query
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.
required: false
schema:
$ref: '#/components/schemas/type_encounters/v4:BillableStatusType'
- name: responsible_party
in: query
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.
required: false
schema:
$ref: '#/components/schemas/type_encounters/v4:ResponsiblePartyType'
- name: claim_ids_ranked_sort
in: query
description: >-
A list of claim IDs to show first. This will return all charge captures 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_ranked_sort
in: query
description: A list of Claim Creation IDs to show first.
required: false
schema:
$ref: '#/components/schemas/type_commons:ChargeCaptureClaimCreationId'
- name: billing_provider_npis_ranked_sort
in: query
description: >-
A list of billing provider NPIs to show first. This will return all charge captures with one of the NPIs in
this list.
required: false
schema:
type: string
- name: service_facility_name_ranked_sort
in: query
description: A string to show first. This will return all charge captures with this service facility name.
required: false
schema:
type: string
- name: primary_payer_ids_ranked_sort
in: query
description: >-
A list of primary payer IDs to show first. This will return all charge captures with one of the primary
payer IDs in this list.
required: false
schema:
type: string
- name: rendering_provider_npis_ranked_sort
in: query
description: >-
A list of rendering provider NPIs to show first. This will return all charge captures with one of the NPIs
in this list.
required: false
schema:
type: string
- name: rendering_provider_names_ranked_sort
in: query
description: >-
A list of rendering provider names to show first. This will return all charge captures with one of the names
in this list.
required: false
schema:
type: string
- name: supervising_provider_npis_ranked_sort
in: query
description: >-
A list of supervising provider NPIs to show first. This will return all charge captures with one of the NPIs
in this list.
required: false
schema:
type: string
- name: supervising_provider_names_ranked_sort
in: query
description: >-
A list of supervising provider names to show first. This will return all charge captures 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_ranked_sort
in: query
description: >-
A list of claim creation categories to sort 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_ranked_sort
in: query
description: A list of tags. This will return all charge captures with one of the tags.
required: false
schema:
type: string
- name: primary_payer_names_ranked_sort
in: query
description: A list of primary payer names to sort by. This will return all charge captures with one of the names.
required: false
schema:
type: string
- name: patient_names_ranked_sort
in: query
description: A list of patient names to sort by. This will return all charge captures with one of the names.
required: false
schema:
type: string
- 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/v1:ChargeCapturePage'
/api/charge_captures/v1/create-from-pre-encounter:
post:
operationId: create-from-pre-encounter-patient
summary: Create a Charge Capture from pre-encounter patient and appointment
description: >-
Create a Charge Capture from a pre-encounter patient and appointment. This endpoint is intended to be used by
consumers who are managing
patients and appointments in the pre-encounter service and is currently under development. Consumers who are not
taking advantage
of the pre-encounter service should use the standard create endpoint.
At encounter creation time, information from the provided patient and appointment objects will be populated
where applicable. In particular, the following fields are populated from the patient and appointment objects:
- Patient
- Referring Provider
- Subscriber Primary
- Subscriber Secondary
- Referral Number
- Responsible Party
- Guarantor
Note that these fields should not be populated in the ChargeCaptureData property of this endpoint, as they will
be overwritten at encounter creation time.
Utilizing this endpoint opts you into automatic updating of the encounter when the patient or appointment is
updated, assuming the
encounter has not already been submitted or adjudicated.
tags:
- subpackage_charge-capture.subpackage_charge-capture/v1
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/v1:ChargeCapture'
'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
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- ChargeExternalIdConflictError
content:
$ref: '#/components/schemas/type_charge-capture/v1:ChargeExternalIdConflictErrorMessage'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
data:
$ref: '#/components/schemas/type_charge-capture/v1:ChargeCaptureData'
description: >-
Charge Capture data contains all the fields needed to create an encounter, but listed as optional.
Candid will use this data when attempting to bundle multiple Charge Captures into a single
encounter.
charge_external_id:
type: string
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.
pre_encounter_patient_id:
$ref: '#/components/schemas/type_commons:PreEncounterPatientId'
pre_encounter_appointment_ids:
type: array
items:
$ref: '#/components/schemas/type_commons:PreEncounterAppointmentId'
originating_system:
type: string
description: An optional string field denoting the originating system of the charge.
claim_creation_category:
type: string
description: An optional string field denoting the user defined category of the claim creation.
ehr_source_url:
type: string
description: >-
External URL reference that links to Charge Capture details within the external system (e.g. the EHR
visit page). Send full URL format for the external link (e.g.
https://emr_charge_capture_url.com/123).
status:
$ref: '#/components/schemas/type_charge-capture/v1:ChargeCaptureStatus'
description: the status of the charge capture
attachment_external_document_ids:
type: array
items:
type: string
description: >-
Provide external attachment IDs which have been uploaded to Candid. They will be associated with the
Encounter at Encounter creation time.
hl7_message_type:
$ref: '#/components/schemas/type_charge-capture/v1:Hl7MessageType'
description: >-
The HL7 message type that produced this write. Used to differentiate post-submission update
behavior. Sent by HL7 producers (conduit); null for manual / script writes.
required:
- data
- charge_external_id
- pre_encounter_patient_id
- pre_encounter_appointment_ids
- status
/api/charge_captures/v1/changes:
patch:
operationId: update-post-billed-changes
summary: Update a ChargeCapturePostBilledChange
tags:
- subpackage_charge-capture.subpackage_charge-capture/v1
parameters:
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: >-
This list of updates will always return at most 1 update that is not resolved. The singular update will
contain the difference between the updated charge and the created encounter.
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_charge-capture/v1:ChargeCapturePostBilledChange'
'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:
charge_capture_change_ids:
type: array
items:
$ref: '#/components/schemas/type_commons:ChargeCapturePostBilledChangeId'
description: |-
A list of UUIDs corresponding to ChargeCapturePostBilledChanges.
All of the charges sent will be marked as resolved
resolved:
type: boolean
description: |-
Whether the change has been resolved. If true, the change will be marked as resolved.
If false, the change will be marked as unresolved.
required:
- charge_capture_change_ids
- resolved
/api/charge_captures/v1/{charge_capture_id}:
patch:
operationId: update
summary: Update Charge Capture
tags:
- subpackage_charge-capture.subpackage_charge-capture/v1
parameters:
- name: charge_capture_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:ChargeCaptureId'
- 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/v1:ChargeCapture'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
data:
$ref: '#/components/schemas/type_charge-capture/v1:ChargeCaptureData'
charge_external_id:
type: string
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.
ehr_source_url:
type: string
description: >-
External URL reference that links to Charge Capture details within the external system (e.g. the EHR
visit page).
Send full URL format for the external link (e.g. https://emr_charge_capture_url.com/123).
originating_system:
type: string
description: An optional string field denoting the originating system of the charge.
claim_creation_category:
type: string
description: An optional string field denoting the user defined category of the claim creation.
patient_external_id:
type: string
description: The patient ID from the external EMR platform for the patient
status:
$ref: '#/components/schemas/type_charge-capture/v1:ChargeCaptureStatus'
description: the status of the charge capture
attachment_external_document_ids:
type: array
items:
type: string
description: >-
Provide external attachment IDs which have been uploaded to Candid. They will be associated with the
Encounter at Encounter creation time.
metadata:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaInstance'
description: |-
Key-value pairs that adhere to metadata schemas.
Multiple metadata instances can be associated with a charge capture.
hl7_message_type:
$ref: '#/components/schemas/type_charge-capture/v1:Hl7MessageType'
description: >-
The HL7 message type that produced this write. Used to differentiate post-submission update
behavior. Sent by HL7 producers (conduit); null for manual / script writes.
get:
operationId: get
summary: Get Charge Capture
tags:
- subpackage_charge-capture.subpackage_charge-capture/v1
parameters:
- name: charge_capture_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:ChargeCaptureId'
- 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/v1:ChargeCapture'
/api/charge_captures/v1/find-by-metadata:
post:
operationId: find-by-metadata
summary: Find Charge Captures by Metadata
tags:
- subpackage_charge-capture.subpackage_charge-capture/v1
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/v1:ChargeCapturePage'
requestBody:
content:
application/json:
schema:
type: object
properties:
metadata:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaInstance'
description: |-
Filter by metadata schema instances. This will return all charge captures
that match any of the provided schema instances.
limit:
type: integer
description: Maximum number of entities per page, defaults to 100.
page_token:
$ref: '#/components/schemas/type_commons:PageToken'
required:
- metadata
/api/contracts/v2/{contract_id}:
get:
operationId: get
summary: Get contract
description: >-
This API provides access to Professional Contracts. For Professional and Institutional Contracts use Contracts
V3.
tags:
- subpackage_contracts.subpackage_contracts/v2
parameters:
- name: contract_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_contracts/v2:ContractId'
- name: organization_id
in: query
description: Organization context for cross-org access. If not provided, defaults to the requesting user's organization.
required: false
schema:
$ref: '#/components/schemas/type_commons:OrganizationId'
- 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_contracts/v2:ContractWithProviders'
'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
delete:
operationId: delete
summary: Delete contract
tags:
- subpackage_contracts.subpackage_contracts/v2
parameters:
- name: contract_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_contracts/v2:ContractId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- ContractIsLinkedToFeeScheduleHttpError
content:
$ref: '#/components/schemas/type_contracts/v2:ContractIsLinkedToFeeScheduleError'
required:
- errorName
- content
patch:
operationId: update
summary: Update contract
tags:
- subpackage_contracts.subpackage_contracts/v2
parameters:
- name: contract_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_contracts/v2:ContractId'
- 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_contracts/v2:ContractWithProviders'
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- ContractInvalidExpirationDateHttpError
content:
$ref: '#/components/schemas/type_contracts/v2:ContractInvalidExpirationDateError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
rendering_provider_ids:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_contracts/v2:RenderingProviderid'
description: |-
A rendering provider isn't contracted directly with the payer but can render
services under the contract held by the contracting provider.
Max items is 4000.
effective_date:
$ref: '#/components/schemas/type_commons:Date'
description: The starting day upon which the contract is effective
expiration_date:
$ref: '#/components/schemas/type_contracts/v2:DateUpdate'
description: An optional end day upon which the contract expires
regions:
$ref: '#/components/schemas/type_contracts/v2:RegionsUpdate'
description: |-
If present, the contract's rendering providers will be patched to this exact
value, overriding what was set before.
contract_status:
$ref: '#/components/schemas/type_contracts/v2:ContractStatus'
authorized_signatory:
$ref: '#/components/schemas/type_contracts/v2:AuthorizedSignatoryUpdate'
commercial_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
medicare_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
medicaid_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
/api/contracts/v2:
get:
operationId: get-multi
summary: Get all contracts
description: >-
This API provides access to Professional Contracts. For Professional and Institutional Contracts use Contracts
V3.
tags:
- subpackage_contracts.subpackage_contracts/v2
parameters:
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- name: limit
in: query
description: Max number of contracts returned. Defaults to 1000. Max is 1000.
required: false
schema:
type: integer
- name: contracting_provider_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_contracts/v2:ContractingProviderId'
- name: rendering_provider_ids
in: query
required: false
schema:
$ref: '#/components/schemas/type_contracts/v2:RenderingProviderid'
- name: payer_names
in: query
description: Filter to contracts that include any of the included payer names.
required: false
schema:
type: string
- name: states
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:State'
- name: contract_status
in: query
description: The status of the contract. Defaults to `pending`
required: false
schema:
$ref: '#/components/schemas/type_contracts/v2:ContractStatus'
- name: sort
in: query
description: Potentially sort by a contract related attribute. Defaults to created_at
required: false
schema:
$ref: '#/components/schemas/type_contracts/v2:ContractSortField'
- name: sort_direction
in: query
description: Direction of sort, defaulting to desc
required: false
schema:
$ref: '#/components/schemas/type_commons:SortDirection'
- 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_contracts/v2:ContractsPage'
post:
operationId: create
summary: Create contract
description: Creates a new contract within the user's current organization
tags:
- subpackage_contracts.subpackage_contracts/v2
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_contracts/v2:ContractWithProviders'
requestBody:
content:
application/json:
schema:
type: object
properties:
effective_date:
$ref: '#/components/schemas/type_commons:Date'
description: The starting day upon which the contract is effective
expiration_date:
$ref: '#/components/schemas/type_commons:Date'
description: An optional end day upon which the contract expires
regions:
$ref: '#/components/schemas/type_commons:Regions'
description: |-
The state(s) to which the contract's coverage extends.
It may also be set to "national" for the entirety of the US.
contract_status:
$ref: '#/components/schemas/type_contracts/v2:ContractStatus'
authorized_signatory:
$ref: '#/components/schemas/type_contracts/v2:AuthorizedSignatory'
commercial_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The commercial plan insurance types this contract applies.
medicare_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicare plan insurance types this contract applies.
medicaid_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicaid plan insurance types this contract applies.
contracting_provider_id:
$ref: '#/components/schemas/type_contracts/v2:ContractingProviderId'
description: The UUID of the provider under agreement to the contract
rendering_provider_ids:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_contracts/v2:RenderingProviderid'
description: |-
A rendering provider isn't contracted directly with the payer but can render
services under the contract held by the contracting provider.
Max items is 4000.
payer_uuid:
type: string
format: uuid
description: The UUID of the insurance company under agreement to the contract
required:
- effective_date
- regions
- commercial_insurance_types
- medicare_insurance_types
- medicaid_insurance_types
- contracting_provider_id
- rendering_provider_ids
- payer_uuid
/api/contracts/v3/{contract_id}:
get:
operationId: get
summary: Get contract
tags:
- subpackage_contracts.subpackage_contracts/v3
parameters:
- name: contract_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_contracts/v3:ContractId'
- 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_contracts/v3:ContractWithProvidersUnion'
'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
delete:
operationId: delete
summary: Delete contract
tags:
- subpackage_contracts.subpackage_contracts/v3
parameters:
- name: contract_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_contracts/v3:ContractId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- ContractIsLinkedToFeeScheduleHttpError
content:
$ref: '#/components/schemas/type_contracts/v2:ContractIsLinkedToFeeScheduleError'
required:
- errorName
- content
patch:
operationId: update
summary: Update contract
tags:
- subpackage_contracts.subpackage_contracts/v3
parameters:
- name: contract_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_contracts/v3:ContractId'
- 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_contracts/v3:ContractWithProvidersUnion'
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- ContractInvalidExpirationDateHttpError
content:
$ref: '#/components/schemas/type_contracts/v2:ContractInvalidExpirationDateError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_contracts/v3:ContractUpdateUnion'
/api/contracts/v3:
get:
operationId: get-multi
summary: Get all contracts
tags:
- subpackage_contracts.subpackage_contracts/v3
parameters:
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- name: limit
in: query
description: Max number of contracts returned. Defaults to 1000. Max is 1000.
required: false
schema:
type: integer
- name: type
in: query
description: The type of contract
required: false
schema:
$ref: '#/components/schemas/type_contracts/v3:ContractType'
- name: contracting_provider_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_contracts/v3:ContractingProviderId'
- name: rendering_provider_ids
in: query
required: false
schema:
$ref: '#/components/schemas/type_contracts/v3:RenderingProviderid'
- name: payer_names
in: query
description: Filter to contracts that include any of the included payer names.
required: false
schema:
type: string
- name: states
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:State'
- name: contract_status
in: query
description: The status of the contract. Defaults to `pending`
required: false
schema:
$ref: '#/components/schemas/type_contracts/v2:ContractStatus'
- name: sort
in: query
description: Potentially sort by a contract related attribute. Defaults to created_at
required: false
schema:
$ref: '#/components/schemas/type_contracts/v2:ContractSortField'
- name: sort_direction
in: query
description: Direction of sort, defaulting to desc
required: false
schema:
$ref: '#/components/schemas/type_commons:SortDirection'
- 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_contracts/v3:ContractsPage'
post:
operationId: create
summary: Create contract
description: Creates a new contract within the user's current organization
tags:
- subpackage_contracts.subpackage_contracts/v3
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_contracts/v3:ContractWithProvidersUnion'
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_contracts/v3:ContractCreateUnion'
/api/contracts/v3/{contract_id}/providers:
get:
operationId: get-contract-providers
summary: Get contract providers
tags:
- subpackage_contracts.subpackage_contracts/v3
parameters:
- name: contract_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_contracts/v3:ContractId'
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- name: limit
in: query
description: Max number of providers returned per page. Defaults to 100. Max is 1000.
required: false
schema:
type: integer
- 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_contracts/v3:ContractProvidersPage'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
post:
operationId: add-contract-providers
summary: Add providers to contract
description: >-
Appends a list of rendering provider IDs to the contract. Provider IDs already on the contract are silently
ignored.
tags:
- subpackage_contracts.subpackage_contracts/v3
parameters:
- name: contract_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_contracts/v3:ContractId'
- 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_contracts/v3:AddContractProvidersResponse'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
rendering_provider_ids:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_contracts/v3:RenderingProviderid'
description: Provider IDs to add to the contract. Max 100,000 per request.
required:
- rendering_provider_ids
delete:
operationId: remove-contract-providers
summary: Remove providers from contract
description: >-
Removes the specified rendering provider IDs from the contract. Returns a 404 if any of the provided IDs are not
currently in the contract.
tags:
- subpackage_contracts.subpackage_contracts/v3
parameters:
- name: contract_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_contracts/v3:ContractId'
- 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_contracts/v3:ContractProviderCount'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
rendering_provider_ids:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_contracts/v3:RenderingProviderid'
description: Provider IDs to remove from the contract. Max 100,000 per request.
required:
- rendering_provider_ids
/api/contracts/v3/{contract_id}/providers/credentialing:
get:
operationId: get-contract-provider-credentialing-spans
summary: Get contract provider credentialing spans
description: >-
Returns rendering providers linked to a contract with their credentialing spans, scoped to the contract's
contracting provider and payer. Providers with no matching spans are included with an empty list.
tags:
- subpackage_contracts.subpackage_contracts/v3
parameters:
- name: contract_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_contracts/v3:ContractId'
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- name: limit
in: query
description: Max number of providers returned per page. Defaults to 100. Max is 1000.
required: false
schema:
type: integer
- 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_contracts/v3:ContractProviderCredentialingPage'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
/api/contracts/v3/{contract_id}/service-facilities:
post:
operationId: create-contract-service-facility
summary: Create contract service facility
tags:
- subpackage_contracts.subpackage_contracts/v3
parameters:
- name: contract_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_contracts/v3:ContractId'
- 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_contracts/v3:ContractServiceFacility'
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
service_facility_id:
type: string
format: uuid
description: The UUID of the service facility
provider_ids:
type: array
uniqueItems: true
items:
type: string
format: uuid
description: The providers who are authorized under the contract
required:
- service_facility_id
- provider_ids
/api/contracts/v3/{contract_id}/service-facilities/{contract_service_facility_id}:
patch:
operationId: update-contract-service-facility
summary: Update contract service facility
tags:
- subpackage_contracts.subpackage_contracts/v3
parameters:
- name: contract_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_contracts/v3:ContractId'
- name: contract_service_facility_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_contracts/v3:ContractServiceFacilityId'
- 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_contracts/v3:ContractServiceFacility'
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
service_facility_id:
type: string
format: uuid
description: The UUID of the service facility
provider_ids:
type: array
uniqueItems: true
items:
type: string
format: uuid
description: The providers who are authorized under the contract
/api/provider-credentialing-span/v2/facility:
post:
operationId: create-facility
summary: Create facility credentialing span
tags:
- subpackage_credentialing.subpackage_credentialing/v2
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_credentialing/v2:FacilityCredentialingSpan'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationsError
content:
type: array
items:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
service_facility_id:
type: string
format: uuid
description: The ID of the service facility covered by the credentialing span.
contracting_provider_id:
type: string
format: uuid
description: The ID of the billing provider for which the service facility is covered by the credentialing span.
payer_uuid:
type: string
format: uuid
description: The ID of the payer covered by the credentialing span.
start_date:
type: string
format: date
description: Start date of the credentialing span.
end_date:
type: string
format: date
description: End date of the credentialing span.
submitted_date:
type: string
format: date
description: Date that the credential paperwork was submitted.
payer_loaded_date:
type: string
format: date
description: Date that the payer loaded the credentialing span into their system.
required:
- service_facility_id
- contracting_provider_id
- payer_uuid
get:
operationId: get-all-facilities
summary: Get all facility credentialing spans
tags:
- subpackage_credentialing.subpackage_credentialing/v2
parameters:
- name: limit
in: query
description: Maximum number of entities per page, defaults to 100.
required: false
schema:
type: integer
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- name: payer_uuid
in: query
description: Filter by payer.
required: false
schema:
type: string
format: uuid
- name: contracting_provider_id
in: query
description: Filter to a particular contracting provider.
required: false
schema:
type: string
format: uuid
- name: service_facility_id
in: query
description: Filter to a particular service facility.
required: false
schema:
type: string
format: uuid
- 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_credentialing/v2:FacilityCredentialingSpanPage'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
/api/provider-credentialing-span/v2/facility/{facility_credentialing_id}:
get:
operationId: get-facility
summary: Get facility credentialing span
tags:
- subpackage_credentialing.subpackage_credentialing/v2
parameters:
- name: facility_credentialing_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_credentialing/v2:FacilityCredentialingSpanId'
- 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_credentialing/v2:FacilityCredentialingSpan'
'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
delete:
operationId: delete-facility
summary: Delete facility credentialing span
description: Soft deletes a credentialing span rate from the system.
tags:
- subpackage_credentialing.subpackage_credentialing/v2
parameters:
- name: facility_credentialing_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_credentialing/v2:FacilityCredentialingSpanId'
- 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
patch:
operationId: update-facility
summary: Update facility credentialing span
tags:
- subpackage_credentialing.subpackage_credentialing/v2
parameters:
- name: facility_credentialing_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_credentialing/v2:FacilityCredentialingSpanId'
- 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_credentialing/v2:FacilityCredentialingSpan'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
contracting_provider_id:
type: string
format: uuid
description: The ID of the billing provider for which the service facility is covered by the credentialing span.
payer_uuid:
type: string
format: uuid
description: The ID of the payer doing the credentialing.
start_date:
type: string
format: date
description: Start date of the credentialing span.
end_date:
type: string
format: date
description: End date of the credentialing span.
submitted_date:
type: string
format: date
description: Date that the credential paperwork was submitted.
payer_loaded_date:
type: string
format: date
description: Date that the payer loaded the credentialing span into their system.
required:
- contracting_provider_id
/api/provider-credentialing-span/v2:
post:
operationId: create
summary: Create provider credentialing span
tags:
- subpackage_credentialing.subpackage_credentialing/v2
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_credentialing/v2:ProviderCredentialingSpan'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationsError
content:
type: array
items:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
rendering_provider_id:
type: string
format: uuid
description: The ID of the rendering provider covered by the credentialing span.
contracting_provider_id:
type: string
format: uuid
description: The ID of the billing provider for which the service facility is covered by the credentialing span.
payer_uuid:
type: string
format: uuid
description: The ID of the payer covered by the credentialing span.
start_date:
type: string
format: date
description: Start date of the credentialing span.
end_date:
type: string
format: date
description: End date of the credentialing span.
regions:
$ref: '#/components/schemas/type_commons:Regions'
description: The states covered by the credentialing span. A span may be national and cover all states.
submitted_date:
type: string
format: date
description: Date that the credential paperwork was submitted.
payer_loaded_date:
type: string
format: date
description: Date that the payer loaded the credentialing span into their system.
required:
- rendering_provider_id
- contracting_provider_id
- payer_uuid
- regions
get:
operationId: get-all
summary: Get all provider credentialing spans
tags:
- subpackage_credentialing.subpackage_credentialing/v2
parameters:
- name: limit
in: query
description: Maximum number of entities per page, defaults to 100.
required: false
schema:
type: integer
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- name: payer_uuid
in: query
description: Filter by payer.
required: false
schema:
type: string
format: uuid
- name: provider_id
in: query
description: Filter to a particular provider. Use in conjunction as_rendering_provider and as_contracting_provider.
required: false
schema:
type: string
format: uuid
- name: as_rendering_provider
in: query
description: >-
Filter to credentialing spans where the provider is a rendering provider. To use this filter provider_id is
required.
required: false
schema:
type: boolean
- name: as_contracting_provider
in: query
description: >-
Filter to credentialing spans where the provider is a contracting provider. To use this filter provider_id
is required.
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_credentialing/v2:ProviderCredentialingSpanPage'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
/api/provider-credentialing-span/v2/{provider_credentialing_id}:
get:
operationId: get
summary: Get provider credentialing span
tags:
- subpackage_credentialing.subpackage_credentialing/v2
parameters:
- name: provider_credentialing_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:ProviderCredentialingSpanId'
- 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_credentialing/v2:ProviderCredentialingSpan'
'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
delete:
operationId: delete
summary: Delete provider credentialing span
description: Soft deletes a credentialing span rate from the system.
tags:
- subpackage_credentialing.subpackage_credentialing/v2
parameters:
- name: provider_credentialing_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:ProviderCredentialingSpanId'
- 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
patch:
operationId: update
summary: Update provider credentialing span
tags:
- subpackage_credentialing.subpackage_credentialing/v2
parameters:
- name: provider_credentialing_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:ProviderCredentialingSpanId'
- 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_credentialing/v2:ProviderCredentialingSpan'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
contracting_provider_id:
type: string
format: uuid
description: The ID of the billing provider for which the service facility is covered by the credentialing span.
payer_uuid:
type: string
format: uuid
description: The ID of the payer doing the credentialing.
start_date:
type: string
format: date
description: Start date of the credentialing span.
end_date:
type: string
format: date
description: End date of the credentialing span.
regions:
$ref: '#/components/schemas/type_commons:Regions'
description: The states covered by the credentialing span. A span may be national and cover all states.
submitted_date:
type: string
format: date
description: Date that the credential paperwork was submitted.
payer_loaded_date:
type: string
format: date
description: Date that the payer loaded the credentialing span into their system.
/api/custom-schemas/v1:
get:
operationId: get-multi
summary: Get all custom schemas
description: Returns all custom schemas.
tags:
- subpackage_custom-schemas.subpackage_custom-schemas/v1
parameters:
- name: organization_id
in: query
description: >-
Filter to a specific organization's schemas. If not provided, defaults to the requesting user's
organization.
required: false
schema:
$ref: '#/components/schemas/type_commons:OrganizationId'
- 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_custom-schemas/v1:SchemaGetMultiResponse'
'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
post:
operationId: create
summary: Create a custom schema
description: >-
Create custom schema with a set of typed keys. Schema keys can be referenced as inputs in user-configurable
rules in the Rules
Engine, and key-value pairs can be attached to claims via the Encounters API.
tags:
- subpackage_custom-schemas.subpackage_custom-schemas/v1
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_custom-schemas/v1:Schema'
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- SchemaValidationHttpFailure
content:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaValidationFailure'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
name:
type: string
description:
type: string
fields:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaField'
required:
- name
- fields
/api/custom-schemas/v1/{schema_id}:
get:
operationId: get
summary: Get custom schema
description: Return a custom schema with a given ID.
tags:
- subpackage_custom-schemas.subpackage_custom-schemas/v1
parameters:
- name: schema_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:SchemaId'
- 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_custom-schemas/v1:Schema'
'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
patch:
operationId: update
summary: Update custom schema
description: Update the name, description, or keys on a preexisting schema.
tags:
- subpackage_custom-schemas.subpackage_custom-schemas/v1
parameters:
- name: schema_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:SchemaId'
- 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_custom-schemas/v1:Schema'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- SchemaValidationHttpFailure
content:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaValidationFailure'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
name:
type: string
description:
type: string
fields_to_add:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaField'
description: A list of typed entries to add to schema. Only additive modifications are permitted.
/api/eligibility/v2/availity:
get:
operationId: submit-eligibility-check-availity
summary: Submit encounter eligibility check (Availity)
description: >-
Candid is deprecating support for this endpoint. It is instead recommended to use [Candid's Stedi
passthrough
endpoint](https://docs.joincandidhealth.com/api-reference/pre-encounter/eligibility-checks/v-1/post).
For assistance with the transition, please reference the [Transitioning to Candid's New Eligibility
Endpoint](https://support.joincandidhealth.com/hc/en-us/articles/34918552872980) document in the Candid Support
Center.
**Availity has transitioned their GET endpoint to a POST endpoint. Candid has updated their pass-through
integration to enable backwards compatibility for the GET endpoint so that customers do not have to immediately
update their integrations.**
**Candid recommends integrations with the [POST
endpoint](https://docs.joincandidhealth.com/api-reference/eligibility/v-2/submit-eligibility-check-availity-post)
to ensure the best possible integration experience. Given the transition, Availity’s documentation will be out
of sync with this endpoint.**
If you'd like access to this endpoint, please reach out to support@joincandidhealth.com with the subject line
"Action: Activate Availity Eligibility API Endpoint
This API is a wrapper around Availity's coverages API. Below are some helpful documentation links:
- [Availity - Coverages 1.0.0 API](https://developer.availity.com/partner/documentation#c_coverages_references)
- [Candid Availity Eligibility Integration
Guide](https://support.joincandidhealth.com/hc/en-us/articles/24218441631892--Availity-Eligibility-Integration-Guide)
A schema of the response object can be found here: [Availity
Docs](https://developer.availity.com/partner/product/191210/api/190898#/Coverages_100/operation/%2Fcoverages%2F{id}/get)
* Note Availity requires a free developer account to access this documentation.
Check connection status of Availity API and partners here:
- [Availity Trading Partner Connection Status](https://www.availity.com/status/)
tags:
- subpackage_eligibility.subpackage_eligibility/v2
parameters:
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
description: Any type
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationError
content:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
post:
operationId: submit-eligibility-check-availity-post
summary: Submit encounter eligibility check (Availity Post)
description: >-
Candid is deprecating support for this endpoint. It is instead recommended to use [Candid's Stedi
passthrough
endpoint](https://docs.joincandidhealth.com/api-reference/pre-encounter/eligibility-checks/v-1/post).
For assistance with the transition, please reference the [Transitioning to Candid's New Eligibility
Endpoint](https://support.joincandidhealth.com/hc/en-us/articles/34918552872980) document in the Candid Support
Center.
If you'd like access to this endpoint, please reach out to support@joincandidhealth.com with the subject line
"Action: Activate Availity Eligibility API Endpoint
This API is a wrapper around Availity's coverages API. Below are some helpful documentation links:
- [Availity - Coverages 1.0.0 API](https://developer.availity.com/partner/documentation#c_coverages_references)
- [Candid Availity Eligibility Integration
Guide](https://support.joincandidhealth.com/hc/en-us/articles/24218441631892--Availity-Eligibility-Integration-Guide)
A schema of the response object can be found here: [Availity
Docs](https://developer.availity.com/partner/product/191210/api/190898#/Coverages_100/operation/%2Fcoverages%2F{id}/get)
* Note Availity requires a free developer account to access this documentation.
Check connection status of Availity API and partners here:
- [Availity Trading Partner Connection Status](https://www.availity.com/status/)
tags:
- subpackage_eligibility.subpackage_eligibility/v2
parameters:
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
description: Any type
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationError
content:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
description: Any type
/api/encounter-attachments/v1/{encounter_id}:
get:
operationId: get
summary: Get Encounter Attachments
tags:
- subpackage_encounter-attachments.subpackage_encounter-attachments/v1
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_encounter-attachments/v1:EncounterAttachment'
put:
operationId: create
summary: Create Encounter Attachment
description: |-
Uploads a file to the encounter. The file will be stored in the
encounter's attachments. Deprecated: Use create-v2 instead.
tags:
- subpackage_encounter-attachments.subpackage_encounter-attachments/v1
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_encounter-attachments/v1:AttachmentId'
requestBody:
content:
multipart/form-data:
schema:
type: object
properties:
attachment_file:
type: string
format: binary
description: |-
The file for upload. The maximum file size is 25MB. The allowed mime types are:
- application/pdf
- image/png
- image/jpeg
- text/plain
- text/csv
- application/vnd.openxmlformats-officedocument.wordprocessingml.document
- application/vnd.openxmlformats-officedocument.spreadsheetml.sheet
attachment_type:
$ref: '#/components/schemas/type_encounter-attachments/v1:EncounterAttachmentType'
required:
- attachment_file
- attachment_type
delete:
operationId: delete
summary: Delete Encounter Attachment
tags:
- subpackage_encounter-attachments.subpackage_encounter-attachments/v1
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
requestBody:
content:
application/json:
schema:
type: object
properties:
attachment_id:
$ref: '#/components/schemas/type_encounter-attachments/v1:AttachmentId'
required:
- attachment_id
/api/encounter-attachments/v1/{encounter_id}/v2:
put:
operationId: create-with-description
summary: Create Encounter Attachment V2
description: |-
Uploads a file to the encounter. The file will be stored in the
encounter's attachments.
tags:
- subpackage_encounter-attachments.subpackage_encounter-attachments/v1
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_encounter-attachments/v1:AttachmentId'
requestBody:
content:
multipart/form-data:
schema:
type: object
properties:
attachment_file:
type: string
format: binary
description: |-
The file for upload. The maximum file size is 25MB. The allowed mime types are:
- application/pdf
- image/png
- image/jpeg
- text/plain
- text/csv
- application/vnd.openxmlformats-officedocument.wordprocessingml.document
- application/vnd.openxmlformats-officedocument.spreadsheetml.sheet
attachment_type:
$ref: '#/components/schemas/type_encounter-attachments/v1:EncounterAttachmentType'
description:
type: string
required:
- attachment_file
- attachment_type
/api/encounter-attachments/v1/create-from-charge-capture-external-id:
post:
operationId: create-with-charge-capture-external-id
summary: Create an Attachment from a Charge Capture external ID
description: >-
Uploads a file using an external identifier. For Charge Capture, the file will be associated with the Encounter
at Encounter creation time.
Note: Attachments created via this endpoint are not searchable via the get endpoint until they are associated
with an encounter.
tags:
- subpackage_encounter-attachments.subpackage_encounter-attachments/v1
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_encounter-attachments/v1:AttachmentId'
requestBody:
content:
multipart/form-data:
schema:
type: object
properties:
charge_capture_external_id:
type: string
attachment_file:
type: string
format: binary
description: |-
The file for upload. The maximum file size is 25MB. The allowed mime types are:
- application/pdf
- image/png
- image/jpeg
- text/plain
- text/csv
- application/vnd.openxmlformats-officedocument.wordprocessingml.document
- application/vnd.openxmlformats-officedocument.spreadsheetml.sheet
attachment_type:
$ref: '#/components/schemas/type_encounter-attachments/v1:EncounterAttachmentType'
description:
type: string
required:
- charge_capture_external_id
- attachment_file
- attachment_type
/api/encounter-attachments/v1/by-charge-capture-external-id/{charge_capture_external_id}:
get:
operationId: get-by-charge-capture-external-id
summary: Get Attachments by Charge Capture External ID
description: Returns all attachments associated with the given charge capture external ID.
tags:
- subpackage_encounter-attachments.subpackage_encounter-attachments/v1
parameters:
- name: charge_capture_external_id
in: path
required: true
schema:
type: string
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_encounter-attachments/v1:ChargeCaptureAttachment'
delete:
operationId: delete-by-charge-capture-external-id
summary: Delete Attachment by Charge Capture External ID
description: Deletes an attachment associated with the given charge capture external ID.
tags:
- subpackage_encounter-attachments.subpackage_encounter-attachments/v1
parameters:
- name: charge_capture_external_id
in: path
required: true
schema:
type: string
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
requestBody:
content:
application/json:
schema:
type: object
properties:
attachment_id:
$ref: '#/components/schemas/type_encounter-attachments/v1:AttachmentId'
required:
- attachment_id
/api/encounter-providers/v2/{encounter_id}:
patch:
operationId: update-referring-provider
summary: Update Referring Provider
tags:
- subpackage_encounter-providers.subpackage_encounter-providers/v2
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_encounter-providers/v2:EncounterProvider'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationsError
content:
type: array
items:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_encounter-providers/v2:ReferringProviderUpdate'
/api/encounter-providers/v2/{encounter_id}/initial-referring-provider:
patch:
operationId: update-initial-referring-provider
summary: Update Initial Referring Provider
tags:
- subpackage_encounter-providers.subpackage_encounter-providers/v2
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_encounter-providers/v2:EncounterProvider'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationsError
content:
type: array
items:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_encounter-providers/v2:InitialReferringProviderUpdate'
delete:
operationId: delete-initial-referring-provider
summary: Delete Initial Referring Provider
tags:
- subpackage_encounter-providers.subpackage_encounter-providers/v2
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'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
/api/encounter-providers/v2/{encounter_id}/supervising-provider:
patch:
operationId: update-supervising-provider
summary: Update Supervising Provider
tags:
- subpackage_encounter-providers.subpackage_encounter-providers/v2
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_encounter-providers/v2:EncounterProvider'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationsError
content:
type: array
items:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_encounter-providers/v2:SupervisingProviderUpdate'
delete:
operationId: delete-supervising-provider
summary: Delete Supervising Provider
tags:
- subpackage_encounter-providers.subpackage_encounter-providers/v2
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'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
/api/encounter-providers/v2/{service_line_id}/ordering-provider:
patch:
operationId: update-ordering-provider
summary: Update Ordering Provider
tags:
- subpackage_encounter-providers.subpackage_encounter-providers/v2
parameters:
- name: service_line_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:ServiceLineId'
- 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_encounter-providers/v2:EncounterProvider'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationsError
content:
type: array
items:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_encounter-providers/v2:OrderingProviderUpdate'
delete:
operationId: delete-ordering-provider
summary: Delete Ordering Provider
tags:
- subpackage_encounter-providers.subpackage_encounter-providers/v2
parameters:
- name: service_line_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:ServiceLineId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'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
/api/encounter-providers/v2/{encounter_id}/create-referring-provider:
post:
operationId: create-referring-provider
summary: Create Referring Provider
tags:
- subpackage_encounter-providers.subpackage_encounter-providers/v2
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_encounter-providers/v2:EncounterProvider'
'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
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EntityConflictError
content:
$ref: '#/components/schemas/type_commons:EntityConflictErrorMessage'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationsError
content:
type: array
items:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_encounter-providers/v2:ReferringProvider'
/api/encounter-providers/v2/{encounter_id}/create-initial-referring-provider:
post:
operationId: create-initial-referring-provider
summary: Create Initial Referring Provider
tags:
- subpackage_encounter-providers.subpackage_encounter-providers/v2
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_encounter-providers/v2:EncounterProvider'
'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
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EntityConflictError
content:
$ref: '#/components/schemas/type_commons:EntityConflictErrorMessage'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationsError
content:
type: array
items:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_encounter-providers/v2:InitialReferringProvider'
/api/encounter-providers/v2/{encounter_id}/create-supervising-provider:
post:
operationId: create-supervising-provider
summary: Create Supervising Provider
tags:
- subpackage_encounter-providers.subpackage_encounter-providers/v2
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_encounter-providers/v2:EncounterProvider'
'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
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EntityConflictError
content:
$ref: '#/components/schemas/type_commons:EntityConflictErrorMessage'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationsError
content:
type: array
items:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_encounter-providers/v2:SupervisingProvider'
/api/encounter-providers/v2/{service_line_id}/create-ordering-provider:
post:
operationId: create-ordering-provider
summary: Create Ordering Provider
tags:
- subpackage_encounter-providers.subpackage_encounter-providers/v2
parameters:
- name: service_line_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:ServiceLineId'
- 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_encounter-providers/v2:EncounterProvider'
'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
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EntityConflictError
content:
$ref: '#/components/schemas/type_commons:EntityConflictErrorMessage'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationsError
content:
type: array
items:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_encounter-providers/v2:OrderingProvider'
/api/encounter-providers/v2/{encounter_id}/referring-provider:
delete:
operationId: delete-referring-provider
summary: Delete Referring Provider
tags:
- subpackage_encounter-providers.subpackage_encounter-providers/v2
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'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
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EntityConflictError
content:
$ref: '#/components/schemas/type_commons:EntityConflictErrorMessage'
required:
- errorName
- content
/api/encounter-supplemental-information/v1/{encounter_id}:
get:
operationId: get
summary: Get Encounter Supplemental Information
tags:
- subpackage_encounter-supplemental-information.subpackage_encounter-supplemental-information/v1
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_encounter-supplemental-information/v1:SupplementalInformation'
put:
operationId: create
summary: Create Encounter Supplemental Information
tags:
- subpackage_encounter-supplemental-information.subpackage_encounter-supplemental-information/v1
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_encounter-supplemental-information/v1:SupplementalInformation'
'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:
$ref: '#/components/schemas/type_encounter-supplemental-information/v1:CreateSupplementalInformationRequest'
/api/encounter-supplemental-information/v1/{encounter_id}/{supplemental_information_id}:
patch:
operationId: update
summary: Update Encounter Supplemental Information
tags:
- subpackage_encounter-supplemental-information.subpackage_encounter-supplemental-information/v1
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- name: supplemental_information_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_encounter-supplemental-information/v1:SupplementalInformationId'
- 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_encounter-supplemental-information/v1:SupplementalInformation'
'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:
$ref: '#/components/schemas/type_encounter-supplemental-information/v1:UpdateSupplementalInformationRequest'
delete:
operationId: delete
summary: Delete Encounter Supplemental Information
tags:
- subpackage_encounter-supplemental-information.subpackage_encounter-supplemental-information/v1
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- name: supplemental_information_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_encounter-supplemental-information/v1:SupplementalInformationId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'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
/api/encounters/v4:
get:
operationId: get-all
summary: Get all encounters
tags:
- subpackage_encounters.subpackage_encounters/v4
parameters:
- name: limit
in: query
description: Maximum number of entities per page, defaults to 100.
required: false
schema:
type: integer
- name: claim_status
in: query
description: Indicates the current status of an insurance claim within the billing process.
required: false
schema:
$ref: '#/components/schemas/type_claims:ClaimStatus'
- name: sort
in: query
description: Defaults to created_at:desc.
required: false
schema:
$ref: '#/components/schemas/type_encounters/v4:EncounterSortOptions'
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- name: date_of_service_min
in: query
description: 'Date formatted as YYYY-MM-DD; eg: 2019-08-25.'
required: false
schema:
type: string
format: date
- name: date_of_service_max
in: query
description: 'Date formatted as YYYY-MM-DD; eg: 2019-08-25.'
required: false
schema:
type: string
format: date
- name: primary_payer_names
in: query
description: Comma delimited string.
required: false
schema:
type: string
- name: search_term
in: query
description: |-
Filter by any of the following fields: encounter_id, claim_id, patient external_id,
patient date of birth, patient first name, patient last name,
or encounter external id.
required: false
schema:
type: string
- name: external_id
in: query
description: Filter to an exact match on encounter external_id, if one exists.
required: false
schema:
$ref: '#/components/schemas/type_commons:EncounterExternalId'
- name: diagnoses_updated_since
in: query
description: 'ISO 8601 timestamp; ideally in UTC (although not required): 2019-08-24T14:15:22Z.'
required: false
schema:
type: string
format: date-time
- name: tag_ids
in: query
description: Filter by name of tags on encounters.
required: false
schema:
$ref: '#/components/schemas/type_tags:TagId'
- name: work_queue_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:WorkQueueId'
- name: billable_status
in: query
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.
required: false
schema:
$ref: '#/components/schemas/type_encounters/v4:BillableStatusType'
- name: responsible_party
in: query
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.
required: false
schema:
$ref: '#/components/schemas/type_encounters/v4:ResponsiblePartyType'
- name: owner_of_next_action
in: query
description: >-
The party who is responsible for taking the next action on an Encounter, as defined by ownership of open
Tasks.
required: false
schema:
$ref: '#/components/schemas/type_encounters/v4:EncounterOwnerOfNextActionType'
- name: patient_external_id
in: query
description: The patient ID from the external EMR platform for the patient
required: false
schema:
type: string
- name: include_merged_patient_data
in: query
description: If true and patient_external_id is set, then also include the encounters of all alternative patients.
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_encounters/v4:EncounterPage'
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationsError
content:
type: array
items:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
'500':
description: Error response with status 500
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- InternalError
content:
$ref: '#/components/schemas/type_commons:InternalErrorMessage'
required:
- errorName
- content
post:
operationId: create
summary: Create professional encounter
tags:
- subpackage_encounters.subpackage_encounters/v4
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_encounters/v4:Encounter'
'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
'422':
description: Raised for universal claims that fail to provider either an attending_provider or rendering_provider value
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EncounterRenderingOrAttendingProviderRequired
description: >-
Raised for universal claims that fail to provider either an attending_provider or
rendering_provider value
content:
$ref: '#/components/schemas/type_encounters/v4:EncounterRenderingOrAttendingProviderRequiredError'
description: >-
Raised for universal claims that fail to provider either an attending_provider or
rendering_provider value
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_encounters/v4:EncounterCreate'
/api/encounters/v4/{encounter_id}:
get:
operationId: get
summary: Get encounter
tags:
- subpackage_encounters.subpackage_encounters/v4
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_encounters/v4:Encounter'
patch:
operationId: update
summary: Update professional encounter
tags:
- subpackage_encounters.subpackage_encounters/v4
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_encounters/v4:Encounter'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- PayerPlanGroupPayerDoesNotMatchInsuranceCardHttpError
content:
$ref: '#/components/schemas/type_encounters/v4:PayerPlanGroupPayerDoesNotMatchInsuranceCardError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_encounters/v4:EncounterUpdate'
/api/encounters/v4/universal:
post:
operationId: create-universal
summary: Create institutional or professional encounter
description: |-
Notice: The UB-04 Data File, 2025, is copyrighted by American Hospital Association (AHA), Chicago, Illinois.
No portion of the THE UB-04 Data File, may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior
express, written consent of AHA.
tags:
- subpackage_encounters.subpackage_encounters/v4
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_encounters/v4:Encounter'
'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
'422':
description: Raised for universal claims that fail to provider either an attending_provider or rendering_provider value
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EncounterRenderingOrAttendingProviderRequired
description: >-
Raised for universal claims that fail to provider either an attending_provider or
rendering_provider value
content:
$ref: '#/components/schemas/type_encounters/v4:EncounterRenderingOrAttendingProviderRequiredError'
description: >-
Raised for universal claims that fail to provider either an attending_provider or
rendering_provider value
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_encounters-universal:UniversalEncounterCreate'
/api/encounters/v4/create-from-pre-encounter/universal:
post:
operationId: create-from-pre-encounter-patient-universal
summary: Create institutional or professional encounter from pre-encounter patient and appointment
description: >-
Create an encounter from a pre-encounter patient and appointment. This endpoint is intended to be used by
consumers who are managing
patients and appointments in the pre-encounter service and is currently under development. Consumers who are not
taking advantage
of the pre-encounter service should use the standard create endpoint.
The endpoint will create an encounter from the provided fields, pulling information from the provided patient
and appointment objects
where applicable. In particular, the following fields are populated from the patient and appointment objects:
- Patient
- Referring Provider
- Subscriber Primary
- Subscriber Secondary
- Referral Number
- Responsible Party
- Guarantor
Utilizing this endpoint opts you into automatic updating of the encounter when the patient or appointment is
updated, assuming the
encounter has not already been submitted or adjudicated.
Notice: The UB-04 Data File, 2025, is copyrighted by American Hospital Association (AHA), Chicago, Illinois.
No portion of the THE UB-04 Data File, may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior
express, written consent of AHA.
tags:
- subpackage_encounters.subpackage_encounters/v4
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_encounters/v4:Encounter'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- PayerPlanGroupPayerDoesNotMatchInsuranceCardHttpError
content:
$ref: '#/components/schemas/type_encounters/v4:PayerPlanGroupPayerDoesNotMatchInsuranceCardError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_encounters-universal:UniversalEncounterCreateFromPreEncounter'
/api/encounters/v4/create-from-pre-encounter:
post:
operationId: create-from-pre-encounter-patient
summary: Create professional encounter from pre-encounter patient and appointment
description: >-
Create an encounter from a pre-encounter patient and appointment. This endpoint is intended to be used by
consumers who are managing
patients and appointments in the pre-encounter service and is currently under development. Consumers who are not
taking advantage
of the pre-encounter service should use the standard create endpoint.
The endpoint will create an encounter from the provided fields, pulling information from the provided patient
and appointment objects
where applicable. In particular, the following fields are populated from the patient and appointment objects:
- Patient
- Referring Provider
- Subscriber Primary
- Subscriber Secondary
- Referral Number
- Responsible Party
- Guarantor
Utilizing this endpoint opts you into automatic updating of the encounter when the patient or appointment is
updated, assuming the
encounter has not already been submitted or adjudicated.
tags:
- subpackage_encounters.subpackage_encounters/v4
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_encounters/v4:Encounter'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- PayerPlanGroupPayerDoesNotMatchInsuranceCardHttpError
content:
$ref: '#/components/schemas/type_encounters/v4:PayerPlanGroupPayerDoesNotMatchInsuranceCardError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_encounters/v4:EncounterCreateFromPreEncounter'
/api/encounters/v4/{encounter_id}/universal:
patch:
operationId: update-universal
summary: Update institutional or professional encounter
description: |-
Notice: The UB-04 Data File, 2025, is copyrighted by American Hospital Association (AHA), Chicago, Illinois.
No portion of the THE UB-04 Data File, may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior
express, written consent of AHA.
tags:
- subpackage_encounters.subpackage_encounters/v4
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_encounters/v4:Encounter'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- PayerPlanGroupPayerDoesNotMatchInsuranceCardHttpError
content:
$ref: '#/components/schemas/type_encounters/v4:PayerPlanGroupPayerDoesNotMatchInsuranceCardError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_encounters-universal:UniversalEncounterUpdate'
/api/events/v1/:
get:
operationId: scan
summary: Scan
description: Scans the last 30 days of events. All results are sorted by created date, descending.
tags:
- subpackage_events.subpackage_events/v1
parameters:
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- name: limit
in: query
description: Number of events to return. Minimum value is 1, maximum is 100. Defaults to 10.
required: false
schema:
type: integer
- name: event_types
in: query
description: |-
Event types to filter on. Defaults to showing all event types.
| Event Type | Description |
|------------|-------------|
| `CandidApi.Encounter.Created` | When a new claim is created |
| `CandidApi.Encounter.StatusUpdated` | When a claim's status has been updated |
| `PreEncounter.Patient.Created` | When a new patient has been created |
| `PreEncounter.Patient.Updated` | When a patient's information has been updated |
| `PreEncounter.Coverage.Created` | When a new coverage has been created for a patient |
| `PreEncounter.Coverage.Updated` | When a patient's coverage has been updated |
| `PreEncounter.Tag.Created` | When a new tag has been created for a patient |
| `PreEncounter.Tag.Updated` | When a patient's tag has been updated |
required: false
schema:
type: string
- name: created_before
in: query
description: Filters for only events created before this time (inclusive).
required: false
schema:
type: string
format: date-time
- name: created_after
in: query
description: Filters for only events created after this time (inclusive).
required: false
schema:
type: string
format: date-time
- 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_events/v1:EventScanPage'
'400':
description: Error response with status 400
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- BadRequestError
content:
$ref: '#/components/schemas/type_commons:BadRequestErrorMessage'
required:
- errorName
- content
'500':
description: Error response with status 500
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- InternalError
content:
$ref: '#/components/schemas/type_commons:InternalErrorMessage'
required:
- errorName
- content
/api/events/v1/{event_id}:
get:
operationId: get
summary: Get
tags:
- subpackage_events.subpackage_events/v1
parameters:
- name: event_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_events/v1:EventId'
- 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_events/v1:Event'
'400':
description: Error response with status 400
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- BadRequestError
content:
$ref: '#/components/schemas/type_commons:BadRequestErrorMessage'
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
'500':
description: Error response with status 500
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- InternalError
content:
$ref: '#/components/schemas/type_commons:InternalErrorMessage'
required:
- errorName
- content
/api/exports/v3:
get:
operationId: get-exports
summary: Get exports
description: >-
API-based exports are in the process of being deprecated in favor of Candid Data Share and are not being offered
to new customers.
Please see the [Candid Data Share docs](https://docs.joincandidhealth.com/introduction/candid-data-share) for
more information.
Retrieve CSV-formatted reports on claim submissions and outcomes. This endpoint returns Export objects that
contain an
authenticated URL to a customer's reports with a 2min TTL. The schema for the CSV export can be found
[here](https://app.joincandidhealth.com/files/exports_schema.csv).
**Schema changes:** Changing column order, removing columns, or changing the name of a column is considered a
[Breaking Change](../../../api-principles/breaking-changes). Adding new columns to the end of the Exports file
is not considered a
Breaking Change and happens periodically. For this reason, it is important that any downstream automation or
processes built on top
of Candid Health's export files be resilient to the addition of new columns at the end of the file.
**SLA guarantees:** Files for a given date are guaranteed to be available after 3 business days. For example,
Friday's file will be
available by Wednesday at the latest. If file generation is still in progress upon request before 3 business
days have passed, the
caller will receive a 422 response. If the file has already been generated, it will be served. Historic files
should be available
up to 90 days in the past by default. Please email our [Support team](mailto:support@joincandidhealth.com) with
any data requests
outside of these stated guarantees.
tags:
- subpackage_exports.subpackage_exports/v3
parameters:
- name: start_date
in: query
description: |-
Beginning date of claim versions returned in the export, ISO 8601 date e.g. 2019-08-24.
Must be at least 1 calendar day in the past. Cannot be earlier than 2022-10-07.
required: true
schema:
type: string
format: date
- name: end_date
in: query
description: |-
Ending date of claim versions returned in the export, ISO 8601 date; e.g. 2019-08-24.
Must be within 30 days of start_date.
required: true
schema:
type: string
format: date
- 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_exports/v3:GetExportsResponse'
'403':
description: Error response with status 403
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- ExportDisabledError
content:
$ref: '#/components/schemas/type_commons:ErrorMessage'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnsupportedExportWindowError
content:
$ref: '#/components/schemas/type_commons:ErrorMessage'
required:
- errorName
- content
'503':
description: Error response with status 503
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- MissingDailyIncrementalExportFileError
content:
$ref: '#/components/schemas/type_commons:ErrorMessage'
required:
- errorName
- content
/api/external-payment-account-config/v1:
get:
operationId: get-multi
summary: Get Multi
tags:
- subpackage_external-payment-account-config.subpackage_external-payment-account-config/v1
parameters:
- name: limit
in: query
description: Defaults to 100
required: false
schema:
type: integer
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- 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_external-payment-account-config/v1:ExternalPaymentAccountConfigPage'
/api/fee-schedules/v3/service-line/{service_line_id}/match:
get:
operationId: get-match
summary: Get Match
description: >-
Gets the rate that matches a service line. No result means no rate exists matching the service line's
dimensions.
tags:
- subpackage_fee-schedules.subpackage_fee-schedules/v3
parameters:
- name: service_line_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:ServiceLineId'
- 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_fee-schedules/v3:MatchResult'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- FailedToBuildServiceLineDimensions
content:
$ref: '#/components/schemas/type_commons:ErrorMessage'
required:
- errorName
- content
/api/fee-schedules/v3/service-line/{service_line_id}/match/{rate_id}:
get:
operationId: test-match
summary: Test Match
description: Tests a service line against a rate to see if it matches.
tags:
- subpackage_fee-schedules.subpackage_fee-schedules/v3
parameters:
- name: service_line_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:ServiceLineId'
- name: rate_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:RateId'
- 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_fee-schedules/v3:MatchTestResult'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- FailedToBuildServiceLineDimensions
content:
$ref: '#/components/schemas/type_commons:ErrorMessage'
required:
- errorName
- content
/api/fee-schedules/v3:
get:
operationId: get-multi
summary: Get Multi
description: >-
Gets a list of dimensions with their rates. The rates returned will always be the most recent versions of those
rates.
tags:
- subpackage_fee-schedules.subpackage_fee-schedules/v3
parameters:
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- name: limit
in: query
description: Max number of dimensions returned. Defaults to 100. Max is 100.
required: false
schema:
type: integer
- name: active_date
in: query
required: false
schema:
type: string
format: date
- name: payer_uuid
in: query
required: false
schema:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
- name: organization_billing_provider_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderId'
- name: states
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:State'
- name: zip_codes
in: query
required: false
schema:
type: string
- name: license_types
in: query
required: false
schema:
$ref: '#/components/schemas/type_organization-providers/v2:LicenseType'
- name: facility_type_codes
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:FacilityTypeCode'
- name: network_types
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:NetworkType'
- name: payer_plan_group_ids
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PayerPlanGroupId'
- name: cpt_code
in: query
required: false
schema:
type: string
- name: modifiers
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:ProcedureModifier'
- 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_fee-schedules/v3:RatesPage'
post:
operationId: upload-fee-schedule
summary: Upload a fee schedule (a collection of rates)
description: >-
Uploads a new fee schedule.
Each rate may either be totally new as qualified by it's dimensions or a new version for an existing rate.
If adding a new version to an existing rate, the rate must be posted with the next version number (previous
version + 1) or a EntityConflictError will
be returned.
Use the dry run flag to discover already existing rates and to run validations. If validations for any rate
fail, no rates will
be saved to the system.
tags:
- subpackage_fee-schedules.subpackage_fee-schedules/v3
parameters:
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_fee-schedules/v3:Rate'
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- FeeScheduleValidationHttpError
content:
type: array
items:
$ref: '#/components/schemas/type_fee-schedules/v3:RateUploadWithPossibleErrors'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
dry_run:
type: boolean
rates:
type: array
items:
$ref: '#/components/schemas/type_fee-schedules/v3:RateUpload'
required:
- dry_run
- rates
/api/fee-schedules/v3/unique-dimension-values:
get:
operationId: get-unique-values-for-dimension
summary: Get Unique Values For Dimension
description: >-
Gets unique values for a dimension based on other selection criteria. The response is a list of dimensions with
your criteria and the unique values populated. This API is useful for driving pivots on dimension values.
tags:
- subpackage_fee-schedules.subpackage_fee-schedules/v3
parameters:
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- name: limit
in: query
description: Max number of values returned. Defaults to 1000. Max is 1000.
required: false
schema:
type: integer
- name: pivot_dimension
in: query
description: The name of the dimension to fetch unique values for.
required: true
schema:
$ref: '#/components/schemas/type_fee-schedules/v3:DimensionName'
- name: payer_uuid
in: query
required: false
schema:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
- name: organization_billing_provider_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderId'
- name: states
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:State'
- name: zip_codes
in: query
required: false
schema:
type: string
- name: license_types
in: query
required: false
schema:
$ref: '#/components/schemas/type_organization-providers/v2:LicenseType'
- name: facility_type_codes
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:FacilityTypeCode'
- name: network_types
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:NetworkType'
- name: payer_plan_group_ids
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PayerPlanGroupId'
- name: cpt_code
in: query
required: false
schema:
type: string
- name: modifiers
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:ProcedureModifier'
- 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_fee-schedules/v3:DimensionsPage'
/api/fee-schedules/v3/{rate_id}/history:
get:
operationId: get-rate-history
summary: Get Rate History
description: Gets every version of a rate.
tags:
- subpackage_fee-schedules.subpackage_fee-schedules/v3
parameters:
- name: rate_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:RateId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: array
items:
$ref: '#/components/schemas/type_fee-schedules/v3:Rate'
'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
/api/fee-schedules/v3/{rate_id}/{version}:
delete:
operationId: delete-rate
summary: Delete a rate
description: Soft deletes a rate from the system. Only the most recent version of a rate can be deleted.
tags:
- subpackage_fee-schedules.subpackage_fee-schedules/v3
parameters:
- name: rate_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:RateId'
- name: version
in: path
required: true
schema:
type: integer
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'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
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EntityConflictError
content:
$ref: '#/components/schemas/type_commons:EntityConflictErrorMessage'
required:
- errorName
- content
/api/fee-schedules/v3/payer-threshold/default:
get:
operationId: get-payer-thresholds-default
summary: Get Payer Thresholds Default
description: Gets the default payer threshold
tags:
- subpackage_fee-schedules.subpackage_fee-schedules/v3
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_fee-schedules/v3:PayerThreshold'
/api/fee-schedules/v3/payer-threshold:
get:
operationId: get-payer-thresholds
summary: Get Payer Thresholds
description: Gets a list of payers and thresholds by their uuids
tags:
- subpackage_fee-schedules.subpackage_fee-schedules/v3
parameters:
- name: payer_uuids
in: query
required: true
schema:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
- 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_fee-schedules/v3:PayerThresholdsPage'
/api/fee-schedules/v3/payer-threshold/{payer_uuid}:
put:
operationId: set-payer-threshold
summary: Set Payer Threshold
description: Sets the threshold information for a payer
tags:
- subpackage_fee-schedules.subpackage_fee-schedules/v3
parameters:
- name: payer_uuid
in: path
required: true
schema:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
- 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_fee-schedules/v3:PayerThreshold'
'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:
$ref: '#/components/schemas/type_fee-schedules/v3:PayerThreshold'
/api/fee-schedules/v3/hard-delete:
post:
operationId: hard-delete-rates
summary: Hard delete rates
description: >-
Hard deletes rates from the system that match the provided dimensions. This is a destructive operation and
cannot be undone. If an empty dimensions object is provided, all rates will be hard deleted. The maximum
number of rates this API will delete at a time is 10000. Returns the number of rates deleted and if that number
is the maximum, the caller should call this API again to continue deleting rates.
tags:
- subpackage_fee-schedules.subpackage_fee-schedules/v3
parameters:
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: integer
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_fee-schedules/v3:OptionalDimensions'
/api/fee-schedules/v3/hard-delete-by-ids:
post:
operationId: hard-delete-rates-by-ids
summary: Hard delete rates by IDs
description: >-
Hard deletes specific rates from the system by their IDs. This is a destructive operation and cannot be undone.
Limited to 100 rate IDs maximum per request. For bulk deletion of more than 100 rates, use the hard_delete_rates
endpoint with dimension filters. Returns the number of rates deleted.
tags:
- subpackage_fee-schedules.subpackage_fee-schedules/v3
parameters:
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Response with status 200
content:
application/json:
schema:
type: integer
requestBody:
content:
application/json:
schema:
type: object
properties:
rate_ids:
type: array
items:
$ref: '#/components/schemas/type_commons:RateId'
required:
- rate_ids
/api/guarantors/v1/{encounter_id}:
post:
operationId: create
summary: Create guarantor
description: Creates a new guarantor and returns the newly created Guarantor object.
tags:
- subpackage_guarantor.subpackage_guarantor/v1
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_guarantor/v1:Guarantor'
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EncounterHasExistingGuarantorError
content:
$ref: '#/components/schemas/type_guarantor/v1:EncounterHasExistingGuarantorErrorType'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationsError
content:
type: array
items:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_guarantor/v1:GuarantorCreate'
/api/guarantors/v1/{guarantor_id}:
get:
operationId: get
summary: Get guarantor
description: Retrieves a guarantor by its `guarantor_id`.
tags:
- subpackage_guarantor.subpackage_guarantor/v1
parameters:
- name: guarantor_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_guarantor/v1:GuarantorId'
- 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_guarantor/v1:Guarantor'
patch:
operationId: update
summary: Update guarantor
description: Updates a guarantor by its `guarantor_id`.
tags:
- subpackage_guarantor.subpackage_guarantor/v1
parameters:
- name: guarantor_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_guarantor/v1:GuarantorId'
- 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_guarantor/v1:Guarantor'
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_guarantor/v1:GuarantorUpdate'
/api/health-care-code-informations/v1/{encounter_id}:
put:
operationId: update
summary: Update
tags:
- subpackage_health-care-code-information.subpackage_health-care-code-information/v1
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_health-care-code-information/v1:HealthCareCodeInformationGetAllResponse'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationError
content:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_health-care-code-information/v1:HealthCareCodeInformationUpdate'
get:
operationId: get-all-for-encounter
summary: Get All For Encounter
tags:
- subpackage_health-care-code-information.subpackage_health-care-code-information/v1
parameters:
- name: encounter_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- 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_health-care-code-information/v1:HealthCareCodeInformationGetAllResponse'
'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
/api/insurance-adjudications/v1/{insurance_adjudication_id}:
get:
operationId: get
summary: Get insurance adjudication
description: Retrieves a previously created insurance adjudication by its `insurance_adjudication_id`.
tags:
- subpackage_insurance-adjudications.subpackage_insurance-adjudications/v1
parameters:
- name: insurance_adjudication_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_insurance-adjudications/v1:InsuranceAdjudicationId'
- 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_insurance-adjudications/v1:InsuranceAdjudication'
'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
/api/insurance-refunds/v1:
get:
operationId: get-multi
summary: Get insurance refunds
description: |-
Returns all insurance refunds satisfying the search criteria AND whose organization_id matches
the current organization_id of the authenticated user.
tags:
- subpackage_insurance-refunds.subpackage_insurance-refunds/v1
parameters:
- name: limit
in: query
description: Defaults to 100. The value must be greater than 0 and less than 1000.
required: false
schema:
type: integer
- name: payer_uuid
in: query
required: false
schema:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
- name: claim_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:ClaimId'
- name: service_line_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:ServiceLineId'
- name: billing_provider_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:ProviderId'
- name: sort
in: query
description: Defaults to refund_timestamp
required: false
schema:
$ref: '#/components/schemas/type_insurance-refunds/v1:InsuranceRefundSortField'
- 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: 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_insurance-refunds/v1:InsuranceRefundsPage'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
post:
operationId: create
summary: Create insurance refund
description: |-
Creates a new insurance refund record and returns the newly created `InsuranceRefund` object.
The allocations can describe whether the refund is being applied toward a specific service line,
claim, or billing provider.
tags:
- subpackage_insurance-refunds.subpackage_insurance-refunds/v1
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_insurance-refunds/v1:InsuranceRefund'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_insurance-refunds/v1:InsuranceRefundCreate'
/api/insurance-refunds/v1/{insurance_refund_id}:
get:
operationId: get
summary: Get insurance refund
description: |-
Retrieves a previously created insurance refund by its `insurance_refund_id`.
If the refund does not exist, a `403` will be thrown.
tags:
- subpackage_insurance-refunds.subpackage_insurance-refunds/v1
parameters:
- name: insurance_refund_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_insurance-refunds/v1:InsuranceRefundId'
- 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_insurance-refunds/v1:InsuranceRefund'
'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
patch:
operationId: update
summary: Update
description: |-
Updates the patient refund record matching the provided insurance_refund_id. If updating the refund amount,
then the allocations must be appropriately updated as well.
tags:
- subpackage_insurance-refunds.subpackage_insurance-refunds/v1
parameters:
- name: insurance_refund_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_insurance-refunds/v1:InsuranceRefundId'
- 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_insurance-refunds/v1:InsuranceRefund'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
refund_timestamp:
type: string
format: date-time
refund_note:
$ref: '#/components/schemas/type_financials:NoteUpdate'
refund_reason:
$ref: '#/components/schemas/type_financials:RefundReasonUpdate'
delete:
operationId: delete
summary: Delete insurance refund
description: |-
Deletes the insurance refund record matching the provided `insurance_refund_id`.
If the matching record's organization_id does not match the authenticated user's
current organization_id, then a response code of `403` will be returned.
tags:
- subpackage_insurance-refunds.subpackage_insurance-refunds/v1
parameters:
- name: insurance_refund_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_insurance-refunds/v1:InsuranceRefundId'
- 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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
/api/medication-dispense/v1:
post:
operationId: create
summary: Medication Dispense Create
tags:
- subpackage_medication-dispense.subpackage_medication-dispense/v1
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_encounters/v4:Encounter'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- InvalidTagNamesError
content:
$ref: '#/components/schemas/type_encounters/v4:InvalidTagNamesErrorType'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_medication-dispense/v1:MedicationDispenseCreate'
/api/non-insurance-payer-payments/v1:
get:
operationId: get-multi
summary: Get non-insurance payer payments
description: Returns all non-insurance payer payments
tags:
- subpackage_non-insurance-payer-payments.subpackage_non-insurance-payer-payments/v1
parameters:
- name: limit
in: query
description: Defaults to 100. The value must be greater than 0 and less than 1000.
required: false
schema:
type: integer
- name: non_insurance_payer_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerId'
- name: check_number
in: query
required: false
schema:
type: string
- name: invoice_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:InvoiceId'
- name: sort
in: query
description: Defaults to refund_timestamp
required: false
schema:
$ref: '#/components/schemas/type_non-insurance-payer-payments/v1:NonInsurancePayerPaymentSortField'
- 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: 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_non-insurance-payer-payments/v1:NonInsurancePayerPaymentsPage'
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
post:
operationId: create
summary: Create non-insurance payer payment
tags:
- subpackage_non-insurance-payer-payments.subpackage_non-insurance-payer-payments/v1
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_non-insurance-payer-payments/v1:NonInsurancePayerPayment'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_non-insurance-payer-payments/v1:NonInsurancePayerPaymentCreate'
/api/non-insurance-payer-payments/v1/{non_insurance_payer_payment_id}:
get:
operationId: get
summary: Get non-insurance payer payment
description: Retrieves a previously created non-insurance payer payment by its `non_insurance_payer_payment_id`.
tags:
- subpackage_non-insurance-payer-payments.subpackage_non-insurance-payer-payments/v1
parameters:
- name: non_insurance_payer_payment_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_non-insurance-payer-payments/v1:NonInsurancePayerPaymentId'
- 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_non-insurance-payer-payments/v1:NonInsurancePayerPayment'
'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
patch:
operationId: update
summary: Update
tags:
- subpackage_non-insurance-payer-payments.subpackage_non-insurance-payer-payments/v1
parameters:
- name: non_insurance_payer_payment_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_non-insurance-payer-payments/v1:NonInsurancePayerPaymentId'
- 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_non-insurance-payer-payments/v1:NonInsurancePayerPayment'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
payment_timestamp:
type: string
format: date-time
payment_note:
$ref: '#/components/schemas/type_financials:NoteUpdate'
invoice_id:
$ref: '#/components/schemas/type_financials:InvoiceUpdate'
delete:
operationId: delete
summary: Delete non-insurance payer payment
description: Deletes the non-insurance payer payment record matching the provided `non_insurance_payer_payment_id`.
tags:
- subpackage_non-insurance-payer-payments.subpackage_non-insurance-payer-payments/v1
parameters:
- name: non_insurance_payer_payment_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_non-insurance-payer-payments/v1:NonInsurancePayerPaymentId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
/api/non-insurance-payer-refunds/v1:
get:
operationId: get-multi
summary: Get non-insurance payer refunds refunds
description: Returns all non-insurance payer refunds satisfying the search criteria
tags:
- subpackage_non-insurance-payer-refunds.subpackage_non-insurance-payer-refunds/v1
parameters:
- name: limit
in: query
description: Defaults to 100. The value must be greater than 0 and less than 1000.
required: false
schema:
type: integer
- name: non_insurance_payer_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerId'
- name: check_number
in: query
required: false
schema:
type: string
- name: invoice_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:InvoiceId'
- name: sort
in: query
description: Defaults to refund_timestamp
required: false
schema:
$ref: '#/components/schemas/type_non-insurance-payer-refunds/v1:NonInsurancePayerRefundSortField'
- 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: 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_non-insurance-payer-refunds/v1:NonInsurancePayerRefundsPage'
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
post:
operationId: create
summary: Create non-insurance payer refund
description: |-
Creates a new non-insurance payer refund record and returns the newly created `NonInsurancePayerRefund` object.
The allocations can describe whether the refund is being applied toward a specific service line,
claim, or billing provider.
tags:
- subpackage_non-insurance-payer-refunds.subpackage_non-insurance-payer-refunds/v1
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_non-insurance-payer-refunds/v1:NonInsurancePayerRefund'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_non-insurance-payer-refunds/v1:NonInsurancePayerRefundCreate'
/api/non-insurance-payer-refunds/v1/{non_insurance_payer_refund_id}:
get:
operationId: get
summary: Get non-insurance payer refund
description: Retrieves a previously created non-insurance payer refund by its `non_insurance_payer_refund_id`.
tags:
- subpackage_non-insurance-payer-refunds.subpackage_non-insurance-payer-refunds/v1
parameters:
- name: non_insurance_payer_refund_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_non-insurance-payer-refunds/v1:NonInsurancePayerRefundId'
- 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_non-insurance-payer-refunds/v1:NonInsurancePayerRefund'
'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
patch:
operationId: update
summary: Update
description: >-
Updates the non-insurance payer refund record matching the provided non_insurance_payer_refund_id. If updating
the refund amount,
then the allocations must be appropriately updated as well.
tags:
- subpackage_non-insurance-payer-refunds.subpackage_non-insurance-payer-refunds/v1
parameters:
- name: non_insurance_payer_refund_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_non-insurance-payer-refunds/v1:NonInsurancePayerRefundId'
- 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_non-insurance-payer-refunds/v1:NonInsurancePayerRefund'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
refund_timestamp:
type: string
format: date-time
refund_note:
$ref: '#/components/schemas/type_financials:NoteUpdate'
refund_reason:
$ref: '#/components/schemas/type_financials:RefundReasonUpdate'
invoice_id:
$ref: '#/components/schemas/type_financials:InvoiceUpdate'
delete:
operationId: delete
summary: Delete non-insurance payer refund
description: Deletes the non-insurance payer refund record matching the provided `non_insurance_payer_refund_id`.
tags:
- subpackage_non-insurance-payer-refunds.subpackage_non-insurance-payer-refunds/v1
parameters:
- name: non_insurance_payer_refund_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_non-insurance-payer-refunds/v1:NonInsurancePayerRefundId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
/api/non-insurance-payers/v1:
post:
operationId: create
summary: Create
tags:
- subpackage_non-insurance-payers.subpackage_non-insurance-payers/v1
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_non-insurance-payers/v1:NonInsurancePayer'
'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
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EntityConflictError
content:
$ref: '#/components/schemas/type_commons:EntityConflictErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_non-insurance-payers/v1:CreateNonInsurancePayerRequest'
get:
operationId: get-multi
summary: Get Multi
tags:
- subpackage_non-insurance-payers.subpackage_non-insurance-payers/v1
parameters:
- name: name
in: query
required: false
schema:
type: string
- name: category
in: query
description: Fuzzy-match category names of non-insurance payers.
required: false
schema:
type: string
- name: categories_exact
in: query
description: |-
Filter by one or more categories by name.
When multiple are present, non-insurance payers with any of the specified
categories will be matched.
required: false
schema:
type: string
- name: clinical_trial_ids
in: query
description: |-
Filter by one or more clinical trials by their `clinical_trial_id`.
When multiple are present, non-insurance payers with any of the specified
clinical trials will be matched.
required: false
schema:
$ref: '#/components/schemas/type_commons:ClinicalTrialId'
- name: enabled
in: query
required: false
schema:
type: boolean
- name: sort
in: query
required: false
schema:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerSortField'
- name: sort_direction
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:SortDirection'
- name: limit
in: query
description: Defaults to 100
required: false
schema:
type: integer
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- name: organization_id
in: query
description: >-
Filter to a specific organization's non-insurance payers. If not provided, defaults to the requesting user's
organization.
required: false
schema:
$ref: '#/components/schemas/type_commons:OrganizationId'
- 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_non-insurance-payers/v1:NonInsurancePayerPage'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
/api/non-insurance-payers/v1/{non_insurance_payer_id}/toggle_enablement:
patch:
operationId: toggle-enablement
summary: Toggle Enablement
tags:
- subpackage_non-insurance-payers.subpackage_non-insurance-payers/v1
parameters:
- name: non_insurance_payer_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerId'
- 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_non-insurance-payers/v1:NonInsurancePayer'
'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:
$ref: '#/components/schemas/type_non-insurance-payers/v1:ToggleNonInsurancePayerEnablementRequest'
/api/non-insurance-payers/v1/categories:
get:
operationId: get-categories
summary: Get non-insurance payer categories
description: |-
Returns a paginated list of all non-insurance payer categories.
Non-insurance payer categories are simply strings and are not stored as a
separate object in Candid. They are created when added to at least one
non-insurance payer's `category` field and are deleted when there are no
longer any non-insurance payers that contain them.
tags:
- subpackage_non-insurance-payers.subpackage_non-insurance-payers/v1
parameters:
- name: search_term
in: query
description: Filters categories by fuzzy matching on name.
required: false
schema:
type: string
- name: limit
in: query
description: Limits the maximum number of categories that will be returned. Defaults to 100.
required: false
schema:
type: integer
- name: page_token
in: query
description: The page token to continue paging through a previous request.
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- 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_non-insurance-payers/v1:NonInsurancePayerCategoriesPage'
/api/non-insurance-payers/v1/{non_insurance_payer_id}:
get:
operationId: get
summary: Get
tags:
- subpackage_non-insurance-payers.subpackage_non-insurance-payers/v1
parameters:
- name: non_insurance_payer_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerId'
- name: organization_id
in: query
description: Organization context for cross-org access. If not provided, defaults to the requesting user's organization.
required: false
schema:
$ref: '#/components/schemas/type_commons:OrganizationId'
- 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_non-insurance-payers/v1:NonInsurancePayer'
'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
patch:
operationId: update
summary: Update
tags:
- subpackage_non-insurance-payers.subpackage_non-insurance-payers/v1
parameters:
- name: non_insurance_payer_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerId'
- 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_non-insurance-payers/v1:NonInsurancePayer'
'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
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EntityConflictError
content:
$ref: '#/components/schemas/type_commons:EntityConflictErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerUpdateRequest'
delete:
operationId: delete
summary: Delete
tags:
- subpackage_non-insurance-payers.subpackage_non-insurance-payers/v1
parameters:
- name: non_insurance_payer_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'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
/api/organization-providers/v3/{organization_provider_id}:
get:
operationId: get
summary: Get organization provider
tags:
- subpackage_organization-providers.subpackage_organization-providers/v3
parameters:
- name: organization_provider_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderId'
- 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_organization-providers/v3:OrganizationProviderV2'
'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
patch:
operationId: update
summary: Update organization provider
tags:
- subpackage_organization-providers.subpackage_organization-providers/v3
parameters:
- name: organization_provider_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderId'
- 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_organization-providers/v3:OrganizationProviderV2'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UpdatesDisabledDueToExternalSystemIntegrationError
content:
$ref: '#/components/schemas/type_commons:UpdatesDisabledDueToExternalSystemIntegrationErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_organization-providers/v3:OrganizationProviderUpdateV2'
/api/organization-providers/v3:
get:
operationId: get-multi
summary: Get all organization providers
tags:
- subpackage_organization-providers.subpackage_organization-providers/v3
parameters:
- name: limit
in: query
description: Limit the number of results returned. Defaults to 100.
required: false
schema:
type: integer
- name: search_term
in: query
description: Filter to a name or a part of a name.
required: false
schema:
type: string
- name: npi
in: query
description: Filter to a specific NPI.
required: false
schema:
type: string
- name: is_rendering
in: query
description: Filter to only rendering providers.
required: false
schema:
type: boolean
- name: is_billing
in: query
description: Filter to only billing providers.
required: false
schema:
type: boolean
- name: organization_provider_ids
in: query
description: Filter to the provided organization provider IDs.
required: false
schema:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderId'
- name: page_token
in: query
description: The page token to continue paging through a previous request.
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- name: sort
in: query
description: Defaults to PROVIDER_NAME_ASC.
required: false
schema:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderSortOptions'
- name: organization_id
in: query
description: >-
Filter to a specific organization's providers. If not provided, defaults to the requesting user's
organization.
required: false
schema:
$ref: '#/components/schemas/type_commons:OrganizationId'
- 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_organization-providers/v3:OrganizationProviderPageV2'
post:
operationId: create
summary: Create organization provider
tags:
- subpackage_organization-providers.subpackage_organization-providers/v3
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_organization-providers/v3:OrganizationProviderV2'
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UpdatesDisabledDueToExternalSystemIntegrationError
content:
$ref: '#/components/schemas/type_commons:UpdatesDisabledDueToExternalSystemIntegrationErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_organization-providers/v3:OrganizationProviderCreateV2'
/api/organization-service-facilities/v2/{organization_service_facility_id}:
get:
operationId: get
summary: Get organization service facility
tags:
- subpackage_organization-service-facilities.subpackage_organization-service-facilities/v2
parameters:
- name: organization_service_facility_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_organization-service-facilities/v2:OrganizationServiceFacilityId'
- 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_organization-service-facilities/v2:OrganizationServiceFacility'
'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
patch:
operationId: update
summary: Update organization service facility
tags:
- subpackage_organization-service-facilities.subpackage_organization-service-facilities/v2
parameters:
- name: organization_service_facility_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_organization-service-facilities/v2:OrganizationServiceFacilityId'
- 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_organization-service-facilities/v2:OrganizationServiceFacility'
'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
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EntityConflictError
content:
$ref: '#/components/schemas/type_commons:EntityConflictErrorMessage'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationError
content:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_organization-service-facilities/v2:OrganizationServiceFacilityUpdate'
delete:
operationId: delete
summary: Delete organization service facility
tags:
- subpackage_organization-service-facilities.subpackage_organization-service-facilities/v2
parameters:
- name: organization_service_facility_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_organization-service-facilities/v2:OrganizationServiceFacilityId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'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
/api/organization-service-facilities/v2:
get:
operationId: get-multi
summary: Get all organization service facilities
tags:
- subpackage_organization-service-facilities.subpackage_organization-service-facilities/v2
parameters:
- name: limit
in: query
description: Limit the number of results returned. Defaults to 100.
required: false
schema:
type: integer
- name: name
in: query
description: Filter to a name or a part of a name.
required: false
schema:
type: string
- name: organization_service_facility_ids
in: query
description: Filter to the provided organization service facility IDs.
required: false
schema:
$ref: '#/components/schemas/type_organization-service-facilities/v2:OrganizationServiceFacilityId'
- name: external_ids
in: query
description: Filter by one or more external_ids.
required: false
schema:
type: string
- name: place_of_service_code
in: query
description: Filter by Place of Service (POS) code.
required: false
schema:
$ref: '#/components/schemas/type_commons:FacilityTypeCode'
- name: page_token
in: query
description: The page token to continue paging through a previous request.
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- name: organization_id
in: query
description: >-
Filter to a specific organization's service facilities. If not provided, defaults to the requesting user's
organization.
required: false
schema:
$ref: '#/components/schemas/type_commons:OrganizationId'
- 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_organization-service-facilities/v2:OrganizationServiceFacilityPage'
post:
operationId: create
summary: Create organization service facility
tags:
- subpackage_organization-service-facilities.subpackage_organization-service-facilities/v2
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_organization-service-facilities/v2:OrganizationServiceFacility'
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EntityConflictError
content:
$ref: '#/components/schemas/type_commons:EntityConflictErrorMessage'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationError
content:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_organization-service-facilities/v2:OrganizationServiceFacilityCreate'
/api/organization-service-facilities/v2/external-id/{external_id}:
get:
operationId: get-by-external-id
summary: Get organization service facility by external_id
description: |-
Looks up a single organization service facility by its `external_id` field. This can be useful
for finding service facilities within Candid which are associated with service facilities in
an external system.
tags:
- subpackage_organization-service-facilities.subpackage_organization-service-facilities/v2
parameters:
- name: external_id
in: path
required: true
schema:
type: string
- 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_organization-service-facilities/v2:OrganizationServiceFacility'
'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
/api/payer-plan-groups/v1:
get:
operationId: get-multi
summary: Get payer plan groups
description: Returns all payer plan groups matching filter criteria.
tags:
- subpackage_payer-plan-groups.subpackage_payer-plan-groups/v1
parameters:
- name: plan_group_name
in: query
required: false
schema:
type: string
- name: payer_uuid
in: query
required: false
schema:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
- name: payer_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_payers/v3:PayerId'
- name: plan_type
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:SourceOfPaymentCode'
- name: is_active
in: query
required: false
schema:
type: boolean
- name: payer_plan_group_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PayerPlanGroupId'
- name: limit
in: query
description: Defaults to 100. Cannot exc
required: false
schema:
type: integer
- name: sort_by_similarity
in: query
description: >-
If this property is passed, the results will be ordered by those that contain a payer_id, payer_name,
plan_group_name, or
payer_address most similar to the value passed. This will take precedence over the sort and sort_direction
properties. This
will always sort in order of most similar to least similar.
required: false
schema:
type: string
- name: sort
in: query
description: >-
Defaults to plan_group_name. If sort_by_similarity is passed, that sort will takes precedence over this
property.
required: false
schema:
$ref: '#/components/schemas/type_payer-plan-groups/v1:PayerPlanGroupSortField'
- name: sort_direction
in: query
description: Sort direction. Defaults to ascending 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: organization_id
in: query
description: >-
Filter to a specific organization's payer plan groups. If not provided, defaults to the requesting user's
organization.
required: false
schema:
$ref: '#/components/schemas/type_commons:OrganizationId'
- 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_payer-plan-groups/v1:PayerPlanGroupPage'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
post:
operationId: create
summary: Create a payer plan group
description: Create a payer plan group
tags:
- subpackage_payer-plan-groups.subpackage_payer-plan-groups/v1
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_payer-plan-groups/v1:PayerPlanGroup'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- PayerPlanGroupAlreadyExistsHttpError
content:
$ref: '#/components/schemas/type_payer-plan-groups/v1:PayerPlanGroupAlreadyExistsError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_payer-plan-groups/v1:MutablePayerPlanGroup'
/api/payer-plan-groups/v1/{payer_plan_group_id}:
get:
operationId: get
summary: Get payer plan group
description: Return a plan group with a given ID.
tags:
- subpackage_payer-plan-groups.subpackage_payer-plan-groups/v1
parameters:
- name: payer_plan_group_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:PayerPlanGroupId'
- 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_payer-plan-groups/v1:PayerPlanGroup'
'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
put:
operationId: update
summary: Update payer plan group
description: Update any of the fields on a payer plan group
tags:
- subpackage_payer-plan-groups.subpackage_payer-plan-groups/v1
parameters:
- name: payer_plan_group_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:PayerPlanGroupId'
- 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_payer-plan-groups/v1:PayerPlanGroup'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- PayerPlanGroupAlreadyExistsHttpError
content:
$ref: '#/components/schemas/type_payer-plan-groups/v1:PayerPlanGroupAlreadyExistsError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_payer-plan-groups/v1:MutablePayerPlanGroup'
patch:
operationId: deactivate
summary: Delete payer plan group
description: Marks the payer plan group as deactivated
tags:
- subpackage_payer-plan-groups.subpackage_payer-plan-groups/v1
parameters:
- name: payer_plan_group_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:PayerPlanGroupId'
- 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_payer-plan-groups/v1:PayerPlanGroup'
'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
/api/payers/v3/{payer_uuid}:
get:
operationId: get
summary: Get payer
tags:
- subpackage_payers.subpackage_payers/v3
parameters:
- name: payer_uuid
in: path
required: true
schema:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
- 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_payers/v3:Payer'
/api/payers/v3:
get:
operationId: get-all
summary: Get all payers
tags:
- subpackage_payers.subpackage_payers/v3
parameters:
- name: limit
in: query
description: Maximum number of entities per page, defaults to 100.
required: false
schema:
type: integer
- name: search_term
in: query
required: false
schema:
type: string
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- 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_payers/v3:PayerPage'
/api/payers/v4/{payer_uuid}:
get:
operationId: get
summary: Get payer
tags:
- subpackage_payers.subpackage_payers/v4
parameters:
- name: payer_uuid
in: path
required: true
schema:
$ref: '#/components/schemas/type_payers/v4:PayerUuid'
- 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_payers/v4:Payer'
/api/payers/v4:
get:
operationId: get-all
summary: Get all payers
tags:
- subpackage_payers.subpackage_payers/v4
parameters:
- name: limit
in: query
description: Maximum number of entities per page, defaults to 100.
required: false
schema:
type: integer
- name: search_term
in: query
required: false
schema:
type: string
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- 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_payers/v4:PayerPage'
/api/service-lines/v2:
post:
operationId: create
summary: Create Service Line
tags:
- subpackage_service-lines.subpackage_service-lines/v2
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_service-lines/v2:ServiceLine'
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EntityConflictError
content:
$ref: '#/components/schemas/type_commons:EntityConflictErrorMessage'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationError
content:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_service-lines/v2:ServiceLineCreateStandalone'
/api/service-lines/v2/universal:
post:
operationId: create-universal
summary: Create Professional or Institutional Service Line
tags:
- subpackage_service-lines.subpackage_service-lines/v2
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_service-lines/v2:ServiceLine'
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EntityConflictError
content:
$ref: '#/components/schemas/type_commons:EntityConflictErrorMessage'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationError
content:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_service-lines/v2:UniversalServiceLineCreateStandalone'
/api/service-lines/v2/{service_line_id}/universal:
patch:
operationId: update-universal
summary: Update service line for encounter that may be institutional or professional.
tags:
- subpackage_service-lines.subpackage_service-lines/v2
parameters:
- name: service_line_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:ServiceLineId'
- 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_service-lines/v2:ServiceLine'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationError
content:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_service-lines/v2:UniversalServiceLineUpdate'
/api/service-lines/v2/{service_line_id}:
patch:
operationId: update
summary: Update Service Line
tags:
- subpackage_service-lines.subpackage_service-lines/v2
parameters:
- name: service_line_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:ServiceLineId'
- 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_service-lines/v2:ServiceLine'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- HttpRequestValidationError
content:
$ref: '#/components/schemas/type_commons:RequestValidationError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_service-lines/v2:ServiceLineUpdate'
delete:
operationId: delete
summary: Delete Service Line
tags:
- subpackage_service-lines.subpackage_service-lines/v2
parameters:
- name: service_line_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:ServiceLineId'
- 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
'409':
description: Error response with status 409
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- EntityConflictError
content:
$ref: '#/components/schemas/type_commons:EntityConflictErrorMessage'
required:
- errorName
- content
/api/superbill/v1:
post:
operationId: create-superbill
summary: Create Superbill
tags:
- subpackage_superbills.subpackage_superbills/v1
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_superbills/v1:SuperbillResponse'
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
type: object
properties:
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
description: Empty string not allowed
date_range_min:
type: string
format: date
description: Minimum (inclusive) date selected for the superbill
date_range_max:
type: string
format: date
description: Maximum (inclusive) date selected for the superbill
pay_to_address:
$ref: '#/components/schemas/type_commons:StreetAddressShortZip'
description: >-
Address that will be displayed on the superbill as the 'Pay to' Address. If not provided this value
will be set from available encounter data.
output_format:
$ref: '#/components/schemas/type_superbills/v1:SuperbillOutputFormat'
description: Output format for the superbill. Defaults to DOCX if not specified.
include_merged_patient_data:
type: boolean
description: If true will include claims from any alternative patients the given patient_external_id has.
required:
- patient_external_id
- date_range_min
- date_range_max
/api/tasks/v3/{task_id}/actions:
get:
operationId: get-actions
summary: Get task actions
tags:
- subpackage_tasks.subpackage_tasks/v3
parameters:
- name: task_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:TaskId'
- 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_tasks/v3:TaskActions'
/api/tasks/v3:
get:
operationId: get-multi
summary: Get all tasks
tags:
- subpackage_tasks.subpackage_tasks/v3
parameters:
- name: limit
in: query
description: Defaults to 100
required: false
schema:
type: integer
- name: page_token
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PageToken'
- name: status
in: query
required: false
schema:
$ref: '#/components/schemas/type_tasks/commons:TaskStatus'
- name: statuses
in: query
description: Only return tasks with a status that matches one in this comma-separated list.
required: false
schema:
type: string
- name: task_type
in: query
required: false
schema:
$ref: '#/components/schemas/type_tasks/commons:TaskType'
- name: task_types
in: query
description: Only return tasks with a task_type that matches one in this comma-separated list.
required: false
schema:
type: string
- name: categories
in: query
description: Only return tasks with categories that match one in this comma-separated list.
required: false
schema:
type: string
- name: updated_since
in: query
description: Only return tasks updated on or after this date-time
required: false
schema:
type: string
format: date-time
- name: encounter_id
in: query
description: Only return tasks associated with this encounter
required: false
schema:
$ref: '#/components/schemas/type_commons:EncounterId'
- name: search_term
in: query
description: Query tasks by encounter_id, claim_id, task_id, or external_id
required: false
schema:
type: string
- name: assigned_to_id
in: query
description: Only return tasks assigned to this user
required: false
schema:
$ref: '#/components/schemas/type_commons:UserId'
- name: date_of_service_min
in: query
description: The minimum date of service for the linked encounter
required: false
schema:
type: string
format: date
- name: date_of_service_max
in: query
description: The maximum date of service for the linked encounter
required: false
schema:
type: string
format: date
- name: billing_provider_npi
in: query
description: The NPI of the billing provider associated with the task's claim
required: false
schema:
type: string
- name: sort
in: query
description: Defaults to updated_at:desc
required: false
schema:
$ref: '#/components/schemas/type_tasks/v3:TaskSortOptions'
- 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_tasks/v3:TaskPage'
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- UnprocessableEntityError
content:
$ref: '#/components/schemas/type_commons:UnprocessableEntityErrorMessage'
required:
- errorName
- content
post:
operationId: create
summary: Create task
tags:
- subpackage_tasks.subpackage_tasks/v3
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_tasks/v3:Task'
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_tasks/v3:TaskCreateV3'
/api/tasks/v3/{task_id}:
get:
operationId: get
summary: Get task
tags:
- subpackage_tasks.subpackage_tasks/v3
parameters:
- name: task_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:TaskId'
- 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_tasks/v3:Task'
'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
patch:
operationId: update
summary: Update task
tags:
- subpackage_tasks.subpackage_tasks/v3
parameters:
- name: task_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:TaskId'
- 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_tasks/v3:Task'
'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
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- TaskUpdatedToDeprecatedStatusError
content:
$ref: '#/components/schemas/type_tasks/v3:TaskUpdatedToDeprecatedStatusErrorType'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_tasks/v3:TaskUpdateV3'
/api/write-offs/v1:
get:
operationId: get-multi
summary: Get all write-offs
description: Returns all write-offs satisfying the search criteria.
tags:
- subpackage_write-offs.subpackage_write-offs/v1
parameters:
- name: limit
in: query
description: Defaults to 100. The value must be greater than 0 and less than 1000.
required: false
schema:
type: integer
- name: patient_external_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:PatientExternalId'
- name: payer_uuid
in: query
required: false
schema:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
- name: service_line_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:ServiceLineId'
- name: claim_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:ClaimId'
- name: billing_provider_id
in: query
required: false
schema:
$ref: '#/components/schemas/type_commons:ProviderId'
- name: sort
in: query
description: Defaults to write_off_timestamp
required: false
schema:
$ref: '#/components/schemas/type_write-offs/v1:WriteOffSortField'
- 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: account_types
in: query
description: Filters the returned values to include only the provided account types.
required: false
schema:
$ref: '#/components/schemas/type_financials:AccountType'
- 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_write-offs/v1:WriteOffsPage'
post:
operationId: create
summary: Create write-off
description: |-
Creates one or many write-offs applied toward a specific service line,
claim, or billing provider.
tags:
- subpackage_write-offs.subpackage_write-offs/v1
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_write-offs/v1:CreateWriteOffsResponse'
requestBody:
content:
application/json:
schema:
type: object
properties:
write_offs:
type: array
items:
$ref: '#/components/schemas/type_write-offs/v1:WriteOffCreate'
required:
- write_offs
/api/write-offs/v1/{write_off_id}:
get:
operationId: get
summary: Get write-off
description: Retrieves a previously created write off by its `write_off_id`.
tags:
- subpackage_write-offs.subpackage_write-offs/v1
parameters:
- name: write_off_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_write-offs/v1:WriteOffId'
- 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_write-offs/v1:WriteOff'
/api/write-offs/v1/{write_off_id}/revert:
post:
operationId: revert
summary: Revert write-off
description: Reverts a write off given a `write_off_id`.
tags:
- subpackage_write-offs.subpackage_write-offs/v1
parameters:
- name: write_off_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_write-offs/v1:WriteOffId'
- 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_write-offs/v1:WriteOff'
/api/write-offs/v1/{adjustment_id}/revert:
post:
operationId: revert-insurance-balance-adjustment
summary: Revert Insurance Balance Adjustment
description: Reverts an Insurance Balance Adjustment given an `adjustment_id`
tags:
- subpackage_write-offs.subpackage_write-offs/v1
parameters:
- name: adjustment_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:AdjustmentId'
- 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_write-offs/v1:WriteOff'
/api/write-offs/v1/{adjustment_id}/revert-era-originated:
post:
operationId: revert-era-originated-insurance-balance-adjustment
summary: Revert ERA-originated Insurance Balance Adjustment
description: Reverts an ERA-originated Insurance Balance Adjustment given an `adjustment_id`
tags:
- subpackage_write-offs.subpackage_write-offs/v1
parameters:
- name: adjustment_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_commons:AdjustmentId'
- 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_commons:AdjustmentId'
/api/diagnoses/v2:
post:
operationId: create
summary: Create diagnosis
description: Creates a new diagnosis for an encounter
tags:
- subpackage_diagnoses
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_diagnoses:Diagnosis'
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/type_diagnoses:StandaloneDiagnosisCreate'
/api/diagnoses/v2/{diagnosis_id}:
patch:
operationId: update
summary: Update diagnosis
description: Updates the diagnosis record matching the provided `diagnosis_id`
tags:
- subpackage_diagnoses
parameters:
- name: diagnosis_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
- 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_diagnoses:Diagnosis'
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- DiagnosisNotFoundHTTPError
content:
$ref: '#/components/schemas/type_diagnoses:DiagnosisNotFoundError'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- DisallowMultiplePrimaryDiagnosisHTTPError
content:
$ref: '#/components/schemas/type_diagnoses:DisallowMultiplePrimaryDiagnosisError'
required:
- errorName
- content
requestBody:
content:
application/json:
schema:
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.
Should be of the appropriate format for the provided `code_type`.
Must obey the ICD-10 format if an ICD-10 code_type is provided, specifically:
- Letter
- Digit
- Digit or the letter `A` or `B`
- (Optional) Period `.`
- 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.
delete:
operationId: delete
summary: Delete diagnosis
description: Deletes the diagnosis record associated with the provided `diagnosis_id`
tags:
- subpackage_diagnoses
parameters:
- name: diagnosis_id
in: path
required: true
schema:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
- name: Authorization
in: header
description: OAuth authentication
required: true
schema:
type: string
responses:
'200':
description: Successful response
'404':
description: Error response with status 404
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- DiagnosisNotFoundHTTPError
content:
$ref: '#/components/schemas/type_diagnoses:DiagnosisNotFoundError'
required:
- errorName
- content
'422':
description: Error response with status 422
content:
application/json:
schema:
type: object
properties:
errorName:
type: string
enum:
- ServiceLinesMustHaveAtLeastOneDiagnosisHTTPError
content:
$ref: '#/components/schemas/type_diagnoses:ServiceLinesMustHaveAtLeastOneDiagnosisError'
required:
- errorName
- content
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
components:
schemas:
type_pre-encounter/eligibilityChecks/v1:IndividualProvider:
type: object
properties:
first_name:
type: string
last_name:
type: string
npi:
type: string
required:
- npi
title: IndividualProvider
type_pre-encounter/eligibilityChecks/v1:OrganizationProvider:
type: object
properties:
organization_name:
type: string
npi:
type: string
required:
- npi
title: OrganizationProvider
type_pre-encounter/eligibilityChecks/v1:Provider:
oneOf:
- $ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:IndividualProvider'
- $ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:OrganizationProvider'
title: Provider
type_pre-encounter/coverages/v1:MemberInfo:
type: object
properties:
member_id:
type: string
description: >-
Stedi requires that you supply at least one of these fields in the request: memberId, dateOfBirth, or
lastName.
However, each payer has different requirements, so you should supply as many of the fields necessary for
each payer
to identify the subscriber/dependent in their system.
first_name:
type: string
last_name:
type: string
date_of_birth:
type: string
format: date
description: >-
Stedi requires that you supply at least one of these fields in the request: memberId, dateOfBirth, or
lastName.
However, each payer has different requirements, so you should supply as many of the fields necessary for
each payer
to identify the subscriber/dependent in their system.
required:
- first_name
- last_name
title: MemberInfo
type_pre-encounter/eligibilityChecks/v1:Encounter:
type: object
properties:
date_of_service:
type: string
format: date
description: Defaults to the current date if not provided.
service_type_codes:
type: array
items:
type: string
description: >-
Defaults to HealthBenefitPlanCoverage (30) if not provided.
Not all payers support multiple service type codes, so it is recommended to only include a single code
per request.
title: Encounter
type_pre-encounter/eligibilityChecks/v1:EligibilityRequest:
type: object
properties:
submitter_transaction_identifier:
type: string
description: >-
A unique identifier for the eligibility check within the batch. Candid returns this identifier in the
response for the
/batch/{batch_id} polling endpoint so you can correlate benefit responses with the original eligibility
check.
payer_id:
type: string
description: Supported payer ID values can be found [here](https://www.stedi.com/healthcare/network).
provider:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:Provider'
subscriber:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:MemberInfo'
description: >-
The primary policyholder for the insurance plan or a dependent with a unique member ID. If a dependent
has a unique member ID, include their information here and leave dependent undefined.
dependent:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:MemberInfo'
description: >-
If a dependent has a unique member ID, include their information as subscriber and leave this field
undefined.
encounter:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:Encounter'
get_existing_check_initiated_after:
type: string
format: date-time
description: >-
If not provided, this endpoint will run a fresh eligibility check. If provided, it will return an existing
successful eligibility check if one exists that was initiated after provided date with the same parameters
(Date of Service, Payer ID, Provider, Subscriber, Dependent, and Encounter).
source:
type: string
portal_password:
type: string
description: The password that the provider uses to log in to the payer's portal. This is not commonly used.
portal_username:
type: string
description: The username that the provider uses to log in to the payer's portal. This is not commonly used.
required:
- payer_id
- provider
- subscriber
description: An object representing the data for an eligibility request.
title: EligibilityRequest
type_pre-encounter/eligibilityChecks/v1:EligibilityCheckErrorSource:
type: string
enum:
- CANDID
- STEDI
description: enum to represent the source of an error in an eligibility check
title: EligibilityCheckErrorSource
type_pre-encounter/eligibilityChecks/v1:EligibilityCheckErrorDetails:
type: object
properties:
field?:
type: string
description?:
type: string
location?:
type: string
possibleResolutions?:
type: string
code?:
type: string
followupAction?:
type: string
description: This object is our fern representation of Stedi's EligbilityCheckError object from their API.
title: EligibilityCheckErrorDetails
type_pre-encounter/eligibilityChecks/v1:EligibilityCheckError:
type: object
properties:
source:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityCheckErrorSource'
errorDetails:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityCheckErrorDetails'
required:
- source
- errorDetails
title: EligibilityCheckError
type_pre-encounter/eligibilityChecks/v1:EligibilityStatus:
type: string
enum:
- ACTIVE
- INACTIVE
- UNKNOWN
description: enum to represent the status of a patient's coverage
title: EligibilityStatus
type_pre-encounter/coverages/v1:PlanDate:
type: object
properties:
start_date:
type: string
format: date
end_date:
type: string
format: date
field_name:
type: string
required:
- start_date
- field_name
title: PlanDate
type_pre-encounter/coverages/v1:Address:
type: object
properties:
address1:
type: string
address2:
type: string
city:
type: string
state:
type: string
postal_code:
type: string
country_code:
type: string
country_sub_division_code:
type: string
title: Address
type_pre-encounter/coverages/v1:ExpandedMemberInfo:
type: object
properties:
member_id:
type: string
group_number:
type: string
first_name:
type: string
middle_name:
type: string
last_name:
type: string
date_of_birth:
type: string
gender:
type: string
address:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:Address'
title: ExpandedMemberInfo
type_pre-encounter/coverages/v1:PlanMetadata:
type: object
properties:
payer_name:
type: string
insurance_type:
type: string
insurance_type_code:
type: string
plan_name:
type: string
member_id:
type: string
group_number:
type: string
start_date:
type: string
format: date
end_date:
type: string
format: date
plan_dates:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:PlanDate'
subscriber:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:ExpandedMemberInfo'
dependent:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:ExpandedMemberInfo'
title: PlanMetadata
type_pre-encounter/coverages/v1:CoverageValue:
type: object
properties:
family:
type: number
format: double
individual:
type: number
format: double
employeeAndSpouse:
type: number
format: double
employeeAndChildren:
type: number
format: double
title: CoverageValue
type_pre-encounter/coverages/v1:PlanCoverageDetails:
type: object
properties:
deductible:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageValue'
deductible_contract:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageValue'
deductible_remaining:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageValue'
deductible_year_to_date:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageValue'
oop_max:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageValue'
oop_max_contract:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageValue'
oop_max_remaining:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageValue'
oop_max_year_to_date:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageValue'
additional_notes:
type: string
title: PlanCoverageDetails
type_pre-encounter/coverages/v1:BenefitType:
type: string
enum:
- DEDUCTIBLE
- DEDUCTIBLE_CONTRACT
- DEDUCTIBLE_REMAINING
- DEDUCTIBLE_YEAR_TO_DATE
- OOP_MAX
- OOP_MAX_CONTRACT
- OOP_MAX_REMAINING
- OOP_MAX_YEAR_TO_DATE
- COPAY
- COINSURANCE
- NON_COVERED
- LIMITATION
title: BenefitType
type_pre-encounter/coverages/v1:CoverageLevel:
type: string
enum:
- EMPLOYEE_AND_CHILDREN
- EMPLOYEE_ONLY
- EMPLOYEE_AND_SPOUSE
- FAMILY
- INDIVIDUAL
title: CoverageLevel
type_pre-encounter/coverages/v1:CoverageValueUnit:
type: string
enum:
- PERCENT
- CURRENCY
- COUNT
title: CoverageValueUnit
type_pre-encounter/coverages/v1:CoverageDetails:
type: object
properties:
type:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:BenefitType'
coverageLevel:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageLevel'
unit:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageValueUnit'
value:
type: number
format: double
additional_notes:
type: string
required:
- type
- coverageLevel
- unit
- value
title: CoverageDetails
type_pre-encounter/coverages/v1:PlanCoverage:
type: object
properties:
in_network:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:PlanCoverageDetails'
in_network_flat:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageDetails'
out_of_network:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:PlanCoverageDetails'
out_of_network_flat:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageDetails'
title: PlanCoverage
type_pre-encounter/coverages/v1:ServiceTypeCode:
type: string
enum:
- '1'
- '2'
- '3'
- '4'
- '5'
- '6'
- '7'
- '8'
- '9'
- '10'
- '11'
- '12'
- '13'
- '14'
- '15'
- '16'
- '17'
- '18'
- '19'
- '20'
- '21'
- '22'
- '23'
- '24'
- '25'
- '26'
- '27'
- '28'
- '30'
- '32'
- '33'
- '34'
- '35'
- '36'
- '37'
- '38'
- '39'
- '40'
- '41'
- '42'
- '43'
- '44'
- '45'
- '46'
- '47'
- '48'
- '49'
- '50'
- '51'
- '52'
- '53'
- '54'
- '55'
- '56'
- '57'
- '58'
- '59'
- '60'
- '61'
- '62'
- '63'
- '64'
- '65'
- '66'
- '67'
- '68'
- '69'
- '70'
- '71'
- '72'
- '73'
- '74'
- '75'
- '76'
- '77'
- '78'
- '79'
- '80'
- '81'
- '82'
- '83'
- '84'
- '85'
- '86'
- '87'
- '88'
- '89'
- '90'
- '91'
- '92'
- '93'
- '94'
- '95'
- '96'
- '97'
- '98'
- '99'
- A0
- A1
- A2
- A3
- A4
- A5
- A6
- A7
- A8
- A9
- AA
- AB
- AC
- AD
- AE
- AF
- AG
- AH
- AI
- AJ
- AK
- AL
- AM
- AN
- AO
- AQ
- AR
- B1
- B2
- B3
- BA
- BB
- BC
- BD
- BE
- BF
- BG
- BH
- BI
- BJ
- BK
- BL
- BM
- BN
- BP
- BQ
- BR
- BS
- BT
- BU
- BV
- BW
- BX
- BY
- BZ
- C1
- CA
- CB
- CC
- CD
- CE
- CF
- CG
- CH
- CI
- CJ
- CK
- CL
- CM
- CN
- CO
- CP
- CQ
- DG
- DM
- DS
- GF
- GN
- GY
- IC
- MH
- NI
- 'ON'
- PT
- PU
- RN
- RT
- TC
- TN
- UC
description: Code identifying the type of service or benefit within a specific insurance policy (X12 008010 Element 1365)
title: ServiceTypeCode
type_pre-encounter/coverages/v1:ServiceCoverageDetails:
type: object
properties:
copay:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageValue'
coinsurance:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageValue'
visits:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageValue'
visits_remaining:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageValue'
additional_notes:
type: string
title: ServiceCoverageDetails
type_pre-encounter/coverages/v1:ServiceCoverage:
type: object
properties:
service_code:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:ServiceTypeCode'
in_network:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:ServiceCoverageDetails'
in_network_flat:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageDetails'
out_of_network:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:ServiceCoverageDetails'
out_of_network_flat:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageDetails'
required:
- service_code
title: ServiceCoverage
type_pre-encounter/coverages/v1:RelatedEntityContact:
type: object
properties:
mode:
type: string
value:
type: string
title: RelatedEntityContact
type_pre-encounter/coverages/v1:BenefitsRelatedEntity:
type: object
properties:
entityIdentifier:
type: string
entityType:
type: string
entityName:
type: string
contactInformation:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:RelatedEntityContact'
serviceTypeCodes:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:ServiceTypeCode'
title: BenefitsRelatedEntity
type_pre-encounter/coverages/v1:NonCoveredDetail:
type: object
properties:
type:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:BenefitType'
coverageLevel:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageLevel'
unit:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageValueUnit'
value:
type: number
format: double
additional_notes:
type: string
service_type_codes:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:ServiceTypeCode'
required:
- type
- coverageLevel
- unit
- value
title: NonCoveredDetail
type_pre-encounter/coverages/v1:CoverageBenefits:
type: object
properties:
plan_coverage:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:PlanCoverage'
service_specific_coverage:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:ServiceCoverage'
benefits_related_entities:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:BenefitsRelatedEntity'
non_covered_details:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:NonCoveredDetail'
notes:
type: string
autoUpdatedEligibilityCheckId:
type: string
title: CoverageBenefits
type_pre-encounter/eligibilityChecks/v1:ParsedResponse:
type: object
properties:
eligibility_status:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityStatus'
plan_metadata:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:PlanMetadata'
benefits:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageBenefits'
required:
- eligibility_status
title: ParsedResponse
type_pre-encounter/eligibilityChecks/v1:RequestCorrection:
type: object
properties:
property:
type: string
request_value:
type: string
corrected_value:
type: string
required:
- property
- request_value
- corrected_value
title: RequestCorrection
type_pre-encounter/eligibilityChecks/v1:EligibilityCheck:
type: object
properties:
batch_id:
type: string
errors:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityCheckError'
request:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityRequest'
response:
description: Any type
parsed_response:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:ParsedResponse'
request_corrections:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:RequestCorrection'
required:
- response
title: EligibilityCheck
type_pre-encounter/eligibilityChecks/v1:EligibilityResponse:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityCheck'
description: An object representing the data for an eligibility response.
title: EligibilityResponse
type_pre-encounter/eligibilityChecks/v1:BatchEligibilityResponse:
type: object
properties:
batch_id:
type: string
submitted_at:
type: string
format: date-time
required:
- batch_id
- submitted_at
description: An object representing the data for a batch eligibility response.
title: BatchEligibilityResponse
type_pre-encounter/common:PageToken:
type: string
description: A token that can be used to retrieve the next or previous page of results
title: PageToken
type_pre-encounter/eligibilityChecks/v1:EligibilityCheckPage:
type: object
properties:
next_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
prev_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
total:
type: integer
items:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityCheck'
required:
- total
- items
title: EligibilityCheckPage
type_pre-encounter/eligibilityChecks/v1:StediPayer:
type: object
properties:
stedi_id:
type: string
display_name:
type: string
primary_payer_id:
type: string
aliases:
type: array
items:
type: string
names:
type: array
items:
type: string
transaction_support:
description: Any type
employer_identification_numbers:
type: array
items:
type: string
payer_enrollment:
description: Any type
parent_payer_group:
type: string
coverage_types:
type: array
items:
type: string
required:
- stedi_id
- display_name
- primary_payer_id
- aliases
- names
- transaction_support
title: StediPayer
type_pre-encounter/eligibilityChecks/v1:StediPayerItem:
type: object
properties:
score:
type: integer
payer:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:StediPayer'
required:
- score
- payer
title: StediPayerItem
type_pre-encounter/eligibilityChecks/v1:PayerSearchResponse:
type: object
properties:
next_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
prev_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
total:
type: integer
items:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:StediPayerItem'
stats:
description: Any type
required:
- total
- items
- stats
title: PayerSearchResponse
type_pre-encounter/common:FilterQueryString:
type: string
description: >-
A serialized list of filters separated by commas indicating filters to apply. Each filter is of the form
'path:operator:value'. Example: 'patient.mrn|eq|12345'. Filters are separated by commas. Example:
'patient.mrn|eq|12345,appointment.startDate|gt|67890'. All filters are ANDed together. Valid operators are
'eq', 'gt', 'lt', 'contains', 'ieq', 'in'. ieq is a case-insensitive equality operator. in allows searching for
values that match any item in a semicolon-separated list (e.g., 'patient.id|in|foo;bar;baz'). Path values are
camelCase.
title: FilterQueryString
type_pre-encounter/common:OrganizationId:
type: string
description: The unique identifier for an Organization in the database
title: OrganizationId
type_pre-encounter/common:UserId:
type: string
description: The unique identifier for a User in the database
title: UserId
type_pre-encounter/eligibilityChecks/v1:MedicareAdvantageRecommendationPayload:
type: object
properties:
ma_benefit:
description: Any type
payer_id:
type: string
payer_name:
type: string
member_id:
type: string
description: An object representing the payload for a Medicare Advantage recommendation.
title: MedicareAdvantageRecommendationPayload
type_pre-encounter/eligibilityChecks/v1:CopayEstimationRecommendationPayload:
type: object
properties:
structured_response:
type: integer
description: The estimated copay amount in cents
exposition:
type: string
description: The AI's explanation of the copay estimate
required:
- exposition
description: Payload for MD visit copay estimation from AI analysis
title: CopayEstimationRecommendationPayload
type_pre-encounter/eligibilityChecks/v1:UserConfiguredPromptsResult:
type: object
properties:
user_prompt_id:
type: string
description: Reference to the user prompt in eligibility config
prompt_name:
type: string
description: User-defined name for the prompt
structured_response:
description: The AI's structured answer (boolean, number, or string)
exposition:
type: string
description: The AI's explanation of the answer
required:
- user_prompt_id
- prompt_name
- structured_response
- exposition
description: Individual result from a single user-configured prompt execution
title: UserConfiguredPromptsResult
type_pre-encounter/eligibilityChecks/v1:UserConfiguredPromptsRecommendationPayload:
type: object
properties:
results:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:UserConfiguredPromptsResult'
description: Array of results from all enabled user-configured prompts
required:
- results
description: Payload for user-configured prompt recommendations from AI analysis
title: UserConfiguredPromptsRecommendationPayload
type_pre-encounter/eligibilityChecks/v1:EligibilityRecommendationPayload:
oneOf:
- type: object
properties:
type:
type: string
enum:
- MEDICARE_ADVANTAGE
description: 'Discriminator value: MEDICARE_ADVANTAGE'
payload:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:MedicareAdvantageRecommendationPayload'
required:
- type
- payload
- type: object
properties:
type:
type: string
enum:
- COORDINATION_OF_BENEFITS
description: 'Discriminator value: COORDINATION_OF_BENEFITS'
payload:
description: Any type
required:
- type
- payload
- type: object
properties:
type:
type: string
enum:
- COPAY_ESTIMATION
description: 'Discriminator value: COPAY_ESTIMATION'
payload:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:CopayEstimationRecommendationPayload'
required:
- type
- payload
- type: object
properties:
type:
type: string
enum:
- USER_CONFIGURED_PROMPTS
description: 'Discriminator value: USER_CONFIGURED_PROMPTS'
payload:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:UserConfiguredPromptsRecommendationPayload'
required:
- type
- payload
discriminator:
propertyName: type
title: EligibilityRecommendationPayload
type_pre-encounter/common:CoverageId:
type: string
format: uuid
description: The unique identifier for a Coverage in the database
title: CoverageId
type_pre-encounter/common:PatientId:
type: string
description: The unique identifier for a Patient
title: PatientId
type_pre-encounter/eligibilityChecks/v1:EligibilityRecommendationPatientInfo:
type: object
properties:
id:
$ref: '#/components/schemas/type_pre-encounter/common:PatientId'
mrn:
type: string
organization_id:
$ref: '#/components/schemas/type_pre-encounter/common:OrganizationId'
last_name:
type: string
first_name:
type: string
date_of_birth:
type: string
format: date
member_id:
type: string
description: |-
An object representing patient information for an eligibility recommendation.
This is used to find recommendations. Each field helps us find the right corresponding
eligibility recommendation for the patient.
title: EligibilityRecommendationPatientInfo
type_pre-encounter/eligibilityChecks/v1:VoteValue:
type: string
enum:
- UPVOTE
- DOWNVOTE
description: Possible vote values for recommendation quality
title: VoteValue
type_pre-encounter/eligibilityChecks/v1:Vote:
type: object
properties:
user_id:
$ref: '#/components/schemas/type_pre-encounter/common:UserId'
description: The user who voted
value:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:VoteValue'
description: The vote value
required:
- user_id
- value
description: User feedback on a recommendation
title: Vote
type_pre-encounter/eligibilityChecks/v1:EligibilityRecommendation:
type: object
properties:
organization_id:
$ref: '#/components/schemas/type_pre-encounter/common:OrganizationId'
description: The organization that owns this object.
deactivated:
type: boolean
description: >-
True if the object is deactivated. Deactivated objects are not returned in search results but are returned
in all other endpoints including scan.
version:
type: integer
description: The version of the object. Any update to any property of an object object will create a new version.
updated_at:
type: string
format: date-time
updating_user_id:
$ref: '#/components/schemas/type_pre-encounter/common:UserId'
description: The user ID of the user who last updated the object.
id:
type: string
description: The unique UUID identifier for an EligibilityRecommendation.
eligibility_check_id:
type: string
recommendation:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityRecommendationPayload'
coverage_id:
$ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
patient:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityRecommendationPatientInfo'
votes:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:Vote'
description: Array of votes for this recommendation
required:
- organization_id
- deactivated
- version
- updated_at
- updating_user_id
- id
- eligibility_check_id
- recommendation
- patient
description: >-
An eligibility recommendation object that contains an EligibilityRecommendationType and a payload of data
denoting the recommendation.
title: EligibilityRecommendation
type_pre-encounter/eligibilityChecks/v1:PostEligibilityRecommendationRequest:
type: object
properties:
eligibility_check_id:
type: string
patient:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityRecommendationPatientInfo'
recommendation:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityRecommendationPayload'
required:
- eligibility_check_id
- patient
- recommendation
title: PostEligibilityRecommendationRequest
type_pre-encounter/common:ErrorBase4xx:
type: object
properties:
message:
type: string
data:
description: Any type
required:
- message
title: ErrorBase4xx
type_pre-encounter/common:VersionConflictErrorBody:
type: object
properties:
message:
type: string
data:
description: Any type
latest_version:
type: integer
required:
- message
title: VersionConflictErrorBody
type_pre-encounter/appointments/v1:AppointmentStatus:
type: string
enum:
- PENDING
- NOT_READY
- READY
- CHECKED_IN
title: AppointmentStatus
type_pre-encounter/appointments/v1:NotReadyReason:
type: string
enum:
- INACTIVE_PRIMARY
- INACTIVE_SECONDARY
- MEDICARE_ADVANTAGE_CONVERSION
- MEDICAID_MANAGED_CONVERSION
- UNAVAILABLE_PRIMARY
- UNAVAILABLE_SECONDARY
- PENDING_PRIMARY
- PENDING_SECONDARY
- ELIGIBILITY_CHECK_FAILED_PRIMARY
- ELIGIBILITY_CHECK_FAILED_SECONDARY
- NEW_COMBO
- NO_COVERAGE
- ERROR
- MANUAL
description: >-
The reason an appointment is NOT_READY. Only set when status is NOT_READY. All values except MANUAL are set by
the automated eligibility check; MANUAL is set by staff via the API.
title: NotReadyReason
type_pre-encounter/appointments/v1:UniversalServiceIdentifier:
type: string
enum:
- MD_Visit
- Treatment
- Tests
- Activity
title: UniversalServiceIdentifier
type_pre-encounter/appointments/v1:Service:
type: object
properties:
universal_service_identifier:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:UniversalServiceIdentifier'
description: Contains the code describing the activity type that is being scheduled.
start_timestamp:
type: string
format: date-time
title: Service
type_pre-encounter/common:NameUse:
type: string
enum:
- USUAL
- OFFICIAL
- TEMP
- NICKNAME
- ANONYMOUS
- OLD
- MAIDEN
title: NameUse
type_pre-encounter/common:Period:
type: object
properties:
start:
type: string
format: date
end:
type: string
format: date
title: Period
type_pre-encounter/common:HumanName:
type: object
properties:
family:
type: string
given:
type: array
items:
type: string
use:
$ref: '#/components/schemas/type_pre-encounter/common:NameUse'
period:
$ref: '#/components/schemas/type_pre-encounter/common:Period'
suffix:
type: string
required:
- family
- given
- use
title: HumanName
type_pre-encounter/common:ExternalProviderType:
type: string
enum:
- PRIMARY
- REFERRING
- ATTENDING
title: ExternalProviderType
type_pre-encounter/common:ContactPointUse:
type: string
enum:
- HOME
- WORK
- TEMP
- OLD
- MOBILE
title: ContactPointUse
type_pre-encounter/common:ContactPoint:
type: object
properties:
value:
type: string
use:
$ref: '#/components/schemas/type_pre-encounter/common:ContactPointUse'
period:
$ref: '#/components/schemas/type_pre-encounter/common:Period'
required:
- value
- use
title: ContactPoint
type_pre-encounter/common:AddressUse:
type: string
enum:
- HOME
- WORK
- TEMP
- OLD
- BILLING
title: AddressUse
type_pre-encounter/common:Address:
type: object
properties:
use:
$ref: '#/components/schemas/type_pre-encounter/common:AddressUse'
line:
type: array
items:
type: string
city:
type: string
state:
type: string
postal_code:
type: string
country:
type: string
county:
type: string
period:
$ref: '#/components/schemas/type_pre-encounter/common:Period'
required:
- use
- line
- city
- state
- postal_code
- country
title: Address
type_pre-encounter/common:CanonicalProviderId:
type: string
description: The unique identifier for a provider configured in the Candid system
title: CanonicalProviderId
type_pre-encounter/common:CanonicalServiceFacilityId:
type: string
description: The unique identifier for a service facility configured in the Candid system
title: CanonicalServiceFacilityId
type_pre-encounter/common:PatientServiceFacility:
type: object
properties:
service_facility_id:
$ref: '#/components/schemas/type_pre-encounter/common:CanonicalServiceFacilityId'
required:
- service_facility_id
description: Represents a canonical service facility attached to a patient or patient dependent object
title: PatientServiceFacility
type_pre-encounter/common:ExternalProvider:
type: object
properties:
name:
$ref: '#/components/schemas/type_pre-encounter/common:HumanName'
type:
$ref: '#/components/schemas/type_pre-encounter/common:ExternalProviderType'
description: Defaults to ATTENDING.
npi:
type: string
telecoms:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:ContactPoint'
addresses:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:Address'
period:
$ref: '#/components/schemas/type_pre-encounter/common:Period'
canonical_id:
$ref: '#/components/schemas/type_pre-encounter/common:CanonicalProviderId'
fax:
type: string
service_facilities:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:PatientServiceFacility'
description: Associated service facilities for this provider.
required:
- name
- telecoms
title: ExternalProvider
type_pre-encounter/appointments/v1:AppointmentWorkQueue:
type: string
enum:
- EMERGENT_ISSUE
- NEW_PATIENT
- RETURNING_PATIENT
- MANUAL_ESCALATION
title: AppointmentWorkQueue
type_pre-encounter/appointments/v1:MutableAppointment:
type: object
properties:
patient_id:
$ref: '#/components/schemas/type_pre-encounter/common:PatientId'
description: The Candid-defined patient identifier.
start_timestamp:
type: string
format: date-time
status:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:AppointmentStatus'
description: >-
Defaults to PENDING. If status is NOT_READY, work_queue must be set. If status is READY or CHECKED_IN,
work_queue must be null. If status is CHECKED_IN, checked_in_timestamp must be set. If checked_in_timestamp
is set, status must be CHECKED_IN.
not_ready_reason:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:NotReadyReason'
description: >-
The reason the appointment is NOT_READY. Must only be set when status is NOT_READY; it is cleared otherwise.
MANUAL is the only value that may be set via the API.
service_duration:
type: integer
description: The requested length of time allotted for the appointment. The units are in minutes.
services:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:Service'
placer_appointment_id:
type: string
description: ID for the appointment/order for the event.
attending_doctor:
$ref: '#/components/schemas/type_pre-encounter/common:ExternalProvider'
description: Attending physician information. The attending physician will be stored as the Current MD for the patient.
estimated_copay_cents:
type: integer
estimated_patient_responsibility_cents:
type: integer
patient_deposit_cents:
type: integer
appointment_details:
type: string
checked_in_timestamp:
type: string
format: date-time
description: >-
The timestamp when the patient checked in for their appointment. If status is CHECKED_IN,
checked_in_timestamp must be set. If checked_in_timestamp is set, status must be CHECKED_IN.
notes:
type: string
location_resource_id:
type: string
description: 'Contains the coded identification of the location being scheduled. Components: ^'
automated_eligibility_check_complete:
type: boolean
description: >-
True if the automated eligibility check has been completed. It is not recommended to change this value
manually via API. This refers explicitly to the automated eligibility check that occurs a specific number of
days before the appointment.
work_queue:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:AppointmentWorkQueue'
description: >-
The work queue that the appointment belongs to. It is not recommended to change this value manually via API.
If status is NOT_READY, work_queue must be set. If status is READY, work_queue must be null.
required:
- patient_id
- start_timestamp
- service_duration
- services
description: An object representing a appointment.
title: MutableAppointment
type_pre-encounter/common:AppointmentId:
type: string
description: The unique identifier for an Appointment.
title: AppointmentId
type_pre-encounter/appointments/v1:Appointment:
type: object
properties:
organization_id:
$ref: '#/components/schemas/type_pre-encounter/common:OrganizationId'
description: The organization that owns this object.
deactivated:
type: boolean
description: >-
True if the object is deactivated. Deactivated objects are not returned in search results but are returned
in all other endpoints including scan.
version:
type: integer
description: The version of the object. Any update to any property of an object object will create a new version.
updated_at:
type: string
format: date-time
updating_user_id:
$ref: '#/components/schemas/type_pre-encounter/common:UserId'
description: The user ID of the user who last updated the object.
patient_id:
$ref: '#/components/schemas/type_pre-encounter/common:PatientId'
description: The Candid-defined patient identifier.
start_timestamp:
type: string
format: date-time
status:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:AppointmentStatus'
description: >-
Defaults to PENDING. If status is NOT_READY, work_queue must be set. If status is READY or CHECKED_IN,
work_queue must be null. If status is CHECKED_IN, checked_in_timestamp must be set. If checked_in_timestamp
is set, status must be CHECKED_IN.
not_ready_reason:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:NotReadyReason'
description: >-
The reason the appointment is NOT_READY. Must only be set when status is NOT_READY; it is cleared otherwise.
MANUAL is the only value that may be set via the API.
service_duration:
type: integer
description: The requested length of time allotted for the appointment. The units are in minutes.
services:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:Service'
placer_appointment_id:
type: string
description: ID for the appointment/order for the event.
attending_doctor:
$ref: '#/components/schemas/type_pre-encounter/common:ExternalProvider'
description: Attending physician information. The attending physician will be stored as the Current MD for the patient.
estimated_copay_cents:
type: integer
estimated_patient_responsibility_cents:
type: integer
patient_deposit_cents:
type: integer
appointment_details:
type: string
checked_in_timestamp:
type: string
format: date-time
description: >-
The timestamp when the patient checked in for their appointment. If status is CHECKED_IN,
checked_in_timestamp must be set. If checked_in_timestamp is set, status must be CHECKED_IN.
notes:
type: string
location_resource_id:
type: string
description: 'Contains the coded identification of the location being scheduled. Components: ^'
automated_eligibility_check_complete:
type: boolean
description: >-
True if the automated eligibility check has been completed. It is not recommended to change this value
manually via API. This refers explicitly to the automated eligibility check that occurs a specific number of
days before the appointment.
work_queue:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:AppointmentWorkQueue'
description: >-
The work queue that the appointment belongs to. It is not recommended to change this value manually via API.
If status is NOT_READY, work_queue must be set. If status is READY, work_queue must be null.
id:
$ref: '#/components/schemas/type_pre-encounter/common:AppointmentId'
required:
- organization_id
- deactivated
- version
- updated_at
- updating_user_id
- patient_id
- start_timestamp
- service_duration
- services
- id
description: An appointment object with immutable server-owned properties.
title: Appointment
type_pre-encounter/lists/v1:SortFieldString:
type: string
description: >-
The field to order by. Valid values are either keys on the list item object or a special ordering
"similar_name:" (Ex: similar_name:John). Similar name ordering uses trigrams to fuzzy match
patient name to the search criteria. Path names are camelCase.
title: SortFieldString
type_pre-encounter/common:SortDirection:
type: string
enum:
- asc
- desc
title: SortDirection
type_pre-encounter/common:ExternalIdentifier:
type: object
properties:
value:
type: string
system:
type: string
period:
$ref: '#/components/schemas/type_pre-encounter/common:Period'
required:
- value
- system
description: An external identifier for a patient
title: ExternalIdentifier
type_pre-encounter/common:Gender:
type: string
enum:
- MAN
- WOMAN
- NON_BINARY
- TWO_SPIRIT
- FEMALE_TO_MALE
- MALE_TO_FEMALE
- OTHER
- UNKNOWN
- REFUSED
title: Gender
type_pre-encounter/common:Sex:
type: string
enum:
- FEMALE
- MALE
- UNKNOWN
- REFUSED
title: Sex
type_pre-encounter/common:SexualOrientation:
type: string
enum:
- HETEROSEXUAL
- HOMOSEXUAL
- BISEXUAL
- TWO_SPIRIT
- OTHER
- UNKNOWN
- REFUSED
title: SexualOrientation
type_pre-encounter/common:Race:
type: string
enum:
- AMERICAN_INDIAN_OR_ALASKA_NATIVE
- WHITE
- BLACK
- ASIAN
- NATIVE_HAWAIIAN_OR_OTHER_PACIFIC_ISLANDER
- MIDDLE_EASTERN_OR_NORTH_AFRICAN
- OTHER
- UNKNOWN
- REFUSED
title: Race
type_pre-encounter/common:Ethnicity:
type: string
enum:
- HISPANIC_OR_LATINO
- NOT_HISPANIC_OR_LATINO
- UNKNOWN
- REFUSED
title: Ethnicity
type_pre-encounter/common:DisabilityStatus:
type: string
enum:
- DISABLED
- NON_DISABLED
title: DisabilityStatus
type_pre-encounter/patients/v1:MaritalStatus:
type: string
enum:
- ANNULLED
- DIVORCED
- INTERLOCUTORY
- SEPARATED
- MARRIED
- COMMON_LAW
- POLYGAMOUS
- DOMESTIC_PARTNER
- UNMARRIED
- NEVER_MARRIED
- WIDOWED
- UNKNOWN
title: MaritalStatus
type_pre-encounter/patients/v1:ElectronicCommunicationConsent:
type: object
properties:
text_communication_consent:
type: boolean
description: Consent for text/SMS communication.
email_communication_consent:
type: boolean
description: Consent for email communication.
description: Granular consent for electronic communication channels.
title: ElectronicCommunicationConsent
type_pre-encounter/patients/v1:ExternalProvenance:
type: object
properties:
external_id:
type: string
system_name:
type: string
required:
- external_id
- system_name
description: Information about the upstream system that owns this patient data.
title: ExternalProvenance
type_pre-encounter/common:Relationship:
type: string
enum:
- SELF
- SPOUSE
- CHILD
- COMMON_LAW_SPOUSE
- OTHER
title: Relationship
type_pre-encounter/patients/v1:Contact:
type: object
properties:
relationship:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:Relationship'
name:
$ref: '#/components/schemas/type_pre-encounter/common:HumanName'
telecoms:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:ContactPoint'
addresses:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:Address'
period:
$ref: '#/components/schemas/type_pre-encounter/common:Period'
hipaa_authorization:
type: boolean
required:
- relationship
- name
- telecoms
- addresses
title: Contact
type_pre-encounter/patients/v1:FilingOrder:
type: object
properties:
coverages:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
required:
- coverages
description: The patient's active coverages, in order of primary, secondary, etc.
title: FilingOrder
type_pre-encounter/patients/v1:CoveragesForRelatedCauses:
type: object
properties:
coverages:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
required:
- coverages
description: Additional coverages for the patient applicable to related causes such as Auto or Workers Comp
title: CoveragesForRelatedCauses
type_pre-encounter/common:CanonicalNonInsurancePayerId:
type: string
description: The unique identifier for a non-insurance payer configured in the Candid system
title: CanonicalNonInsurancePayerId
type_pre-encounter/common:CanonicalClinicalTrialId:
type: string
description: The unique identifier for a clinical trial configured in the Candid system
title: CanonicalClinicalTrialId
type_pre-encounter/common:CanonicalClinicalTrialAssociation:
type: object
properties:
id:
$ref: '#/components/schemas/type_pre-encounter/common:CanonicalClinicalTrialId'
clinical_trial_arm:
type: string
period:
$ref: '#/components/schemas/type_pre-encounter/common:Period'
required:
- id
title: CanonicalClinicalTrialAssociation
type_pre-encounter/common:CanonicalNonInsurancePayerAssociation:
type: object
properties:
id:
$ref: '#/components/schemas/type_pre-encounter/common:CanonicalNonInsurancePayerId'
member_id:
type: string
period:
$ref: '#/components/schemas/type_pre-encounter/common:Period'
clinical_trial_info:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:CanonicalClinicalTrialAssociation'
description: A patient cannot be associated with a given trial more than once
required:
- id
title: CanonicalNonInsurancePayerAssociation
type_pre-encounter/patients/v1:Guarantor:
type: object
properties:
name:
$ref: '#/components/schemas/type_pre-encounter/common:HumanName'
telecom:
$ref: '#/components/schemas/type_pre-encounter/common:ContactPoint'
email:
type: string
birth_date:
type: string
format: date
address:
$ref: '#/components/schemas/type_pre-encounter/common:Address'
required:
- name
- address
title: Guarantor
type_pre-encounter/common:PayerId:
type: string
description: The unique identifier for a Payer in the database
title: PayerId
type_pre-encounter/common:AdditionalPayerInformation:
type: object
properties:
availity_eligibility_id:
type: string
availity_payer_id:
type: string
availity_payer_name:
type: string
availity_remittance_payer_id:
type: string
title: AdditionalPayerInformation
type_pre-encounter/patients/v1:AuthorizationUnit:
type: string
enum:
- VISIT
- UNIT
title: AuthorizationUnit
type_pre-encounter/patients/v1:Authorization:
type: object
properties:
payer_id:
$ref: '#/components/schemas/type_pre-encounter/common:PayerId'
payer_name:
type: string
additional_payer_information:
$ref: '#/components/schemas/type_pre-encounter/common:AdditionalPayerInformation'
authorization_number:
type: string
cpt_code:
type: string
apply_for_all_cpt_codes:
type: boolean
description: If true, then the authorization will apply for all claims for the payer that fall in range the `period`.
no_prior_authorization_required:
type: boolean
description: >-
If true, indicates that prior authorization is not required and prior authorization number will not be set
on the claim for this authorization.
units:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:AuthorizationUnit'
quantity:
type: integer
period:
$ref: '#/components/schemas/type_pre-encounter/common:Period'
notes:
type: string
billing_provider_npi:
type: string
description: The NPI of the billing provider for which this authorization applies.
service_facility:
$ref: '#/components/schemas/type_pre-encounter/common:PatientServiceFacility'
description: When set, specifies the service facility for which this authorization applies.
dx_codes:
type: array
uniqueItems: true
items:
type: string
description: >-
When set, the authorization will only apply when at least one of these diagnosis codes is found on the
claim/service lines (in addition to other criteria).
required:
- payer_id
- payer_name
- authorization_number
- cpt_code
- units
title: Authorization
type_pre-encounter/patients/v1:ReferralUnit:
type: string
enum:
- VISIT
- UNIT
title: ReferralUnit
type_pre-encounter/patients/v1:Referral:
type: object
properties:
provider:
$ref: '#/components/schemas/type_pre-encounter/common:ExternalProvider'
referral_number:
type: string
period:
$ref: '#/components/schemas/type_pre-encounter/common:Period'
notes:
type: string
serviceFacility:
$ref: '#/components/schemas/type_pre-encounter/common:PatientServiceFacility'
units:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:ReferralUnit'
quantity:
type: integer
cptCodes:
type: array
items:
type: string
applyForAllCptCodes:
type: boolean
required:
- provider
- referral_number
title: Referral
type_pre-encounter/patients/v1:DoNotInvoiceReason:
type: string
enum:
- BANKRUPTCY
- DECEASED
- HARDSHIP
- OTHER
- COLLECTIONS
- BAD_ADDRESS
- PROFESSIONAL_COURTESY
title: DoNotInvoiceReason
type_pre-encounter/common:NoteId:
type: string
description: The unique identifier for a Note.
title: NoteId
type_pre-encounter/common:TagId:
type: string
description: The unique identifier for a Tag.
title: TagId
type_pre-encounter/patients/v1:ReferralSource:
type: string
enum:
- HOSPITAL
- REFERRING_MD
- SELF
- OTHER
title: ReferralSource
type_pre-encounter/patients/v1:SpecializationCategory:
type: string
enum:
- BEHAVIORAL_HEALTH_THERAPY
- CARDIOLOGY
- DERMATOLOGY
- ENDOCRINOLOGY
- ENT
- GASTROENTEROLOGY
- GENERAL_SURGERY
- GENETICS
- HEMATOLOGY
- INFECTIOUS_DISEASE
- NEUROLOGY
- NUTRITIONAL_THERAPY
- OB_GYN
- ONCOLOGY
- OPHTHALMOLOGY
- ORTHOPEDICS
- PAIN_MANAGEMENT
- PEDIATRICS
- PHYSICAL_THERAPY
- PODIATRY
- PRIMARY_CARE
- PSYCHIATRY
- PULMONOLOGY
- RADIOLOGY
- RHEUMATOLOGY
- SCREENING
- UROLOGY
- OTHER
title: SpecializationCategory
type_pre-encounter/patients/v1:ReferralType:
type: string
enum:
- DIRECTED
- ROTATION
- OVERNIGHT
title: ReferralType
type_pre-encounter/patients/v1:OriginationDetail:
type: object
properties:
referral_source:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:ReferralSource'
referring_provider:
$ref: '#/components/schemas/type_pre-encounter/common:ExternalProvider'
specialization_categories:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:SpecializationCategory'
referral_type:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:ReferralType'
required:
- referral_source
title: OriginationDetail
type_pre-encounter/patients/v1:InferredPatientMetadata:
type: object
properties:
inferred_encounter_id:
type: string
inferred_encounter_latest_date_of_service:
type: string
format: date
required:
- inferred_encounter_id
- inferred_encounter_latest_date_of_service
title: InferredPatientMetadata
type_pre-encounter/patients/v1:AdvancedDirective:
type: string
enum:
- NONE
- DURABLE_POWER_OF_ATTORNEY
- LIVING_WILL
- DO_NOT_RESUSCITATE
- STANDARD_PRECAUTIONS
- FALL_RISK
title: AdvancedDirective
type_pre-encounter/patients/v1:MutablePatientWithMrn:
type: object
properties:
name:
$ref: '#/components/schemas/type_pre-encounter/common:HumanName'
other_names:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:HumanName'
description: Other names for the patient.
other_identifiers:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:ExternalIdentifier'
description: Other identifiers for the patient.
gender:
$ref: '#/components/schemas/type_pre-encounter/common:Gender'
birth_date:
type: string
format: date
social_security_number:
type: string
biological_sex:
$ref: '#/components/schemas/type_pre-encounter/common:Sex'
description: >-
The biological sex of the patient. This corresponds to the HL7 AdministrativeGender
https://www.hl7.org/fhir/valueset-administrative-gender.html
sexual_orientation:
$ref: '#/components/schemas/type_pre-encounter/common:SexualOrientation'
description: The sexual orientation of the patient.
pronouns:
type: array
items:
type: string
description: The pronouns of the patient.
race:
$ref: '#/components/schemas/type_pre-encounter/common:Race'
ethnicity:
$ref: '#/components/schemas/type_pre-encounter/common:Ethnicity'
disability_status:
$ref: '#/components/schemas/type_pre-encounter/common:DisabilityStatus'
marital_status:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:MaritalStatus'
deceased:
type: string
format: date-time
description: Time of death for the patient. Leave unset if the patient is not deceased.
multiple_birth:
type: integer
description: >-
The number of siblings the patient was born with. Leave unset if the patient was not part of a multiple
birth.
primary_address:
$ref: '#/components/schemas/type_pre-encounter/common:Address'
description: The primary address for the patient.
other_addresses:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:Address'
description: Other addresses for the patient.
primary_telecom:
$ref: '#/components/schemas/type_pre-encounter/common:ContactPoint'
description: The primary phone number for the patient.
other_telecoms:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:ContactPoint'
description: Other phone numbers for the patient.
email:
type: string
electronic_communication_opt_in:
type: boolean
description: >-
Use electronic_communication_consent for granular channel-level consent. This field is kept in sync
automatically but should not be used for new integrations.
electronic_communication_consent:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:ElectronicCommunicationConsent'
description: Granular consent for electronic communication channels.
photo:
type: string
language:
type: string
external_provenance:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:ExternalProvenance'
description: Information about the upstream system that owns this patient data. Leave unset if Candid owns patient data.
contacts:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Contact'
description: Contacts for the patient.
general_practitioners:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:ExternalProvider'
filing_order:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:FilingOrder'
coverages_for_related_causes:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:CoveragesForRelatedCauses'
non_insurance_payers:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:CanonicalNonInsurancePayerId'
non_insurance_payer_associations:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:CanonicalNonInsurancePayerAssociation'
guarantor:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Guarantor'
self_pay:
type: boolean
authorizations:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Authorization'
referrals:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Referral'
primary_service_facility_id:
type: string
service_facilities:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:PatientServiceFacility'
description: Associated service facilities for this patient.
do_not_invoice_reason:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:DoNotInvoiceReason'
description: If this value is defined, the customer will not be invoiced.
note_ids:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:NoteId'
tag_ids:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:TagId'
origination_detail:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:OriginationDetail'
description: Information about the patient source, if applicable.
inferred_patient_metadata:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:InferredPatientMetadata'
description: Metadata for the patient used for patient inference from encounters.
orcon:
type: boolean
description: >-
ORCON (Originator Controlled) - When set to true, the Candid system will hide this patient from downstream
integrations. Updates made in the Candid UI will unset this flag. Defaults to false.
advanced_directives:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:AdvancedDirective'
hipaa_code:
type: string
mrn:
type: string
description: The medical record number for the patient.
required:
- name
- other_names
- birth_date
- biological_sex
- primary_address
- other_addresses
- other_telecoms
- contacts
- general_practitioners
- filing_order
- mrn
title: MutablePatientWithMrn
type_pre-encounter/coverages/v1:CoverageStatus:
type: string
enum:
- ACTIVE
- CANCELLED
- DRAFT
- ENTERED_IN_ERROR
description: enum to represent the statuses defined at https://build.fhir.org/valueset-fm-status.html
title: CoverageStatus
type_pre-encounter/appointments/v1:Visit:
type: object
properties:
patient_id:
$ref: '#/components/schemas/type_pre-encounter/common:PatientId'
organization_id:
$ref: '#/components/schemas/type_pre-encounter/common:OrganizationId'
patient:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:MutablePatientWithMrn'
start_time:
type: string
format: date-time
status:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:AppointmentStatus'
primary_coverage_status:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageStatus'
secondary_coverage_status:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageStatus'
required:
- patient_id
- organization_id
- patient
- start_time
- status
description: A visit is a collection of appointments that occur on the same day.
title: Visit
type_pre-encounter/appointments/v1:VisitsPage:
type: object
properties:
next_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
prev_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
total:
type: integer
items:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:Visit'
required:
- total
- items
title: VisitsPage
type_pre-encounter/coverages/v1:Subscriber:
type: object
properties:
name:
$ref: '#/components/schemas/type_pre-encounter/common:HumanName'
date_of_birth:
type: string
format: date
biological_sex:
$ref: '#/components/schemas/type_pre-encounter/common:Sex'
address:
$ref: '#/components/schemas/type_pre-encounter/common:Address'
employer_name:
type: string
required:
- name
- biological_sex
title: Subscriber
type_pre-encounter/coverages/v1:NetworkType:
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: NetworkType
type_pre-encounter/coverages/v1: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_pre-encounter/common:PayerPlanGroupId:
type: string
format: uuid
description: The unique identifier for a PayerPlanGroup in the database
title: PayerPlanGroupId
type_pre-encounter/coverages/v1:CarveOutType:
type: string
enum:
- BEHAVIORAL
- MEDICAL
- THERAPY
title: CarveOutType
type_pre-encounter/coverages/v1:CoverageCarveOut:
type: object
properties:
carve_out:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CarveOutType'
member_id:
type: string
payer_id:
$ref: '#/components/schemas/type_pre-encounter/common:PayerId'
payer_name:
type: string
group_number:
type: string
plan_type:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:NetworkType'
type:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:InsuranceTypeCode'
payer_plan_group_id:
$ref: '#/components/schemas/type_pre-encounter/common:PayerPlanGroupId'
description: The ID of the Candid configured payer plan group associated with this coverage
required:
- carve_out
- member_id
- payer_id
- payer_name
title: CoverageCarveOut
type_pre-encounter/coverages/v1:InsurancePlan:
type: object
properties:
member_id:
type: string
payer_id:
$ref: '#/components/schemas/type_pre-encounter/common:PayerId'
payer_name:
type: string
additional_payer_information:
$ref: '#/components/schemas/type_pre-encounter/common:AdditionalPayerInformation'
group_number:
type: string
name:
type: string
plan_type:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:NetworkType'
type:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:InsuranceTypeCode'
period:
$ref: '#/components/schemas/type_pre-encounter/common:Period'
insurance_card_image_locator:
type: string
address:
$ref: '#/components/schemas/type_pre-encounter/common:Address'
payer_plan_group_id:
$ref: '#/components/schemas/type_pre-encounter/common:PayerPlanGroupId'
description: The ID of the Candid configured payer plan group associated with this coverage
carve_outs:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageCarveOut'
required:
- member_id
- payer_id
- payer_name
title: InsurancePlan
type_pre-encounter/eligibilityChecks/v1:EligibilityCheckStatus:
type: string
enum:
- COMPLETED
- FAILED
- PENDING
description: enum to represent the status of an eligibility checks
title: EligibilityCheckStatus
type_pre-encounter/eligibilityChecks/v1:EligibilityCheckMetadata:
type: object
properties:
check_id:
type: string
service_code:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:ServiceTypeCode'
status:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityCheckStatus'
initiated_by:
$ref: '#/components/schemas/type_pre-encounter/common:UserId'
initiated_at:
type: string
format: date-time
required:
- check_id
- service_code
- status
- initiated_by
- initiated_at
title: EligibilityCheckMetadata
type_pre-encounter/coverages/v1:LatestEligibilityCheck:
type: object
properties:
check_id:
type: string
status:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityStatus'
initiated_at:
type: string
format: date-time
errors:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityCheckErrorDetails'
required:
- check_id
- status
- initiated_at
description: A type to represent the latest eligibility check status of a coverage.
title: LatestEligibilityCheck
type_pre-encounter/coverages/v1:MutableCoverage:
type: object
properties:
status:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageStatus'
description: The status indiciating if the coverage is active or not.
subscriber:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:Subscriber'
description: >-
The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit
of the policy for services rendered to them or their family is due.
relationship:
$ref: '#/components/schemas/type_pre-encounter/common:Relationship'
description: The relationship of beneficiary (patient) to the subscriber. https://hl7.org/fhir/valueset-relationship.html
patient:
$ref: '#/components/schemas/type_pre-encounter/common:PatientId'
description: The canonical Candid patient UUID corresponding with the patient who benefits from the insurance coverage
insurance_plan:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:InsurancePlan'
verified:
type: boolean
description: A boolean indicating if the coverage has been verified by a user.
eligibility_checks:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityCheckMetadata'
description: A list of eligibility check metadata that have been initiated on this coverage.
latest_eligibility_check:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:LatestEligibilityCheck'
description: The latest eligibility check metadata that has been initiated on this coverage.
benefits:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageBenefits'
description: The eligibility of the patient for the coverage, manually verified by users.
orcon:
type: boolean
description: >-
ORCON (Originator Controlled) - When set to true, the Candid system will hide this coverage from downstream
integrations. Updates made in the Candid UI will unset this flag. Defaults to false.
auto_update_enabled:
type: boolean
description: >-
Default to true. When set to true, the Candid system will automatically update this coverage with the latest
eligibility check benefits information. Auto update behavior is also set at the eligibilityConfig org level
configuration.
previous_appointment_copays:
type: object
additionalProperties:
type: integer
description: >-
A map of UniversalServiceIdentifier (MD_Visit, Treatment, Tests, Activity) to copay values in cents. This is
used to track copay values for each service type to handle OOP max resets correctly.
required:
- status
- subscriber
- relationship
- patient
- insurance_plan
- verified
title: MutableCoverage
type_pre-encounter/coverages/v1:Coverage:
type: object
properties:
organization_id:
$ref: '#/components/schemas/type_pre-encounter/common:OrganizationId'
description: The organization that owns this object.
deactivated:
type: boolean
description: >-
True if the object is deactivated. Deactivated objects are not returned in search results but are returned
in all other endpoints including scan.
version:
type: integer
description: The version of the object. Any update to any property of an object object will create a new version.
updated_at:
type: string
format: date-time
updating_user_id:
$ref: '#/components/schemas/type_pre-encounter/common:UserId'
description: The user ID of the user who last updated the object.
status:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageStatus'
description: The status indiciating if the coverage is active or not.
subscriber:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:Subscriber'
description: >-
The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit
of the policy for services rendered to them or their family is due.
relationship:
$ref: '#/components/schemas/type_pre-encounter/common:Relationship'
description: The relationship of beneficiary (patient) to the subscriber. https://hl7.org/fhir/valueset-relationship.html
patient:
$ref: '#/components/schemas/type_pre-encounter/common:PatientId'
description: The canonical Candid patient UUID corresponding with the patient who benefits from the insurance coverage
insurance_plan:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:InsurancePlan'
verified:
type: boolean
description: A boolean indicating if the coverage has been verified by a user.
eligibility_checks:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityCheckMetadata'
description: A list of eligibility check metadata that have been initiated on this coverage.
latest_eligibility_check:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:LatestEligibilityCheck'
description: The latest eligibility check metadata that has been initiated on this coverage.
benefits:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:CoverageBenefits'
description: The eligibility of the patient for the coverage, manually verified by users.
orcon:
type: boolean
description: >-
ORCON (Originator Controlled) - When set to true, the Candid system will hide this coverage from downstream
integrations. Updates made in the Candid UI will unset this flag. Defaults to false.
auto_update_enabled:
type: boolean
description: >-
Default to true. When set to true, the Candid system will automatically update this coverage with the latest
eligibility check benefits information. Auto update behavior is also set at the eligibilityConfig org level
configuration.
previous_appointment_copays:
type: object
additionalProperties:
type: integer
description: >-
A map of UniversalServiceIdentifier (MD_Visit, Treatment, Tests, Activity) to copay values in cents. This is
used to track copay values for each service type to handle OOP max resets correctly.
id:
$ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
required:
- organization_id
- deactivated
- version
- updated_at
- updating_user_id
- status
- subscriber
- relationship
- patient
- insurance_plan
- verified
- id
description: A coverage object with immutable server-owned properties.
title: Coverage
type_pre-encounter/coverages/v1:CoveragesPage:
type: object
properties:
next_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
prev_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
total:
type: integer
items:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:Coverage'
required:
- total
- items
title: CoveragesPage
type_pre-encounter/coverages/v1:PayerPlanGroupFields:
type: object
properties:
payer_plan_group_id:
$ref: '#/components/schemas/type_pre-encounter/common:PayerPlanGroupId'
payer_id:
$ref: '#/components/schemas/type_pre-encounter/common:PayerId'
payer_name:
type: string
plan_type:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:NetworkType'
required:
- payer_plan_group_id
- payer_id
- payer_name
- plan_type
title: PayerPlanGroupFields
type_pre-encounter/coverages/v1:CoverageEligibilityCheckResponse:
type: object
properties:
metadata:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityCheckMetadata'
check:
$ref: '#/components/schemas/type_pre-encounter/eligibilityChecks/v1:EligibilityCheck'
required:
- metadata
title: CoverageEligibilityCheckResponse
type_pre-encounter/images/v1:ImageStatus:
type: string
enum:
- PENDING
- UPLOADED
- FAILED
title: ImageStatus
type_pre-encounter/images/v1:CoverageImageSide:
type: string
enum:
- FRONT
- BACK
title: CoverageImageSide
type_pre-encounter/images/v1:CoverageAssociation:
type: object
properties:
id:
$ref: '#/components/schemas/type_pre-encounter/common:CoverageId'
side:
$ref: '#/components/schemas/type_pre-encounter/images/v1:CoverageImageSide'
required:
- id
- side
description: An association to a Coverage.
title: CoverageAssociation
type_pre-encounter/images/v1:PatientAssociation:
type: object
properties:
id:
$ref: '#/components/schemas/type_pre-encounter/common:PatientId'
notes:
type: string
required:
- id
description: An association to a Patient.
title: PatientAssociation
type_pre-encounter/images/v1:MutableImage:
type: object
properties:
file_name:
type: string
display_name:
type: string
file_type:
type: string
status:
$ref: '#/components/schemas/type_pre-encounter/images/v1:ImageStatus'
coverage:
$ref: '#/components/schemas/type_pre-encounter/images/v1:CoverageAssociation'
patient:
$ref: '#/components/schemas/type_pre-encounter/images/v1:PatientAssociation'
required:
- file_name
- display_name
- file_type
- status
description: An object representing an Image.
title: MutableImage
type_pre-encounter/images/v1:ImageId:
type: string
description: The unique identifier for an Image
title: ImageId
type_pre-encounter/images/v1:Image:
type: object
properties:
organization_id:
$ref: '#/components/schemas/type_pre-encounter/common:OrganizationId'
description: The organization that owns this object.
deactivated:
type: boolean
description: >-
True if the object is deactivated. Deactivated objects are not returned in search results but are returned
in all other endpoints including scan.
version:
type: integer
description: The version of the object. Any update to any property of an object object will create a new version.
updated_at:
type: string
format: date-time
updating_user_id:
$ref: '#/components/schemas/type_pre-encounter/common:UserId'
description: The user ID of the user who last updated the object.
file_name:
type: string
display_name:
type: string
file_type:
type: string
status:
$ref: '#/components/schemas/type_pre-encounter/images/v1:ImageStatus'
coverage:
$ref: '#/components/schemas/type_pre-encounter/images/v1:CoverageAssociation'
patient:
$ref: '#/components/schemas/type_pre-encounter/images/v1:PatientAssociation'
id:
$ref: '#/components/schemas/type_pre-encounter/images/v1:ImageId'
signed_url:
type: string
description: >-
A signed URL to the image. This url can be used to upload an image to GCP storage or to read the image
contents.
required:
- organization_id
- deactivated
- version
- updated_at
- updating_user_id
- file_name
- display_name
- file_type
- status
- id
- signed_url
description: An Image object with immutable server-owned properties.
title: Image
type_pre-encounter/images/v1:ImageSortField:
type: string
enum:
- updatedAt
- fileName
- displayName
- fileType
- status
title: ImageSortField
type_pre-encounter/patients/v1:Patient:
type: object
properties:
organization_id:
$ref: '#/components/schemas/type_pre-encounter/common:OrganizationId'
description: The organization that owns this object.
deactivated:
type: boolean
description: >-
True if the object is deactivated. Deactivated objects are not returned in search results but are returned
in all other endpoints including scan.
version:
type: integer
description: The version of the object. Any update to any property of an object object will create a new version.
updated_at:
type: string
format: date-time
updating_user_id:
$ref: '#/components/schemas/type_pre-encounter/common:UserId'
description: The user ID of the user who last updated the object.
name:
$ref: '#/components/schemas/type_pre-encounter/common:HumanName'
other_names:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:HumanName'
description: Other names for the patient.
other_identifiers:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:ExternalIdentifier'
description: Other identifiers for the patient.
gender:
$ref: '#/components/schemas/type_pre-encounter/common:Gender'
birth_date:
type: string
format: date
social_security_number:
type: string
biological_sex:
$ref: '#/components/schemas/type_pre-encounter/common:Sex'
description: >-
The biological sex of the patient. This corresponds to the HL7 AdministrativeGender
https://www.hl7.org/fhir/valueset-administrative-gender.html
sexual_orientation:
$ref: '#/components/schemas/type_pre-encounter/common:SexualOrientation'
description: The sexual orientation of the patient.
pronouns:
type: array
items:
type: string
description: The pronouns of the patient.
race:
$ref: '#/components/schemas/type_pre-encounter/common:Race'
ethnicity:
$ref: '#/components/schemas/type_pre-encounter/common:Ethnicity'
disability_status:
$ref: '#/components/schemas/type_pre-encounter/common:DisabilityStatus'
marital_status:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:MaritalStatus'
deceased:
type: string
format: date-time
description: Time of death for the patient. Leave unset if the patient is not deceased.
multiple_birth:
type: integer
description: >-
The number of siblings the patient was born with. Leave unset if the patient was not part of a multiple
birth.
primary_address:
$ref: '#/components/schemas/type_pre-encounter/common:Address'
description: The primary address for the patient.
other_addresses:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:Address'
description: Other addresses for the patient.
primary_telecom:
$ref: '#/components/schemas/type_pre-encounter/common:ContactPoint'
description: The primary phone number for the patient.
other_telecoms:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:ContactPoint'
description: Other phone numbers for the patient.
email:
type: string
electronic_communication_opt_in:
type: boolean
description: >-
Use electronic_communication_consent for granular channel-level consent. This field is kept in sync
automatically but should not be used for new integrations.
electronic_communication_consent:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:ElectronicCommunicationConsent'
description: Granular consent for electronic communication channels.
photo:
type: string
language:
type: string
external_provenance:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:ExternalProvenance'
description: Information about the upstream system that owns this patient data. Leave unset if Candid owns patient data.
contacts:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Contact'
description: Contacts for the patient.
general_practitioners:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:ExternalProvider'
filing_order:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:FilingOrder'
coverages_for_related_causes:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:CoveragesForRelatedCauses'
non_insurance_payers:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:CanonicalNonInsurancePayerId'
non_insurance_payer_associations:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:CanonicalNonInsurancePayerAssociation'
guarantor:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Guarantor'
self_pay:
type: boolean
authorizations:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Authorization'
referrals:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Referral'
primary_service_facility_id:
type: string
service_facilities:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:PatientServiceFacility'
description: Associated service facilities for this patient.
do_not_invoice_reason:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:DoNotInvoiceReason'
description: If this value is defined, the customer will not be invoiced.
note_ids:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:NoteId'
tag_ids:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:TagId'
origination_detail:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:OriginationDetail'
description: Information about the patient source, if applicable.
inferred_patient_metadata:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:InferredPatientMetadata'
description: Metadata for the patient used for patient inference from encounters.
orcon:
type: boolean
description: >-
ORCON (Originator Controlled) - When set to true, the Candid system will hide this patient from downstream
integrations. Updates made in the Candid UI will unset this flag. Defaults to false.
advanced_directives:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:AdvancedDirective'
hipaa_code:
type: string
id:
$ref: '#/components/schemas/type_pre-encounter/common:PatientId'
description: The unique UUID identifier for a Patient. Patient ID is used in machine contexts.
mrn:
type: string
description: >-
The medical record number for the patient. Human-friendly Candid generated MRNs are of the form
"YYMMDDXXXX", where "YYMMDD" is the date of patient creation and "XXXX" is a zero-padded incrementing
integer.
required:
- organization_id
- deactivated
- version
- updated_at
- updating_user_id
- name
- other_names
- birth_date
- biological_sex
- primary_address
- other_addresses
- other_telecoms
- contacts
- general_practitioners
- filing_order
- id
- mrn
description: A patient object with immutable server-owned properties.
title: Patient
type_pre-encounter/lists/v1:PatientListItem:
type: object
properties:
patient:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Patient'
primary_coverage:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:MutableCoverage'
secondary_coverage:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:MutableCoverage'
tertiary_coverage:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:MutableCoverage'
next_appointment:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:MutableAppointment'
primary_mrn:
type: string
alternative_mrns:
type: array
items:
type: string
required:
- patient
- alternative_mrns
title: PatientListItem
type_pre-encounter/lists/v1:PatientListPage:
type: object
properties:
next_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
prev_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
total:
type: integer
items:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/lists/v1:PatientListItem'
required:
- total
- items
title: PatientListPage
type_pre-encounter/lists/v1:AppointmentListItem:
type: object
properties:
appointment:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:Appointment'
patient:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:MutablePatientWithMrn'
primary_coverage:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:MutableCoverage'
secondary_coverage:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:MutableCoverage'
primary_service_type:
$ref: '#/components/schemas/type_pre-encounter/appointments/v1:UniversalServiceIdentifier'
required:
- appointment
- patient
title: AppointmentListItem
type_pre-encounter/lists/v1:AppointmentListPage:
type: object
properties:
next_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
prev_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
total:
type: integer
items:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/lists/v1:AppointmentListItem'
required:
- total
- items
title: AppointmentListPage
type_pre-encounter/notes/v1:Note:
type: object
properties:
organization_id:
$ref: '#/components/schemas/type_pre-encounter/common:OrganizationId'
description: The organization that owns this object.
deactivated:
type: boolean
description: >-
True if the object is deactivated. Deactivated objects are not returned in search results but are returned
in all other endpoints including scan.
version:
type: integer
description: The version of the object. Any update to any property of an object object will create a new version.
updated_at:
type: string
format: date-time
updating_user_id:
$ref: '#/components/schemas/type_pre-encounter/common:UserId'
description: The user ID of the user who last updated the object.
value:
type: string
author_email:
type: string
author_name:
type: string
id:
$ref: '#/components/schemas/type_pre-encounter/common:NoteId'
created_at:
type: string
format: date-time
required:
- organization_id
- deactivated
- version
- updated_at
- updating_user_id
- value
- id
- created_at
description: A Note object with immutable server-owned properties.
title: Note
type_pre-encounter/notes/v1:MutableNote:
type: object
properties:
value:
type: string
author_email:
type: string
author_name:
type: string
required:
- value
description: An object representing a Note.
title: MutableNote
type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProviderId:
type: string
format: uuid
description: The unique identifier for an OrganizationExternalProvider in the database
title: OrganizationExternalProviderId
type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProviderType:
type: string
enum:
- REFERRING
- PRIMARY
- TREATING
title: OrganizationExternalProviderType
type_pre-encounter/organizationExternalProviders/v1: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
title: LicenseType
type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProvider:
type: object
properties:
organization_id:
$ref: '#/components/schemas/type_pre-encounter/common:OrganizationId'
description: The organization that owns this object.
deactivated:
type: boolean
description: >-
True if the object is deactivated. Deactivated objects are not returned in search results but are returned
in all other endpoints including scan.
version:
type: integer
description: The version of the object. Any update to any property of an object object will create a new version.
updated_at:
type: string
format: date-time
updating_user_id:
$ref: '#/components/schemas/type_pre-encounter/common:UserId'
description: The user ID of the user who last updated the object.
name:
$ref: '#/components/schemas/type_pre-encounter/common:HumanName'
types:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProviderType'
npi:
type: string
tax_id:
type: string
taxonomy_code:
type: string
phone_number:
type: string
fax_number:
type: string
license_type:
$ref: '#/components/schemas/type_pre-encounter/organizationExternalProviders/v1:LicenseType'
addresses:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:Address'
id:
$ref: '#/components/schemas/type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProviderId'
required:
- organization_id
- deactivated
- version
- updated_at
- updating_user_id
- name
- types
- id
description: An OrganizationExternalProvider object with immutable server-owned properties.
title: OrganizationExternalProvider
type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProviderSortField:
type: string
description: >-
The field to order by. Valid values are keys on the provider object (e.g., name.family, npi, updatedAt,
createdAt) or a special ordering "similar_name:" (Ex: similar_name:John). Similar name ordering
uses trigrams to fuzzy match provider name to the search criteria.
title: OrganizationExternalProviderSortField
type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProviderPage:
type: object
properties:
next_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
prev_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
total:
type: integer
items:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProvider'
required:
- total
- items
title: OrganizationExternalProviderPage
type_pre-encounter/organizationExternalProviders/v1:MutableOrganizationExternalProvider:
type: object
properties:
name:
$ref: '#/components/schemas/type_pre-encounter/common:HumanName'
types:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/organizationExternalProviders/v1:OrganizationExternalProviderType'
npi:
type: string
tax_id:
type: string
taxonomy_code:
type: string
phone_number:
type: string
fax_number:
type: string
license_type:
$ref: '#/components/schemas/type_pre-encounter/organizationExternalProviders/v1:LicenseType'
addresses:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:Address'
required:
- name
- types
description: An object representing an organization-level external provider.
title: MutableOrganizationExternalProvider
type_pre-encounter/patients/v1:MutablePatient:
type: object
properties:
name:
$ref: '#/components/schemas/type_pre-encounter/common:HumanName'
other_names:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:HumanName'
description: Other names for the patient.
other_identifiers:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:ExternalIdentifier'
description: Other identifiers for the patient.
gender:
$ref: '#/components/schemas/type_pre-encounter/common:Gender'
birth_date:
type: string
format: date
social_security_number:
type: string
biological_sex:
$ref: '#/components/schemas/type_pre-encounter/common:Sex'
description: >-
The biological sex of the patient. This corresponds to the HL7 AdministrativeGender
https://www.hl7.org/fhir/valueset-administrative-gender.html
sexual_orientation:
$ref: '#/components/schemas/type_pre-encounter/common:SexualOrientation'
description: The sexual orientation of the patient.
pronouns:
type: array
items:
type: string
description: The pronouns of the patient.
race:
$ref: '#/components/schemas/type_pre-encounter/common:Race'
ethnicity:
$ref: '#/components/schemas/type_pre-encounter/common:Ethnicity'
disability_status:
$ref: '#/components/schemas/type_pre-encounter/common:DisabilityStatus'
marital_status:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:MaritalStatus'
deceased:
type: string
format: date-time
description: Time of death for the patient. Leave unset if the patient is not deceased.
multiple_birth:
type: integer
description: >-
The number of siblings the patient was born with. Leave unset if the patient was not part of a multiple
birth.
primary_address:
$ref: '#/components/schemas/type_pre-encounter/common:Address'
description: The primary address for the patient.
other_addresses:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:Address'
description: Other addresses for the patient.
primary_telecom:
$ref: '#/components/schemas/type_pre-encounter/common:ContactPoint'
description: The primary phone number for the patient.
other_telecoms:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:ContactPoint'
description: Other phone numbers for the patient.
email:
type: string
electronic_communication_opt_in:
type: boolean
description: >-
Use electronic_communication_consent for granular channel-level consent. This field is kept in sync
automatically but should not be used for new integrations.
electronic_communication_consent:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:ElectronicCommunicationConsent'
description: Granular consent for electronic communication channels.
photo:
type: string
language:
type: string
external_provenance:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:ExternalProvenance'
description: Information about the upstream system that owns this patient data. Leave unset if Candid owns patient data.
contacts:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Contact'
description: Contacts for the patient.
general_practitioners:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:ExternalProvider'
filing_order:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:FilingOrder'
coverages_for_related_causes:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:CoveragesForRelatedCauses'
non_insurance_payers:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:CanonicalNonInsurancePayerId'
non_insurance_payer_associations:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:CanonicalNonInsurancePayerAssociation'
guarantor:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Guarantor'
self_pay:
type: boolean
authorizations:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Authorization'
referrals:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Referral'
primary_service_facility_id:
type: string
service_facilities:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:PatientServiceFacility'
description: Associated service facilities for this patient.
do_not_invoice_reason:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:DoNotInvoiceReason'
description: If this value is defined, the customer will not be invoiced.
note_ids:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:NoteId'
tag_ids:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/common:TagId'
origination_detail:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:OriginationDetail'
description: Information about the patient source, if applicable.
inferred_patient_metadata:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:InferredPatientMetadata'
description: Metadata for the patient used for patient inference from encounters.
orcon:
type: boolean
description: >-
ORCON (Originator Controlled) - When set to true, the Candid system will hide this patient from downstream
integrations. Updates made in the Candid UI will unset this flag. Defaults to false.
advanced_directives:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:AdvancedDirective'
hipaa_code:
type: string
required:
- name
- other_names
- birth_date
- biological_sex
- primary_address
- other_addresses
- other_telecoms
- contacts
- general_practitioners
- filing_order
description: An object representing patient demographics information.
title: MutablePatient
type_pre-encounter/patients/v1:PatientSortField:
type: string
description: >-
The field to order by. Valid values are either keys on the patient object or a special ordering
"similar_name:" (Ex: similar_name:John). Similar name ordering uses trigrams to fuzzy match
patient names to the search criteria.
title: PatientSortField
type_pre-encounter/patients/v1:PatientPage:
type: object
properties:
next_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
prev_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
total:
type: integer
items:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Patient'
required:
- total
- items
title: PatientPage
type_pre-encounter/patients/v1:PatientCoverageSnapshot:
type: object
properties:
patient:
$ref: '#/components/schemas/type_pre-encounter/patients/v1:Patient'
primary_coverage:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:Coverage'
secondary_coverage:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:Coverage'
tertiary_coverage:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:Coverage'
coverages_for_related_causes:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/coverages/v1:Coverage'
required:
- patient
- coverages_for_related_causes
title: PatientCoverageSnapshot
type_pre-encounter/tags/v1:Tag:
type: object
properties:
organization_id:
$ref: '#/components/schemas/type_pre-encounter/common:OrganizationId'
description: The organization that owns this object.
deactivated:
type: boolean
description: >-
True if the object is deactivated. Deactivated objects are not returned in search results but are returned
in all other endpoints including scan.
version:
type: integer
description: The version of the object. Any update to any property of an object object will create a new version.
updated_at:
type: string
format: date-time
updating_user_id:
$ref: '#/components/schemas/type_pre-encounter/common:UserId'
description: The user ID of the user who last updated the object.
value:
type: string
description:
type: string
alert:
type: boolean
id:
$ref: '#/components/schemas/type_pre-encounter/common:TagId'
required:
- organization_id
- deactivated
- version
- updated_at
- updating_user_id
- value
- id
description: A Tag object with immutable server-owned properties.
title: Tag
type_pre-encounter/tags/v1:TagPage:
type: object
properties:
next_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
prev_page_token:
$ref: '#/components/schemas/type_pre-encounter/common:PageToken'
total:
type: integer
items:
type: array
items:
$ref: '#/components/schemas/type_pre-encounter/tags/v1:Tag'
required:
- total
- items
title: TagPage
type_pre-encounter/tags/v1:MutableTag:
type: object
properties:
value:
type: string
description:
type: string
alert:
type: boolean
required:
- value
description: An object representing a Tag.
title: MutableTag
type_auth/default:AuthGetTokenResponse:
type: object
properties:
access_token:
type: string
expires_in:
type: integer
description: Time in seconds.
token_type:
type: string
required:
- access_token
- expires_in
- token_type
title: AuthGetTokenResponse
type_auth/default:TooManyRequestsErrorType:
type: object
properties:
message:
type: string
required:
- message
title: TooManyRequestsErrorType
type_auth/default:InvalidContentTypeErrorType:
type: object
properties:
message:
type: string
required:
- message
title: InvalidContentTypeErrorType
type_payment-account-configs:PaymentAccountConfigId:
type: string
format: uuid
title: PaymentAccountConfigId
type_commons:PatientExternalId:
type: string
title: PatientExternalId
type_commons:ServiceLineId:
type: string
format: uuid
title: ServiceLineId
type_commons:ClaimId:
type: string
format: uuid
title: ClaimId
type_invoices/v2:InvoiceItemAttributionCreate:
oneOf:
- type: object
properties:
type:
type: string
enum:
- service_line_id
description: 'Discriminator value: service_line_id'
value:
$ref: '#/components/schemas/type_commons:ServiceLineId'
required:
- type
- value
- type: object
properties:
type:
type: string
enum:
- claim_id
description: 'Discriminator value: claim_id'
value:
$ref: '#/components/schemas/type_commons:ClaimId'
required:
- type
- value
- type: object
properties:
type:
type: string
enum:
- unattributed
description: 'Discriminator value: unattributed'
required:
- type
discriminator:
propertyName: type
description: Points to the claim or service line that this invoice is attributed to
title: InvoiceItemAttributionCreate
type_invoices/v2:InvoiceItemCreate:
type: object
properties:
attribution:
$ref: '#/components/schemas/type_invoices/v2:InvoiceItemAttributionCreate'
amount_cents:
type: integer
required:
- attribution
- amount_cents
title: InvoiceItemCreate
type_invoices/v2:InvoiceStatus:
type: string
enum:
- DRAFT
- OPEN
- PAID
- VOID
- UNCOLLECTIBLE
- HELD
title: InvoiceStatus
type_import-invoice/v1:CreateImportInvoiceRequest:
type: object
properties:
external_payment_account_config_id:
$ref: '#/components/schemas/type_payment-account-configs:PaymentAccountConfigId'
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
external_customer_identifier:
type: string
description: Id of the customer in the source system
note:
type: string
due_date:
type: string
format: date
description: If given as None, days_until_due in the payment config will be used to create a default date
items:
type: array
items:
$ref: '#/components/schemas/type_invoices/v2:InvoiceItemCreate'
status:
$ref: '#/components/schemas/type_invoices/v2:InvoiceStatus'
external_identifier:
type: string
description: Id of the invoice being imported in the source system. Warning - This field CANNOT be updated.
customer_invoice_url:
type: string
description: Link to the patient view of the invoice in the third-party service
required:
- external_payment_account_config_id
- patient_external_id
- external_customer_identifier
- items
- status
- external_identifier
title: CreateImportInvoiceRequest
type_commons:InvoiceId:
type: string
format: uuid
title: InvoiceId
type_invoices/v2:ClaimInvoiceItem:
type: object
properties:
claim_id:
$ref: '#/components/schemas/type_commons:ClaimId'
amount_cents:
type: integer
required:
- claim_id
- amount_cents
title: ClaimInvoiceItem
type_invoices/v2:ServiceLineInvoiceItem:
type: object
properties:
service_line_id:
$ref: '#/components/schemas/type_commons:ServiceLineId'
amount_cents:
type: integer
required:
- service_line_id
- amount_cents
title: ServiceLineInvoiceItem
type_invoices/v2:ClaimInvoiceItemInfo:
type: object
properties:
claim_invoice_item:
$ref: '#/components/schemas/type_invoices/v2:ClaimInvoiceItem'
service_line_invoice_items:
type: object
additionalProperties:
$ref: '#/components/schemas/type_invoices/v2:ServiceLineInvoiceItem'
required:
- service_line_invoice_items
title: ClaimInvoiceItemInfo
type_invoices/v2:UnattributedInvoiceItem:
type: object
properties:
amount_cents:
type: integer
required:
- amount_cents
title: UnattributedInvoiceItem
type_invoices/v2:InvoiceItemInfo:
type: object
properties:
claim_invoice_items:
type: object
additionalProperties:
$ref: '#/components/schemas/type_invoices/v2:ClaimInvoiceItemInfo'
unattributed_items:
type: array
items:
$ref: '#/components/schemas/type_invoices/v2:UnattributedInvoiceItem'
required:
- claim_invoice_items
- unattributed_items
title: InvoiceItemInfo
type_import-invoice/v1:ImportInvoice:
type: object
properties:
id:
$ref: '#/components/schemas/type_commons:InvoiceId'
created_at:
type: string
format: date-time
updated_at:
type: string
format: date-time
items:
$ref: '#/components/schemas/type_invoices/v2:InvoiceItemInfo'
description: The InvoiceItem rollup which contains all claim and service line invoice items
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
external_customer_identifier:
type: string
description: Id of the customer in the source system
status:
$ref: '#/components/schemas/type_invoices/v2:InvoiceStatus'
external_identifier:
type: string
description: Id of the invoice being imported in the source system
note:
type: string
customer_invoice_url:
type: string
description: Link to the patient view of the invoice in the third-party service
due_date:
type: string
format: date
amount_cents:
type: integer
description: Total monetary amount (in cents) of all Invoice Items
required:
- id
- created_at
- updated_at
- items
- patient_external_id
- external_customer_identifier
- status
- external_identifier
- due_date
- amount_cents
title: ImportInvoice
type_commons:UnprocessableEntityErrorMessage:
type: object
properties:
message:
type: string
title: UnprocessableEntityErrorMessage
type_commons:EntityConflictErrorMessage:
type: object
properties:
entity_name:
type: string
required:
- entity_name
title: EntityConflictErrorMessage
type_commons:EncounterExternalId:
type: string
title: EncounterExternalId
type_invoices/v2:InvoiceSortField:
type: string
enum:
- CREATED_AT
- UPDATED_AT
- PATIENT_EXTERNAL_ID
- NOTE
- DUE_DATE
- STATUS
title: InvoiceSortField
type_commons:SortDirection:
type: string
enum:
- asc
- desc
title: SortDirection
type_commons:PageToken:
type: string
title: PageToken
type_import-invoice/v1:ImportInvoicesPage:
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_import-invoice/v1:ImportInvoice'
required:
- items
title: ImportInvoicesPage
type_commons:EntityNotFoundErrorMessage:
type: object
properties:
id:
type: string
required:
- id
title: EntityNotFoundErrorMessage
type_import-invoice/v1:InvoiceItemUpdateType:
type: string
enum:
- APPEND
- OVERWRITE
title: InvoiceItemUpdateType
type_import-invoice/v1:InvoiceItemInfoUpdate:
type: object
properties:
update_type:
$ref: '#/components/schemas/type_import-invoice/v1:InvoiceItemUpdateType'
description: >-
The only supported update operations for invoice items is to either overwrite the entire list of invoice
items
or to append new invoice items
items:
type: array
items:
$ref: '#/components/schemas/type_invoices/v2:InvoiceItemCreate'
required:
- update_type
- items
title: InvoiceItemInfoUpdate
type_import-invoice/v1:ImportInvoiceUpdateRequest:
type: object
properties:
customer_invoice_url:
type: string
description: Link to the patient view of the invoice in the third-party service
status:
$ref: '#/components/schemas/type_invoices/v2:InvoiceStatus'
note:
type: string
due_date:
type: string
format: date
items:
$ref: '#/components/schemas/type_import-invoice/v1:InvoiceItemInfoUpdate'
description: None here represents there is no update to the invoice items
title: ImportInvoiceUpdateRequest
type_commons:EncounterId:
type: string
format: uuid
title: EncounterId
type_patient-ar/v1:PatientARStatus:
type: string
enum:
- invoiceable
- non_invoiceable
title: PatientARStatus
type_patient-ar/v1:InventoryRecord:
type: object
properties:
claim_id:
$ref: '#/components/schemas/type_commons:ClaimId'
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
timestamp:
type: string
format: date-time
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
patient_ar_status:
$ref: '#/components/schemas/type_patient-ar/v1:PatientARStatus'
required:
- claim_id
- encounter_id
- timestamp
- patient_external_id
- patient_ar_status
title: InventoryRecord
type_patient-ar/v1:ListInventoryPagedResponse:
type: object
properties:
records:
type: array
items:
$ref: '#/components/schemas/type_patient-ar/v1:InventoryRecord'
description: List of inventory records matching the filters
next_page_token:
$ref: '#/components/schemas/type_commons:PageToken'
description: Token for the next page of results, if available
required:
- records
title: ListInventoryPagedResponse
type_patient-ar/v1:InvalidFiltersErrorType:
type: object
properties:
message:
type: string
required:
- message
title: InvalidFiltersErrorType
type_commons:UnauthorizedErrorMessage:
type: object
properties:
message:
type: string
title: UnauthorizedErrorMessage
type_patient-ar/v1:PatientPaymentAllocation:
type: object
properties:
source_id:
type: string
description: >-
Payment identifier from the source system (e.g., patient portal, manual entry). Note multiple allocations
may exist for a single payment and
thus may share the same source_id.
amount_cents:
type: integer
description: The amount of the patient payment in cents.
required:
- amount_cents
title: PatientPaymentAllocation
type_patient-ar/v1:PatientPaymentInfo:
type: object
properties:
total_payment_cents:
type: integer
description: The total amount of patient payments in cents for the service line.
items:
type: array
items:
$ref: '#/components/schemas/type_patient-ar/v1:PatientPaymentAllocation'
description: A list of patient payment items associated with the service line.
required:
- total_payment_cents
- items
title: PatientPaymentInfo
type_patient-ar/v1:InsuranceAdjustmentInfo:
type: object
properties:
total_adjustment_cents:
type: integer
description: The total amount of insurance adjustments in cents for the service line.
required:
- total_adjustment_cents
title: InsuranceAdjustmentInfo
type_patient-ar/v1:InsurancePaymentInfo:
type: object
properties:
total_payment_cents:
type: integer
description: The total amount of insurance payments in cents for the service line.
required:
- total_payment_cents
title: InsurancePaymentInfo
type_patient-ar/v1:NonInsuranceAdjustmentInfo:
type: object
properties:
total_adjustment_cents:
type: integer
description: The total amount of non-insurance adjustments in cents for the service line.
required:
- total_adjustment_cents
title: NonInsuranceAdjustmentInfo
type_patient-ar/v1:NonInsurancePaymentInfo:
type: object
properties:
total_payment_cents:
type: integer
description: The total amount of non-insurance payments in cents for the service line.
required:
- total_payment_cents
title: NonInsurancePaymentInfo
type_patient-ar/v1:PatientAdjustmentInfo:
type: object
properties:
total_adjustment_cents:
type: integer
description: The total amount of patient adjustments in cents for the service line.
required:
- total_adjustment_cents
title: PatientAdjustmentInfo
type_patient-ar/v1:ServiceLineItemization:
type: object
properties:
service_line_id:
$ref: '#/components/schemas/type_commons:ServiceLineId'
description: The ID of the service line.
procedure_code:
type: string
description: The procedure code (CPT/HCPCS) associated with the service line.
date_of_service:
type: string
format: date
description: The date of service for the service line.
patient_balance_cents:
type: integer
description: The total patient balance in cents for the service line. Negative values indicate a credit balance.
charge_amount_cents:
type: integer
description: The total charge amount in cents for the service line.
insurance_adjustments:
$ref: '#/components/schemas/type_patient-ar/v1:InsuranceAdjustmentInfo'
insurance_payments:
$ref: '#/components/schemas/type_patient-ar/v1:InsurancePaymentInfo'
non_insurance_adjustments:
$ref: '#/components/schemas/type_patient-ar/v1:NonInsuranceAdjustmentInfo'
non_insurance_payments:
$ref: '#/components/schemas/type_patient-ar/v1:NonInsurancePaymentInfo'
patient_adjustments:
$ref: '#/components/schemas/type_patient-ar/v1:PatientAdjustmentInfo'
patient_payments:
$ref: '#/components/schemas/type_patient-ar/v1:PatientPaymentInfo'
copay_cents:
type: integer
description: The copay amount in cents for the service line.
coinsurance_cents:
type: integer
description: The coinsurance amount in cents for the service line.
deductible_cents:
type: integer
description: The deductible amount in cents for the service line.
required:
- service_line_id
- procedure_code
- date_of_service
- patient_balance_cents
- charge_amount_cents
- insurance_adjustments
- insurance_payments
- non_insurance_adjustments
- non_insurance_payments
- patient_adjustments
- patient_payments
- copay_cents
- coinsurance_cents
- deductible_cents
title: ServiceLineItemization
type_patient-ar/v1:InvoiceItemizationResponse:
type: object
properties:
claim_id:
$ref: '#/components/schemas/type_commons:ClaimId'
description: The ID of the claim associated with the invoice itemization.
patient_balance_cents:
type: integer
description: The total patient balance in cents for the claim. Negative values indicate a credit balance.
claim_level_patient_payments:
$ref: '#/components/schemas/type_patient-ar/v1:PatientPaymentInfo'
service_line_itemization:
type: array
items:
$ref: '#/components/schemas/type_patient-ar/v1:ServiceLineItemization'
description: A list of service line itemizations for the claim.
required:
- claim_id
- patient_balance_cents
- claim_level_patient_payments
- service_line_itemization
title: InvoiceItemizationResponse
type_commons:ProviderId:
type: string
format: uuid
title: ProviderId
type_financials:PatientTransactionSource:
type: string
enum:
- MANUAL_ENTRY
- CHARGEBEE
- SQUARE
- STRIPE
- ELATION
- CEDAR
- HEALTHIE
- REALLOCATION
- PHREESIA
- INSTAMED
- SHERPA_HEALTH
title: PatientTransactionSource
type_patient-payments/v4:PatientPaymentSortField:
type: string
enum:
- payment_source
- amount_cents
- payment_timestamp
- payment_note
title: PatientPaymentSortField
type_patient-payments/v4:PatientPaymentId:
type: string
format: uuid
title: PatientPaymentId
type_commons:OrganizationId:
type: string
format: uuid
title: OrganizationId
type_commons:AllocationId:
type: string
format: uuid
title: AllocationId
type_commons:AppointmentId:
type: string
title: AppointmentId
type_financials:AllocationTarget:
oneOf:
- type: object
properties:
type:
type: string
enum:
- service_line
description: 'Discriminator value: service_line'
service_line_id:
$ref: '#/components/schemas/type_commons:ServiceLineId'
claim_id:
$ref: '#/components/schemas/type_commons:ClaimId'
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
required:
- type
- service_line_id
- claim_id
- encounter_id
- type: object
properties:
type:
type: string
enum:
- claim
description: 'Discriminator value: claim'
claim_id:
$ref: '#/components/schemas/type_commons:ClaimId'
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
required:
- type
- claim_id
- encounter_id
- type: object
properties:
type:
type: string
enum:
- billing_provider_id
description: 'Discriminator value: billing_provider_id'
billing_provider_id:
$ref: '#/components/schemas/type_commons:ProviderId'
required:
- type
- billing_provider_id
- type: object
properties:
type:
type: string
enum:
- appointment
description: 'Discriminator value: appointment'
appointment_id:
$ref: '#/components/schemas/type_commons:AppointmentId'
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
required:
- type
- appointment_id
- patient_external_id
- type: object
properties:
type:
type: string
enum:
- unattributed
description: 'Discriminator value: unattributed'
required:
- type
discriminator:
propertyName: type
description: |-
Allocation targets describe whether the portion of a payment is being applied toward a specific service line,
claim, billing provider, or is unallocated.
title: AllocationTarget
type_commons:Date:
type: string
description: ISO 8601 date; formatted YYYY-MM-DD (i.e. 2012-02-01)
title: Date
type_financials:AllocationEarmarkType:
oneOf:
- type: object
properties:
type:
type: string
enum:
- date_of_service
description: 'Discriminator value: date_of_service'
value:
$ref: '#/components/schemas/type_commons:Date'
required:
- type
- value
description: Earmark for auto-allocation to an encounter with this specific date of service
- type: object
properties:
type:
type: string
enum:
- external_encounter_id
description: 'Discriminator value: external_encounter_id'
value:
$ref: '#/components/schemas/type_commons:EncounterExternalId'
required:
- type
- value
description: >-
Earmark for auto-allocation to an encounter with this specific external ID (more specific than date of
service)
discriminator:
propertyName: type
description: >-
If enabled for your organization, defines how a patient prepayment allocation should be earmarked for future
auto-allocation.
Earmarks hold the allocation until a matching encounter is created, then attempt to allocate to that encounter.
Only applicable for unattributed allocations.
title: AllocationEarmarkType
type_financials:BalanceEarmark:
type: object
properties:
id:
type: string
format: uuid
target:
$ref: '#/components/schemas/type_financials:AllocationEarmarkType'
description: The target for this earmark (date of service or external encounter ID)
amount_earmarked_cents:
type: integer
description: The amount earmarked in cents for future allocation
created_by_allocation_id:
$ref: '#/components/schemas/type_commons:AllocationId'
description: The ID of the allocation that created this earmark
required:
- id
- target
description: |-
Represents an active balance earmarking record that holds allocated funds for future auto-allocation.
Earmarks are created when funds are allocated but should be held for a specific encounter or date of service.
Only active (non-deleted) earmarks are returned.
title: BalanceEarmark
type_financials:Allocation:
type: object
properties:
allocation_id:
$ref: '#/components/schemas/type_commons:AllocationId'
amount_cents:
type: integer
target:
$ref: '#/components/schemas/type_financials:AllocationTarget'
earmark:
$ref: '#/components/schemas/type_financials:BalanceEarmark'
description: >-
The active earmark created by this allocation, if any. Only present when this allocation created an earmark
for future auto-allocation and the earmark has not been deleted.
allocated_on:
type: string
format: date-time
required:
- amount_cents
- target
title: Allocation
type_patient-payments/v4:PaymentMethod:
oneOf:
- type: object
properties:
type:
type: string
enum:
- cash
description: 'Discriminator value: cash'
required:
- type
- type: object
properties:
type:
type: string
enum:
- check
description: 'Discriminator value: check'
check_number:
type: string
required:
- type
- check_number
- type: object
properties:
type:
type: string
enum:
- card
description: 'Discriminator value: card'
required:
- type
- type: object
properties:
type:
type: string
enum:
- money_order
description: 'Discriminator value: money_order'
money_order_serial_number:
type: string
required:
- type
- money_order_serial_number
discriminator:
propertyName: type
title: PaymentMethod
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_commons:StreetAddressShortZip:
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
required:
- address1
- city
- state
- zip_code
title: StreetAddressShortZip
type_patient-payments/v4:PaymentMethodDetail:
type: object
properties:
payment_method:
$ref: '#/components/schemas/type_patient-payments/v4:PaymentMethod'
collected_at_address:
$ref: '#/components/schemas/type_commons:StreetAddressShortZip'
required:
- payment_method
title: PaymentMethodDetail
type_patient-payments/v4:PatientPayment:
type: object
properties:
patient_payment_id:
$ref: '#/components/schemas/type_patient-payments/v4:PatientPaymentId'
organization_id:
$ref: '#/components/schemas/type_commons:OrganizationId'
source_internal_id:
type: string
payment_source:
$ref: '#/components/schemas/type_financials:PatientTransactionSource'
amount_cents:
type: integer
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
payment_timestamp:
type: string
format: date-time
payment_note:
type: string
allocations:
type: array
items:
$ref: '#/components/schemas/type_financials:Allocation'
invoice:
$ref: '#/components/schemas/type_commons:InvoiceId'
payment_method_detail:
$ref: '#/components/schemas/type_patient-payments/v4:PaymentMethodDetail'
required:
- patient_payment_id
- organization_id
- payment_source
- amount_cents
- patient_external_id
- allocations
title: PatientPayment
type_patient-payments/v4:PatientPaymentsPage:
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_patient-payments/v4:PatientPayment'
required:
- items
title: PatientPaymentsPage
type_financials:AllocationTargetCreate:
oneOf:
- type: object
properties:
type:
type: string
enum:
- service_line_by_id
description: 'Discriminator value: service_line_by_id'
value:
$ref: '#/components/schemas/type_commons:ServiceLineId'
required:
- type
- value
- type: object
properties:
type:
type: string
enum:
- claim_by_id
description: 'Discriminator value: claim_by_id'
value:
$ref: '#/components/schemas/type_commons:ClaimId'
required:
- type
- value
- type: object
properties:
type:
type: string
enum:
- claim_by_encounter_external_id
description: 'Discriminator value: claim_by_encounter_external_id'
value:
$ref: '#/components/schemas/type_commons:EncounterExternalId'
required:
- type
- value
- type: object
properties:
type:
type: string
enum:
- billing_provider_by_id
description: 'Discriminator value: billing_provider_by_id'
value:
$ref: '#/components/schemas/type_commons:ProviderId'
required:
- type
- value
- type: object
properties:
type:
type: string
enum:
- appointment_by_id_and_patient_external_id
description: 'Discriminator value: appointment_by_id_and_patient_external_id'
appointment_id:
$ref: '#/components/schemas/type_commons:AppointmentId'
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
required:
- type
- appointment_id
- patient_external_id
- type: object
properties:
type:
type: string
enum:
- unattributed
description: 'Discriminator value: unattributed'
required:
- type
discriminator:
propertyName: type
description: |-
Allocation targets describe whether the portion of a payment is being applied toward a specific service line,
claim, billing provider, or is unallocated.
title: AllocationTargetCreate
type_financials:AllocationCreate:
type: object
properties:
amount_cents:
type: integer
target:
$ref: '#/components/schemas/type_financials:AllocationTargetCreate'
earmark:
$ref: '#/components/schemas/type_financials:AllocationEarmarkType'
description: >-
If enabled for your organization, optional earmarking configuration for patient prepayments.
When provided on unattributed allocations, holds the payment for future auto-allocation to matching
encounters.
required:
- amount_cents
- target
description: >-
Allocations are portions of payments that are applied to specific resources, known as targets. Each allocation
has
and amount, defined in cents, and a target.
title: AllocationCreate
type_patient-payments/v4:PaymentMethodCreate:
oneOf:
- type: object
properties:
type:
type: string
enum:
- cash
description: 'Discriminator value: cash'
required:
- type
- type: object
properties:
type:
type: string
enum:
- check
description: 'Discriminator value: check'
check_number:
type: string
required:
- type
- check_number
- type: object
properties:
type:
type: string
enum:
- card
description: 'Discriminator value: card'
required:
- type
- type: object
properties:
type:
type: string
enum:
- money_order
description: 'Discriminator value: money_order'
money_order_serial_number:
type: string
required:
- type
- money_order_serial_number
discriminator:
propertyName: type
title: PaymentMethodCreate
type_organization-service-facilities/v2:OrganizationServiceFacilityId:
type: string
format: uuid
title: OrganizationServiceFacilityId
type_patient-payments/v4:PaymentMethodDetailCreate:
type: object
properties:
payment_method:
$ref: '#/components/schemas/type_patient-payments/v4:PaymentMethodCreate'
collected_at_address:
$ref: '#/components/schemas/type_commons:StreetAddressShortZip'
organization_service_facility_id:
$ref: '#/components/schemas/type_organization-service-facilities/v2:OrganizationServiceFacilityId'
required:
- payment_method
title: PaymentMethodDetailCreate
type_financials:PatientPaymentCreateSource:
type: string
enum:
- MANUAL_ENTRY
- PHREESIA
- SHERPA_HEALTH
description: Allowed payment sources when creating a patient payment via the API.
title: PatientPaymentCreateSource
type_financials:NoteUpdate:
oneOf:
- type: object
properties:
type:
type: string
enum:
- set
description: 'Discriminator value: set'
value:
type: string
required:
- type
- value
- type: object
properties:
type:
type: string
enum:
- remove
description: 'Discriminator value: remove'
required:
- type
discriminator:
propertyName: type
title: NoteUpdate
type_financials:InvoiceUpdate:
oneOf:
- type: object
properties:
type:
type: string
enum:
- set
description: 'Discriminator value: set'
value:
$ref: '#/components/schemas/type_commons:InvoiceId'
required:
- type
- value
- type: object
properties:
type:
type: string
enum:
- remove
description: 'Discriminator value: remove'
required:
- type
discriminator:
propertyName: type
title: InvoiceUpdate
type_patient-refunds/v1:PatientRefundSortField:
type: string
enum:
- refund_source
- amount_cents
- refund_timestamp
- refund_reason
- refund_note
title: PatientRefundSortField
type_patient-refunds/v1:PatientRefundId:
type: string
format: uuid
title: PatientRefundId
type_financials:RefundReason:
type: string
enum:
- OVERCHARGED
- ENTERED_IN_ERROR
- TRANSFER
title: RefundReason
type_patient-refunds/v1:PatientRefund:
type: object
properties:
patient_refund_id:
$ref: '#/components/schemas/type_patient-refunds/v1:PatientRefundId'
organization_id:
$ref: '#/components/schemas/type_commons:OrganizationId'
source_internal_id:
type: string
refund_source:
$ref: '#/components/schemas/type_financials:PatientTransactionSource'
amount_cents:
type: integer
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
refund_timestamp:
type: string
format: date-time
refund_note:
type: string
allocations:
type: array
items:
$ref: '#/components/schemas/type_financials:Allocation'
invoice:
$ref: '#/components/schemas/type_commons:InvoiceId'
refund_reason:
$ref: '#/components/schemas/type_financials:RefundReason'
required:
- patient_refund_id
- organization_id
- refund_source
- amount_cents
- patient_external_id
- allocations
title: PatientRefund
type_patient-refunds/v1:PatientRefundsPage:
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_patient-refunds/v1:PatientRefund'
required:
- items
title: PatientRefundsPage
type_financials:AllocationOverdraftDetail:
type: object
properties:
allocation_target:
$ref: '#/components/schemas/type_financials:AllocationTarget'
description: The allocation target that would be overdrafted (service_line, claim, unattributed, etc.)
patient_paid_amount_cents:
type: integer
description: The amount in cents that the patient has currently paid toward this target (available to reallocate from)
current_balance_cents:
type: integer
description: The current balance in cents on this entity before the reallocation
overage_amount_cents:
type: integer
description: The amount in cents by which the reallocation would overdraft (always positive)
error_message:
type: string
description: A descriptive error message explaining the overdraft condition
required:
- allocation_target
- patient_paid_amount_cents
- current_balance_cents
- overage_amount_cents
- error_message
description: |-
Structured information about an allocation that would be overdrafted.
Provides entity-specific details to display in a table format.
title: AllocationOverdraftDetail
type_financials:ReallocationWouldOverdraftErrorContent:
type: object
properties:
messages:
type: array
items:
type: string
description: |-
Legacy field containing error messages as strings.
Deprecated - use allocation_details for structured data.
Will be removed in a future version after frontend migration.
allocation_details:
type: array
items:
$ref: '#/components/schemas/type_financials:AllocationOverdraftDetail'
description: |-
Structured details about which allocations would be overdrafted.
Each detail includes entity type, ID, and error message for table display.
required:
- messages
description: |-
Error content when a reallocation would cause an account to be overdrafted.
Contains both legacy string messages and new structured allocation details.
title: ReallocationWouldOverdraftErrorContent
type_financials:RefundReasonUpdate:
oneOf:
- type: object
properties:
type:
type: string
enum:
- set
description: 'Discriminator value: set'
value:
$ref: '#/components/schemas/type_financials:RefundReason'
required:
- type
- value
- type: object
properties:
type:
type: string
enum:
- remove
description: 'Discriminator value: remove'
required:
- type
discriminator:
propertyName: type
title: RefundReasonUpdate
type_billing-notes/v2:BillingNoteId:
type: string
format: uuid
title: BillingNoteId
type_billing-notes/v2:BillingNoteType:
type: string
enum:
- manual
- system
- queue_added
- queue_moved
- task_created
title: BillingNoteType
type_billing-notes/v2:BillingNoteMetadata:
oneOf:
- type: object
properties:
type:
type: string
enum:
- queue_added
description: 'Discriminator value: queue_added'
queue_id:
type: string
queue_name:
type: string
required:
- type
- queue_id
- queue_name
- type: object
properties:
type:
type: string
enum:
- queue_moved
description: 'Discriminator value: queue_moved'
from_queue_id:
type: string
from_queue_name:
type: string
to_queue_id:
type: string
to_queue_name:
type: string
required:
- type
- from_queue_id
- from_queue_name
- to_queue_id
- to_queue_name
- type: object
properties:
type:
type: string
enum:
- task_created
description: 'Discriminator value: task_created'
task_id:
type: string
format: uuid
task_type:
type: string
required:
- type
- task_id
- task_type
discriminator:
propertyName: type
title: BillingNoteMetadata
type_billing-notes/v2:BillingNote:
type: object
properties:
text:
type: string
description: Empty string not allowed.
billing_note_id:
$ref: '#/components/schemas/type_billing-notes/v2:BillingNoteId'
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
created_at:
type: string
format: date-time
description: |-
An [RFC 3339, section 5.6 datetime](https://ijmacd.github.io/rfc3339-iso8601/).
For example, 2017-07-21T17:32:28Z.
author_auth0_id:
type: string
author_name:
type: string
billing_note_type:
$ref: '#/components/schemas/type_billing-notes/v2:BillingNoteType'
billing_note_metadata:
$ref: '#/components/schemas/type_billing-notes/v2:BillingNoteMetadata'
required:
- text
- billing_note_id
- encounter_id
- created_at
title: BillingNote
type_commons:OrganizationNotAuthorizedErrorMessage:
type: object
properties:
message:
type: string
required:
- message
title: OrganizationNotAuthorizedErrorMessage
type_commons:RequestValidationError:
type: object
properties:
fieldName:
type: string
humanReadableMessage:
type: string
required:
- fieldName
title: RequestValidationError
type_commons:ChargeCaptureClaimCreationId:
type: string
format: uuid
title: ChargeCaptureClaimCreationId
type_charge-capture-bundles/v1:ChargeCaptureClaimCreationStatus:
type: string
enum:
- not-started
- in-error
- successful
- successful-dry-run
- aborted
- held
title: ChargeCaptureClaimCreationStatus
type_commons:ChargeCaptureId:
type: string
format: uuid
title: ChargeCaptureId
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_encounters/v4:PriorAuthorizationNumber:
type: string
title: PriorAuthorizationNumber
type_tags:TagId:
type: string
title: TagId
type_encounters/v4:BillableStatusType:
type: string
enum:
- BILLABLE
- NOT_BILLABLE
title: BillableStatusType
type_encounters/v4:ResponsiblePartyType:
type: string
enum:
- INSURANCE_PAY
- SELF_PAY
- UNKNOWN
title: ResponsiblePartyType
type_encounters/v4:SynchronicityType:
type: string
enum:
- Synchronous
- Asynchronous
title: SynchronicityType
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_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_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: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_diagnoses:DiagnosisTypeCode:
type: string
enum:
- ABF
- ABJ
- ABK
- APR
- BF
- BJ
- BK
- PR
- DR
- LOI
title: DiagnosisTypeCode
type_yes-no-indicator:YesNoIndicator:
type: string
enum:
- 'YES'
- 'NO'
- UNKNOWN
- NOT_APPLICABLE
title: YesNoIndicator
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.
Should be of the appropriate format for the provided `code_type`.
Must obey the ICD-10 format if an ICD-10 code_type is provided, specifically:
- Letter
- Digit
- Digit or the letter `A` or `B`
- (Optional) Period `.`
- 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_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:Npi:
type: string
title: Npi
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_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: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_commons:ReportTransmissionCode:
type: string
enum:
- BM
- EL
- FX
title: ReportTransmissionCode
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_commons:EPSDTReferralConditionIndicatorCode:
type: string
enum:
- AV
- NU
- S2
- ST
title: EPSDTReferralConditionIndicatorCode
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_encounters/v4:RxCui:
type: string
title: RxCui
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_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_commons:PhoneNumberType:
type: string
enum:
- Home
- Mobile
- Work
title: PhoneNumberType
type_commons:PhoneNumberOptional:
type: object
properties:
number:
type: string
type:
$ref: '#/components/schemas/type_commons:PhoneNumberType'
title: PhoneNumberOptional
type_commons:Email:
type: string
title: Email
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_individual:Gender:
type: string
enum:
- male
- female
- other
- not_given
- unknown
title: Gender
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_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_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_commons:PayerPlanGroupId:
type: string
format: uuid
title: PayerPlanGroupId
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_commons:EmrPayerCrosswalk:
type: string
enum:
- HEALTHIE
- CANVAS
- WAYSTAR
- PAYER_PLAN_GROUP
title: EmrPayerCrosswalk
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 Plan Groups 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 group name here. See Payer
Information documentation for details.
title: InsuranceCardCreateOptional
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_encounters/v4:InterventionCategory:
type: string
enum:
- allopathic
- naturopathic
- tests
- lifestyle
title: InterventionCategory
type_encounters/v4:LabCodeType:
type: string
enum:
- quest
- labcorp
title: LabCodeType
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_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_commons:SchemaId:
type: string
format: uuid
title: SchemaId
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_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:ClaimSubmissionPayerResponsibilityType:
type: string
enum:
- primary
- secondary
title: ClaimSubmissionPayerResponsibilityType
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_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_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: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'
- '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_commons:Decimal:
type: string
description: String representation of a Decimal that can be parsed by most libraries.
title: Decimal
type_commons:ServiceLineUnits:
type: string
enum:
- MJ
- UN
title: ServiceLineUnits
type_service-lines/v2:ServiceIdQualifier:
type: string
enum:
- EN
- EO
- HI
- N4
- 'ON'
- UK
- UP
title: ServiceIdQualifier
type_service-lines/v2:MeasurementUnitCode:
type: string
enum:
- ML
- UN
- GR
- F2
- ME
title: MeasurementUnitCode
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_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_service-lines/v2:TestResultType:
type: string
enum:
- HEMATOCRIT
- HEMOGLOBIN
- LDL
- VITAMIN_D
title: TestResultType
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_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_encounters/v4:PatientHistoryCategoryEnum:
type: string
enum:
- present_illness
- medical
- family
- social
title: PatientHistoryCategoryEnum
type_encounters/v4:IntakeQuestionId:
type: string
title: IntakeQuestionId
type_encounters/v4:IntakeFollowUpId:
type: string
title: IntakeFollowUpId
type_encounters/v4:IntakeFollowUpOptional:
type: object
properties:
id:
$ref: '#/components/schemas/type_encounters/v4:IntakeFollowUpId'
text:
type: string
response:
type: string
title: IntakeFollowUpOptional
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: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_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_billing-notes/v2:BillingNoteBaseOptional:
type: object
properties:
text:
type: string
description: Empty string not allowed.
title: BillingNoteBaseOptional
type_non-insurance-payers/v1:NonInsurancePayerId:
type: string
format: uuid
title: NonInsurancePayerId
type_commons:ClinicalTrialId:
type: string
format: uuid
title: ClinicalTrialId
type_individual:PatientClinicalTrialInfoCreateOptional:
type: object
properties:
clinical_trial_arm:
type: string
clinical_trial_id:
$ref: '#/components/schemas/type_commons:ClinicalTrialId'
title: PatientClinicalTrialInfoCreateOptional
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_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_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_encounter-providers/v2:ProviderSecondaryIdentificationQualifier:
type: string
enum:
- 0B
- 1G
- G2
- LU
title: ProviderSecondaryIdentificationQualifier
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_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:QualifierCode:
type: string
enum:
- DQ
- DN
- DK
- P3
title: QualifierCode
type_encounter-providers/v2:ReferringProviderSecondaryIdentificationQualifier:
type: string
enum:
- 0B
- 1G
- G2
title: ReferringProviderSecondaryIdentificationQualifier
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_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_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_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_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-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
title: LicenseType
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_commons:BillingProviderCommercialLicenseType:
type: string
enum:
- '0'
- A
- B
- C
- D
- E
- F
- G
- H
- I
title: BillingProviderCommercialLicenseType
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_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_related-causes/v1:RelatedCausesCode:
type: string
enum:
- AA
- AB
- AP
- EM
- OA
- ZZ
title: RelatedCausesCode
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_property-and-casualty/v1:PropertyCasualtyPatientIdentifierQualifier:
type: string
enum:
- 1W
- SY
title: PropertyCasualtyPatientIdentifierQualifier
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_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
Required 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.
OR
This date is the onset of acute symptoms for the current illness or condition.
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_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_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_charge-capture-bundles/v1:ChargeCaptureClaimCreationSortField:
type: string
enum:
- created_at
title: ChargeCaptureClaimCreationSortField
type_charge-capture/v1:ChargeCaptureStatus:
type: string
enum:
- planned
- not-billable
- billable
- aborted
- entered-in-error
title: ChargeCaptureStatus
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_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_custom-schemas/v1:SchemaInstance:
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.
required:
- schema_id
- content
title: SchemaInstance
type_charge-capture/v1:Hl7MessageType:
type: string
enum:
- BAR
- DFT
- ADT
description: >-
HL7 message type that produced a charge-capture write. Values match the bare MSH-9-1 code emitted by HL7
producers (conduit). Constrains the `hl7_message_type` field on charge-capture create/update payloads so that
whitespace, case drift, or non-canonical values are rejected at the API boundary instead of silently bypassing
the BAR/DFT discriminator.
title: Hl7MessageType
type_commons:ChargeCapturePostBilledChangeId:
type: string
format: uuid
title: ChargeCapturePostBilledChangeId
type_charge-capture/v1:ChargeCapturePostBilledChange:
type: object
properties:
id:
$ref: '#/components/schemas/type_commons:ChargeCapturePostBilledChangeId'
message:
type: string
resolved:
type: boolean
required:
- id
- message
- resolved
description: >-
ChargeCapturePostBilledChange represents a change to a ChargeCapture that occurred after the ChargeCapture's
status moved to BILLED. Action must be taken to resolve the update, and then the update should be marked as
resolved.
title: ChargeCapturePostBilledChange
type_charge-capture/v1:ChargeCapture:
type: object
properties:
id:
$ref: '#/components/schemas/type_commons:ChargeCaptureId'
status:
$ref: '#/components/schemas/type_charge-capture/v1:ChargeCaptureStatus'
charge_capture_data:
$ref: '#/components/schemas/type_charge-capture/v1:ChargeCaptureData'
date_of_service:
type: string
format: date
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
charge_external_id:
type: string
ehr_source_url:
type: string
originating_system:
type: string
claim_creation_category:
type: string
metadata:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaInstance'
description: |-
Key-value pairs that adhere to metadata schemas.
Multiple metadata instances can be associated with a charge capture.
error:
$ref: '#/components/schemas/type_charge-capture/v1:ChargeCaptureError'
updates:
type: array
items:
$ref: '#/components/schemas/type_charge-capture/v1:ChargeCapturePostBilledChange'
description: >-
This list of updates will always return at most 1 update that is not resolved. The singular update will
contain the difference between the updated charge and the created encounter.
claim_creation_id:
$ref: '#/components/schemas/type_commons:ChargeCaptureClaimCreationId'
required:
- id
- status
- charge_capture_data
- patient_external_id
- charge_external_id
- updates
title: ChargeCapture
type_commons:Primitive:
type: string
enum:
- BOOLEAN
- DOUBLE
- INTEGER
- STRING
description: |-
The BOOLEAN and STRING primitives respectively map to the `boolean` and `string` JSON data types.
The DOUBLE and INTEGER primitives must be written as a JSON `number` type.
title: Primitive
type_encounters/v4:SchemaInstanceValidationError:
oneOf:
- type: object
properties:
type:
type: string
enum:
- multiple_instances_for_schema
description: 'Discriminator value: multiple_instances_for_schema'
schema_id:
$ref: '#/components/schemas/type_commons:SchemaId'
required:
- type
- schema_id
- type: object
properties:
type:
type: string
enum:
- value_does_not_match_key_type
description: 'Discriminator value: value_does_not_match_key_type'
schema_id:
$ref: '#/components/schemas/type_commons:SchemaId'
key:
type: string
expected_value_type:
$ref: '#/components/schemas/type_commons:Primitive'
value:
description: Any type
required:
- type
- schema_id
- key
- expected_value_type
- value
- type: object
properties:
type:
type: string
enum:
- key_does_not_exist
description: 'Discriminator value: key_does_not_exist'
key:
type: string
schema_id:
$ref: '#/components/schemas/type_commons:SchemaId'
required:
- type
- key
- schema_id
- type: object
properties:
type:
type: string
enum:
- schema_does_not_exist
description: 'Discriminator value: schema_does_not_exist'
schema_id:
$ref: '#/components/schemas/type_commons:SchemaId'
required:
- type
- schema_id
- type: object
properties:
type:
type: string
enum:
- schema_unauthorized_access
description: 'Discriminator value: schema_unauthorized_access'
schema_id:
$ref: '#/components/schemas/type_commons:SchemaId'
required:
- type
- schema_id
discriminator:
propertyName: type
title: SchemaInstanceValidationError
type_encounters/v4:SchemaInstanceValidationFailure:
type: object
properties:
errors:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:SchemaInstanceValidationError'
required:
- errors
title: SchemaInstanceValidationFailure
type_charge-capture/v1:ChargeExternalIdConflictErrorMessage:
type: object
properties:
message:
type: string
title: ChargeExternalIdConflictErrorMessage
type_commons:PreEncounterPatientId:
type: string
format: uuid
title: PreEncounterPatientId
type_commons:PreEncounterAppointmentId:
type: string
format: uuid
title: PreEncounterAppointmentId
type_charge-capture/v1:ChargeCaptureSortField:
type: string
enum:
- created_at
- date_of_service
title: ChargeCaptureSortField
type_charge-capture/v1:ChargeCapturePage:
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/v1:ChargeCapture'
item_count:
type: integer
required:
- items
- item_count
title: ChargeCapturePage
type_contracts/v2:ContractId:
type: string
format: uuid
title: ContractId
type_commons:Regions:
oneOf:
- type: object
properties:
type:
type: string
enum:
- states
description: 'Discriminator value: states'
states:
type: array
items:
$ref: '#/components/schemas/type_commons:State'
required:
- type
- states
- type: object
properties:
type:
type: string
enum:
- national
description: 'Discriminator value: national'
required:
- type
discriminator:
propertyName: type
title: Regions
type_contracts/v2:ContractStatus:
type: string
enum:
- pending
- effective
- cancelled
title: ContractStatus
type_contracts/v2:AuthorizedSignatory:
type: object
properties:
first_name:
type: string
last_name:
type: string
title:
type: string
email:
type: string
phone:
type: string
fax:
type: string
title: AuthorizedSignatory
type_contracts/v2:InsuranceTypes:
oneOf:
- type: object
properties:
type:
type: string
enum:
- allApply
description: 'Discriminator value: allApply'
required:
- type
- type: object
properties:
type:
type: string
enum:
- noneApply
description: 'Discriminator value: noneApply'
required:
- type
- type: object
properties:
type:
type: string
enum:
- theseApply
description: 'Discriminator value: theseApply'
value:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_commons:InsuranceTypeCode'
required:
- type
- value
discriminator:
propertyName: type
title: InsuranceTypes
type_organization-providers/v2:ProviderType:
type: string
enum:
- INDIVIDUAL
- ORGANIZATION
title: ProviderType
type_commons:StreetAddressLongZip:
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
required:
- address1
- city
- state
- zip_code
- zip_plus_four_code
title: StreetAddressLongZip
type_organization-providers/v2:AddressType:
type: string
enum:
- DEFAULT
title: AddressType
type_organization-providers/v2:OrganizationProviderAddress:
type: object
properties:
address:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
description: The address of the provider
address_type:
$ref: '#/components/schemas/type_organization-providers/v2:AddressType'
description: The address type of the provider
required:
- address
- address_type
title: OrganizationProviderAddress
type_organization-providers/v2:OrganizationProviderId:
type: string
format: uuid
title: OrganizationProviderId
type_organization-providers/v2:EmploymentStatus:
type: string
enum:
- ACTIVE
- TERMINATED
title: EmploymentStatus
type_organization-providers/v2:OrganizationProvider:
type: object
properties:
npi:
type: string
description: The NPI of the provider. This must be all digits [0-9] and exactly 10 characters long.
is_rendering:
type: boolean
description: Whether the provider can be used to render services.
is_billing:
type: boolean
description: Whether the provider can be used to bill services.
first_name:
type: string
description: The first name of the provider, if the provider is an individual.
last_name:
type: string
description: The last name of the provider, if the provider is an individual.
organization_name:
type: string
description: The name of the provider, if the provider is an organization.
provider_type:
$ref: '#/components/schemas/type_organization-providers/v2:ProviderType'
description: Whether the provider is an individual (NPPES Type 1) or organization (NPPES Type 2) provider.
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.
taxonomy_code:
type: string
description: A code designating classification and specialization.
license_type:
$ref: '#/components/schemas/type_organization-providers/v2:LicenseType'
description: The type of license that the provider holds.
ptan:
type: string
description: The Provider Transaction Access Number for the provider.
medicaid_provider_id:
type: string
description: The medicaid provider ID for the provider.
addresses:
type: array
items:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderAddress'
description: The addresses associated with this provider.
organization_provider_id:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderId'
description: Auto-generated ID set on creation
employment_status:
$ref: '#/components/schemas/type_organization-providers/v2:EmploymentStatus'
description: The employment status for the provider.
employment_start_date:
$ref: '#/components/schemas/type_commons:Date'
description: The employment start date for the provider.
employment_termination_date:
$ref: '#/components/schemas/type_commons:Date'
description: The employment termination date for the provider.
required:
- npi
- is_rendering
- is_billing
- provider_type
- license_type
- organization_provider_id
- employment_status
title: OrganizationProvider
type_payers/v3:PayerUuid:
type: string
format: uuid
title: PayerUuid
type_payers/v3:Payer:
type: object
properties:
payer_uuid:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
description: Auto-generated ID set on creation.
payer_id:
type: string
description: The primary national payer ID of the payer.
payer_name:
type: string
description: The primary display name of the payer.
availity_payer_name:
type: string
description: The name of the payer as it appears in Availity.
availity_claims_payer_id:
type: string
description: The ID of the payer as it appears in Availity.
availity_eligibility_id:
type: string
description: The eligibility ID of the payer as it appears in Availity.
availity_remittance_payer_id:
type: string
description: The remittance ID of the payer as it appears in Availity.
street_address:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
required:
- payer_uuid
- payer_id
- payer_name
title: Payer
type_contracts/v2:ContractWithProviders:
type: object
properties:
effective_date:
$ref: '#/components/schemas/type_commons:Date'
description: The starting day upon which the contract is effective
expiration_date:
$ref: '#/components/schemas/type_commons:Date'
description: An optional end day upon which the contract expires
regions:
$ref: '#/components/schemas/type_commons:Regions'
description: |-
The state(s) to which the contract's coverage extends.
It may also be set to "national" for the entirety of the US.
contract_status:
$ref: '#/components/schemas/type_contracts/v2:ContractStatus'
authorized_signatory:
$ref: '#/components/schemas/type_contracts/v2:AuthorizedSignatory'
commercial_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The commercial plan insurance types this contract applies.
medicare_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicare plan insurance types this contract applies.
medicaid_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicaid plan insurance types this contract applies.
contract_id:
$ref: '#/components/schemas/type_contracts/v2:ContractId'
contracting_provider:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProvider'
description: The provider under contract
provider_count:
type: integer
description: The number of linked providers who can render medical services under this contract
payer:
$ref: '#/components/schemas/type_payers/v3:Payer'
description: The insurance company under contract
rendering_provider_ids:
type: array
uniqueItems: true
items:
type: string
format: uuid
description: The providers who can render medical services under the contract
required:
- effective_date
- regions
- commercial_insurance_types
- medicare_insurance_types
- medicaid_insurance_types
- contract_id
- contracting_provider
- provider_count
- payer
- rendering_provider_ids
title: ContractWithProviders
type_contracts/v2:ContractingProviderId:
type: string
format: uuid
title: ContractingProviderId
type_contracts/v2:RenderingProviderid:
type: string
format: uuid
title: RenderingProviderid
type_contracts/v2:ContractSortField:
type: string
enum:
- created_at
- payer_name
- payer_id
- billing_provider_name
- effective_date
- contract_status
title: ContractSortField
type_contracts/v2:Contract:
type: object
properties:
effective_date:
$ref: '#/components/schemas/type_commons:Date'
description: The starting day upon which the contract is effective
expiration_date:
$ref: '#/components/schemas/type_commons:Date'
description: An optional end day upon which the contract expires
regions:
$ref: '#/components/schemas/type_commons:Regions'
description: |-
The state(s) to which the contract's coverage extends.
It may also be set to "national" for the entirety of the US.
contract_status:
$ref: '#/components/schemas/type_contracts/v2:ContractStatus'
authorized_signatory:
$ref: '#/components/schemas/type_contracts/v2:AuthorizedSignatory'
commercial_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The commercial plan insurance types this contract applies.
medicare_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicare plan insurance types this contract applies.
medicaid_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicaid plan insurance types this contract applies.
contract_id:
$ref: '#/components/schemas/type_contracts/v2:ContractId'
contracting_provider:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProvider'
description: The provider under contract
provider_count:
type: integer
description: The number of linked providers who can render medical services under this contract
payer:
$ref: '#/components/schemas/type_payers/v3:Payer'
description: The insurance company under contract
required:
- effective_date
- regions
- commercial_insurance_types
- medicare_insurance_types
- medicaid_insurance_types
- contract_id
- contracting_provider
- provider_count
- payer
title: Contract
type_contracts/v2:ContractsPage:
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_contracts/v2:Contract'
required:
- items
title: ContractsPage
type_contracts/v2:ContractIsLinkedToFeeScheduleError:
type: object
properties:
message:
type: string
required:
- message
title: ContractIsLinkedToFeeScheduleError
type_contracts/v2:DateUpdate:
oneOf:
- type: object
properties:
type:
type: string
enum:
- set
description: 'Discriminator value: set'
value:
$ref: '#/components/schemas/type_commons:Date'
required:
- type
- value
- type: object
properties:
type:
type: string
enum:
- remove
description: 'Discriminator value: remove'
required:
- type
discriminator:
propertyName: type
title: DateUpdate
type_contracts/v2:RegionsUpdate:
oneOf:
- type: object
properties:
type:
type: string
enum:
- set
description: 'Discriminator value: set'
value:
$ref: '#/components/schemas/type_commons:Regions'
required:
- type
- value
- type: object
properties:
type:
type: string
enum:
- remove
description: 'Discriminator value: remove'
required:
- type
discriminator:
propertyName: type
title: RegionsUpdate
type_contracts/v2:AuthorizedSignatoryUpdate:
oneOf:
- type: object
properties:
type:
type: string
enum:
- set
description: 'Discriminator value: set'
first_name:
type: string
last_name:
type: string
title:
type: string
email:
type: string
phone:
type: string
fax:
type: string
required:
- type
- type: object
properties:
type:
type: string
enum:
- remove
description: 'Discriminator value: remove'
required:
- type
discriminator:
propertyName: type
title: AuthorizedSignatoryUpdate
type_contracts/v2:ContractInvalidExpirationDateError:
type: object
properties:
message:
type: string
required:
- message
title: ContractInvalidExpirationDateError
type_contracts/v3:ContractId:
type: string
format: uuid
title: ContractId
type_contracts/v3:ContractServiceFacilityId:
type: string
format: uuid
title: ContractServiceFacilityId
type_contracts/v3:ContractServiceFacility:
type: object
properties:
service_facility_id:
type: string
format: uuid
description: The UUID of the service facility
provider_ids:
type: array
uniqueItems: true
items:
type: string
format: uuid
description: The providers who are authorized under the contract
contract_id:
$ref: '#/components/schemas/type_contracts/v3:ContractId'
description: The UUID of the contract
contract_service_facility_id:
$ref: '#/components/schemas/type_contracts/v3:ContractServiceFacilityId'
required:
- service_facility_id
- provider_ids
- contract_id
- contract_service_facility_id
title: ContractServiceFacility
type_contracts/v3:ContractWithProvidersUnion:
oneOf:
- type: object
properties:
type:
type: string
enum:
- professional
description: 'Discriminator value: professional'
effective_date:
$ref: '#/components/schemas/type_commons:Date'
description: The starting day upon which the contract is effective
expiration_date:
$ref: '#/components/schemas/type_commons:Date'
description: An optional end day upon which the contract expires
regions:
$ref: '#/components/schemas/type_commons:Regions'
description: |-
The state(s) to which the contract's coverage extends.
It may also be set to "national" for the entirety of the US.
contract_status:
$ref: '#/components/schemas/type_contracts/v2:ContractStatus'
authorized_signatory:
$ref: '#/components/schemas/type_contracts/v2:AuthorizedSignatory'
commercial_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The commercial plan insurance types this contract applies.
medicare_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicare plan insurance types this contract applies.
medicaid_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicaid plan insurance types this contract applies.
contract_id:
$ref: '#/components/schemas/type_contracts/v3:ContractId'
contracting_provider:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProvider'
description: The provider under contract
provider_count:
type: integer
description: The number of linked providers who can render medical services under this contract
payer:
$ref: '#/components/schemas/type_payers/v3:Payer'
description: The insurance company under contract
rendering_provider_ids:
type: array
uniqueItems: true
items:
type: string
format: uuid
description: |-
Deprecated. Use the dedicated providers endpoints to manage rendering providers
(GET/POST/DELETE /api/contracts/v3/{contract_id}/providers).
This field returns a maximum of 4,000 IDs
required:
- type
- effective_date
- regions
- commercial_insurance_types
- medicare_insurance_types
- medicaid_insurance_types
- contract_id
- contracting_provider
- provider_count
- payer
- rendering_provider_ids
- type: object
properties:
type:
type: string
enum:
- institutional
description: 'Discriminator value: institutional'
effective_date:
$ref: '#/components/schemas/type_commons:Date'
description: The starting day upon which the contract is effective
expiration_date:
$ref: '#/components/schemas/type_commons:Date'
description: An optional end day upon which the contract expires
regions:
$ref: '#/components/schemas/type_commons:Regions'
description: |-
The state(s) to which the contract's coverage extends.
It may also be set to "national" for the entirety of the US.
contract_status:
$ref: '#/components/schemas/type_contracts/v2:ContractStatus'
authorized_signatory:
$ref: '#/components/schemas/type_contracts/v2:AuthorizedSignatory'
commercial_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The commercial plan insurance types this contract applies.
medicare_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicare plan insurance types this contract applies.
medicaid_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicaid plan insurance types this contract applies.
contract_id:
$ref: '#/components/schemas/type_contracts/v3:ContractId'
contracting_provider:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProvider'
description: The provider under contract
provider_count:
type: integer
description: The number of linked providers who can render medical services under this contract
payer:
$ref: '#/components/schemas/type_payers/v3:Payer'
description: The insurance company under contract
contract_service_facilities:
type: array
items:
$ref: '#/components/schemas/type_contracts/v3:ContractServiceFacility'
description: The service facilities under contract
required:
- type
- effective_date
- regions
- commercial_insurance_types
- medicare_insurance_types
- medicaid_insurance_types
- contract_id
- contracting_provider
- provider_count
- payer
- contract_service_facilities
discriminator:
propertyName: type
title: ContractWithProvidersUnion
type_contracts/v3:ContractType:
type: string
enum:
- professional
- institutional
title: ContractType
type_contracts/v3:ContractingProviderId:
type: string
format: uuid
title: ContractingProviderId
type_contracts/v3:RenderingProviderid:
type: string
format: uuid
title: RenderingProviderid
type_contracts/v3:ContractUnion:
oneOf:
- type: object
properties:
type:
type: string
enum:
- professional
description: 'Discriminator value: professional'
effective_date:
$ref: '#/components/schemas/type_commons:Date'
description: The starting day upon which the contract is effective
expiration_date:
$ref: '#/components/schemas/type_commons:Date'
description: An optional end day upon which the contract expires
regions:
$ref: '#/components/schemas/type_commons:Regions'
description: |-
The state(s) to which the contract's coverage extends.
It may also be set to "national" for the entirety of the US.
contract_status:
$ref: '#/components/schemas/type_contracts/v2:ContractStatus'
authorized_signatory:
$ref: '#/components/schemas/type_contracts/v2:AuthorizedSignatory'
commercial_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The commercial plan insurance types this contract applies.
medicare_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicare plan insurance types this contract applies.
medicaid_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicaid plan insurance types this contract applies.
contract_id:
$ref: '#/components/schemas/type_contracts/v3:ContractId'
contracting_provider:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProvider'
description: The provider under contract
provider_count:
type: integer
description: The number of linked providers who can render medical services under this contract
payer:
$ref: '#/components/schemas/type_payers/v3:Payer'
description: The insurance company under contract
required:
- type
- effective_date
- regions
- commercial_insurance_types
- medicare_insurance_types
- medicaid_insurance_types
- contract_id
- contracting_provider
- provider_count
- payer
- type: object
properties:
type:
type: string
enum:
- institutional
description: 'Discriminator value: institutional'
effective_date:
$ref: '#/components/schemas/type_commons:Date'
description: The starting day upon which the contract is effective
expiration_date:
$ref: '#/components/schemas/type_commons:Date'
description: An optional end day upon which the contract expires
regions:
$ref: '#/components/schemas/type_commons:Regions'
description: |-
The state(s) to which the contract's coverage extends.
It may also be set to "national" for the entirety of the US.
contract_status:
$ref: '#/components/schemas/type_contracts/v2:ContractStatus'
authorized_signatory:
$ref: '#/components/schemas/type_contracts/v2:AuthorizedSignatory'
commercial_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The commercial plan insurance types this contract applies.
medicare_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicare plan insurance types this contract applies.
medicaid_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicaid plan insurance types this contract applies.
contract_id:
$ref: '#/components/schemas/type_contracts/v3:ContractId'
contracting_provider:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProvider'
description: The provider under contract
provider_count:
type: integer
description: The number of linked providers who can render medical services under this contract
payer:
$ref: '#/components/schemas/type_payers/v3:Payer'
description: The insurance company under contract
required:
- type
- effective_date
- regions
- commercial_insurance_types
- medicare_insurance_types
- medicaid_insurance_types
- contract_id
- contracting_provider
- provider_count
- payer
discriminator:
propertyName: type
title: ContractUnion
type_contracts/v3:ContractsPage:
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_contracts/v3:ContractUnion'
required:
- items
title: ContractsPage
type_contracts/v3:ContractServiceFacilityBase:
type: object
properties:
service_facility_id:
type: string
format: uuid
description: The UUID of the service facility
provider_ids:
type: array
uniqueItems: true
items:
type: string
format: uuid
description: The providers who are authorized under the contract
required:
- service_facility_id
- provider_ids
title: ContractServiceFacilityBase
type_contracts/v3:ContractCreateUnion:
oneOf:
- type: object
properties:
type:
type: string
enum:
- professional
description: 'Discriminator value: professional'
effective_date:
$ref: '#/components/schemas/type_commons:Date'
description: The starting day upon which the contract is effective
expiration_date:
$ref: '#/components/schemas/type_commons:Date'
description: An optional end day upon which the contract expires
regions:
$ref: '#/components/schemas/type_commons:Regions'
description: |-
The state(s) to which the contract's coverage extends.
It may also be set to "national" for the entirety of the US.
contract_status:
$ref: '#/components/schemas/type_contracts/v2:ContractStatus'
authorized_signatory:
$ref: '#/components/schemas/type_contracts/v2:AuthorizedSignatory'
commercial_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The commercial plan insurance types this contract applies.
medicare_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicare plan insurance types this contract applies.
medicaid_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicaid plan insurance types this contract applies.
contract_type:
$ref: '#/components/schemas/type_contracts/v3:ContractType'
description: The type of contract
contracting_provider_id:
$ref: '#/components/schemas/type_contracts/v3:ContractingProviderId'
description: The UUID of the provider under agreement to the contract
payer_uuid:
type: string
format: uuid
description: The UUID of the insurance company under agreement to the contract
rendering_provider_ids:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_contracts/v3:RenderingProviderid'
required:
- type
- effective_date
- regions
- commercial_insurance_types
- medicare_insurance_types
- medicaid_insurance_types
- contract_type
- contracting_provider_id
- payer_uuid
- rendering_provider_ids
- type: object
properties:
type:
type: string
enum:
- institutional
description: 'Discriminator value: institutional'
effective_date:
$ref: '#/components/schemas/type_commons:Date'
description: The starting day upon which the contract is effective
expiration_date:
$ref: '#/components/schemas/type_commons:Date'
description: An optional end day upon which the contract expires
regions:
$ref: '#/components/schemas/type_commons:Regions'
description: |-
The state(s) to which the contract's coverage extends.
It may also be set to "national" for the entirety of the US.
contract_status:
$ref: '#/components/schemas/type_contracts/v2:ContractStatus'
authorized_signatory:
$ref: '#/components/schemas/type_contracts/v2:AuthorizedSignatory'
commercial_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The commercial plan insurance types this contract applies.
medicare_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicare plan insurance types this contract applies.
medicaid_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
description: The Medicaid plan insurance types this contract applies.
contract_type:
$ref: '#/components/schemas/type_contracts/v3:ContractType'
description: The type of contract
contracting_provider_id:
$ref: '#/components/schemas/type_contracts/v3:ContractingProviderId'
description: The UUID of the provider under agreement to the contract
payer_uuid:
type: string
format: uuid
description: The UUID of the insurance company under agreement to the contract
contract_service_facilities:
type: array
items:
$ref: '#/components/schemas/type_contracts/v3:ContractServiceFacilityBase'
required:
- type
- effective_date
- regions
- commercial_insurance_types
- medicare_insurance_types
- medicaid_insurance_types
- contract_type
- contracting_provider_id
- payer_uuid
- contract_service_facilities
discriminator:
propertyName: type
title: ContractCreateUnion
type_contracts/v3:ContractUpdateUnion:
oneOf:
- type: object
properties:
type:
type: string
enum:
- professional
description: 'Discriminator value: professional'
effective_date:
$ref: '#/components/schemas/type_commons:Date'
description: The starting day upon which the contract is effective
expiration_date:
$ref: '#/components/schemas/type_contracts/v2:DateUpdate'
description: An optional end day upon which the contract expires
regions:
$ref: '#/components/schemas/type_contracts/v2:RegionsUpdate'
description: |-
If present, the contract's rendering providers will be patched to this exact
value, overriding what was set before.
contract_status:
$ref: '#/components/schemas/type_contracts/v2:ContractStatus'
authorized_signatory:
$ref: '#/components/schemas/type_contracts/v2:AuthorizedSignatoryUpdate'
commercial_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
medicare_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
medicaid_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
rendering_provider_ids:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_contracts/v3:RenderingProviderid'
description: >-
Deprecated. Use the dedicated providers endpoints to manage rendering providers
(GET/POST/DELETE /api/contracts/v3/{contract_id}/providers).
Attempting to set this property will raise an error if the contract already has more than 4,000
rendering providers.
required:
- type
- type: object
properties:
type:
type: string
enum:
- institutional
description: 'Discriminator value: institutional'
effective_date:
$ref: '#/components/schemas/type_commons:Date'
description: The starting day upon which the contract is effective
expiration_date:
$ref: '#/components/schemas/type_contracts/v2:DateUpdate'
description: An optional end day upon which the contract expires
regions:
$ref: '#/components/schemas/type_contracts/v2:RegionsUpdate'
description: |-
If present, the contract's rendering providers will be patched to this exact
value, overriding what was set before.
contract_status:
$ref: '#/components/schemas/type_contracts/v2:ContractStatus'
authorized_signatory:
$ref: '#/components/schemas/type_contracts/v2:AuthorizedSignatoryUpdate'
commercial_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
medicare_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
medicaid_insurance_types:
$ref: '#/components/schemas/type_contracts/v2:InsuranceTypes'
contract_service_facility_ids:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_contracts/v3:ContractServiceFacilityId'
required:
- type
discriminator:
propertyName: type
title: ContractUpdateUnion
type_contracts/v3:ContractProvidersPage:
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_organization-providers/v2:OrganizationProvider'
required:
- items
title: ContractProvidersPage
type_commons:DateRangeOptionalEnd:
type: object
properties:
start_date:
$ref: '#/components/schemas/type_commons:Date'
end_date:
$ref: '#/components/schemas/type_commons:Date'
required:
- start_date
title: DateRangeOptionalEnd
type_identifiers:IdentifierCode:
type: string
enum:
- MCR
- MCD
title: IdentifierCode
type_identifiers:IdentifierValue:
oneOf:
- type: object
properties:
type:
type: string
enum:
- medicare_provider_identifier
description: 'Discriminator value: medicare_provider_identifier'
state:
$ref: '#/components/schemas/type_commons:State'
provider_number:
type: string
required:
- type
- state
- provider_number
- type: object
properties:
type:
type: string
enum:
- medicaid_provider_identifier
description: 'Discriminator value: medicaid_provider_identifier'
state:
$ref: '#/components/schemas/type_commons:State'
provider_number:
type: string
required:
- type
- state
- provider_number
discriminator:
propertyName: type
title: IdentifierValue
type_identifiers:IdentifierId:
type: string
format: uuid
title: IdentifierId
type_identifiers:Identifier:
type: object
properties:
period:
$ref: '#/components/schemas/type_commons:DateRangeOptionalEnd'
identifier_code:
$ref: '#/components/schemas/type_identifiers:IdentifierCode'
identifier_value:
$ref: '#/components/schemas/type_identifiers:IdentifierValue'
identifier_id:
$ref: '#/components/schemas/type_identifiers:IdentifierId'
required:
- identifier_code
- identifier_value
- identifier_id
title: Identifier
type_organization-providers/v3:OrganizationProviderV2:
type: object
properties:
npi:
type: string
description: The NPI of the provider. This must be all digits [0-9] and exactly 10 characters long.
is_rendering:
type: boolean
description: Whether the provider can be used to render services.
is_billing:
type: boolean
description: Whether the provider can be used to bill services.
first_name:
type: string
description: The first name of the provider, if the provider is an individual.
last_name:
type: string
description: The last name of the provider, if the provider is an individual.
organization_name:
type: string
description: The name of the provider, if the provider is an organization.
provider_type:
$ref: '#/components/schemas/type_organization-providers/v2:ProviderType'
description: Whether the provider is an individual (NPPES Type 1) or organization (NPPES Type 2) provider.
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.
taxonomy_code:
type: string
description: A code designating classification and specialization.
license_type:
$ref: '#/components/schemas/type_organization-providers/v2:LicenseType'
description: The type of license that the provider holds.
addresses:
type: array
items:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderAddress'
description: The addresses associated with this provider.
employment_start_date:
type: string
format: date
description: The employment start date for the provider.
employment_termination_date:
type: string
format: date
description: The employment termination date for the provider.
organization_provider_id:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderId'
description: Auto-generated ID set on creation.
qualifications:
type: array
items:
$ref: '#/components/schemas/type_identifiers:Identifier'
description: Qualification given to a provider (PTAN, Medicaid Provider Id etc.).
required:
- npi
- is_rendering
- is_billing
- provider_type
- license_type
- organization_provider_id
- qualifications
title: OrganizationProviderV2
type_credentialing/v2:CredentialingSpanStatus:
type: string
enum:
- work_in_progress
- pending
- effective
- expired
description: Stage of a credentialing span in the credentialing workflow.
title: CredentialingSpanStatus
type_credentialing/v2:ProviderCredentialingSpanId:
type: string
format: uuid
title: ProviderCredentialingSpanId
type_credentialing/v2:ProviderCredentialingSpan:
type: object
properties:
contracting_provider:
$ref: '#/components/schemas/type_organization-providers/v3:OrganizationProviderV2'
description: The practice location at which the rendering provider is covered by the credentialing span.
payer:
$ref: '#/components/schemas/type_payers/v3:Payer'
description: The payer doing the credentialing.
start_date:
type: string
format: date
description: Start date of the credentialing span.
end_date:
type: string
format: date
description: End date of the credentialing span.
submitted_date:
type: string
format: date
description: Date that the credential paperwork was submitted.
credentialing_status:
$ref: '#/components/schemas/type_credentialing/v2:CredentialingSpanStatus'
description: Status of the credentialing span.
payer_loaded_date:
type: string
format: date
description: Date that the payer loaded the credentialing span into their system.
is_enabled:
type: boolean
description: Is the credentialing span enabled?
provider_credentialing_span_id:
$ref: '#/components/schemas/type_credentialing/v2:ProviderCredentialingSpanId'
rendering_provider:
$ref: '#/components/schemas/type_organization-providers/v3:OrganizationProviderV2'
description: The rendering provider covered by the credentialing span.
regions:
$ref: '#/components/schemas/type_commons:Regions'
description: The states covered by the credentialing span. A span may be national and cover all states.
medallion_payer_enrollment_id:
type: string
format: uuid
description: Provider ID for the related medallion payer enrollment.
source:
type: string
description: Source of the credentialing span.
required:
- contracting_provider
- payer
- credentialing_status
- is_enabled
- provider_credentialing_span_id
- rendering_provider
- regions
- source
title: ProviderCredentialingSpan
type_contracts/v3:ContractProviderCredentialing:
type: object
properties:
provider:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProvider'
credentialing_spans:
type: array
items:
$ref: '#/components/schemas/type_credentialing/v2:ProviderCredentialingSpan'
required:
- provider
- credentialing_spans
description: A rendering provider with their credentialing spans scoped to the contract's contracting provider and payer.
title: ContractProviderCredentialing
type_contracts/v3:ContractProviderCredentialingPage:
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_contracts/v3:ContractProviderCredentialing'
required:
- items
title: ContractProviderCredentialingPage
type_contracts/v3:AddContractProvidersResponse:
type: object
properties:
provider_count:
type: integer
description: The total number of rendering providers currently associated with this contract after the operation
added_count:
type: integer
description: The number of rendering providers that were newly added to the contract
ignored_count:
type: integer
description: The number of rendering provider IDs that were already associated with the contract and thus ignored
required:
- provider_count
- added_count
- ignored_count
title: AddContractProvidersResponse
type_contracts/v3:ContractProviderCount:
type: object
properties:
provider_count:
type: integer
description: The total number of rendering providers currently associated with this contract
required:
- provider_count
title: ContractProviderCount
type_credentialing/v2:FacilityCredentialingSpanId:
type: string
format: uuid
title: FacilityCredentialingSpanId
type_organization-service-facilities/v2:ServiceFacilityStatus:
type: string
enum:
- active
- inactive
- suspended
title: ServiceFacilityStatus
type_organization-service-facilities/v2:ServiceFacilityOperationalStatus:
type: string
enum:
- C
- H
- I
- K
- O
- U
title: ServiceFacilityOperationalStatus
type_organization-service-facilities/v2:ServiceFacilityMode:
type: string
enum:
- instance
- kind
title: ServiceFacilityMode
type_organization-service-facilities/v2:ServiceFacilityType:
type: string
enum:
- DX
- CVDX
- CATH
- ECHO
- GIDX
- ENDOS
- RADDX
- RADO
- RNEU
- HOSP
- CHR
- GACH
- MHSP
- PSYCHF
- RH
- RHAT
- RHII
- RHMAD
- RHPI
- RHPIH
- RHPIMS
- RHPIVS
- RHYAD
- HU
- BMTU
- CCU
- CHEST
- EPIL
- ER
- ETU
- HD
- HLAB
- INLAB
- OUTLAB
- HRAD
- HUSCS
- ICU
- PEDICU
- PEDNICU
- INPHARM
- MBL
- NCCS
- NS
- OUTPHARM
- PEDU
- PHU
- RHU
- SLEEP
- NCCF
- SNF
- OF
- ALL
- AMPUT
- BMTC
- BREAST
- CANC
- CAPC
- CARD
- PEDCARD
- COAG
- CRS
- DERM
- ENDO
- PEDE
- ENT
- FMC
- GI
- PEDGI
- GIM
- GYN
- HEM
- PEDHEM
- HTN
- IEC
- INFD
- PEDID
- INV
- LYMPH
- MGEN
- NEPH
- PEDNEPH
- NEUR
- OB
- OMS
- ONCL
- PEDHO
- OPH
- OPTC
- ORTHO
- HAND
- PAINCL
- PC
- PEDC
- PEDRHEUM
- POD
- PREV
- PROCTO
- PROFF
- PROS
- PSI
- PSY
- RHEUM
- SPMED
- SU
- PLS
- URO
- TR
- TRAVEL
- WND
- RTF
- PRC
- SURF
- DADDR
- MOBL
- AMB
- PHARM
- ACC
- COMM
- CSC
- PTRES
- SCHOOL
- UPC
- WORK
title: ServiceFacilityType
type_organization-service-facilities/v2:ServiceFacilityPhysicalType:
type: string
enum:
- si
- bu
- wi
- wa
- lvl
- co
- ro
- bd
- ve
- ho
- ca
- rd
- area
- jdn
title: ServiceFacilityPhysicalType
type_organization-service-facilities/v2:OrganizationServiceFacility:
type: object
properties:
organization_service_facility_id:
$ref: '#/components/schemas/type_organization-service-facilities/v2:OrganizationServiceFacilityId'
name:
type: string
description: The name of the service facility.
aliases:
type: array
items:
type: string
description: A list of alternate names for the service facility.
description:
type: string
description: A description of the service facility.
external_id:
type: string
description: >-
An ID for this service facility used in an external system (e.g. your EMR). Service facilities can be
queried by this field.
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.
place_of_service_code:
$ref: '#/components/schemas/type_commons:FacilityTypeCode'
description: The Place of Service (POS) code for this service facility.
clia_number:
type: string
description: The associated CLIA number with this service facility. Can be used to populate CLIA numbers on encounters.
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.
status:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityStatus'
description: The status of the service facility.
operational_status:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityOperationalStatus'
description: The operational status of the service facility.
mode:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityMode'
description: The mode of the service facility.
type:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityType'
description: The type of the service facility.
physical_type:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityPhysicalType'
description: The physical type of the service facility.
telecoms:
type: array
items:
type: string
description: A list of contact methods for the service facility.
address:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
description: The address of the service facility.
required:
- organization_service_facility_id
- name
- aliases
- telecoms
- address
title: OrganizationServiceFacility
type_credentialing/v2:FacilityCredentialingSpan:
type: object
properties:
contracting_provider:
$ref: '#/components/schemas/type_organization-providers/v3:OrganizationProviderV2'
description: The practice location at which the rendering provider is covered by the credentialing span.
payer:
$ref: '#/components/schemas/type_payers/v3:Payer'
description: The payer doing the credentialing.
start_date:
type: string
format: date
description: Start date of the credentialing span.
end_date:
type: string
format: date
description: End date of the credentialing span.
submitted_date:
type: string
format: date
description: Date that the credential paperwork was submitted.
credentialing_status:
$ref: '#/components/schemas/type_credentialing/v2:CredentialingSpanStatus'
description: Status of the credentialing span.
payer_loaded_date:
type: string
format: date
description: Date that the payer loaded the credentialing span into their system.
is_enabled:
type: boolean
description: Is the credentialing span enabled?
facility_credentialing_span_id:
$ref: '#/components/schemas/type_credentialing/v2:FacilityCredentialingSpanId'
service_facility:
$ref: '#/components/schemas/type_organization-service-facilities/v2:OrganizationServiceFacility'
description: The service facility covered by the credentialing span.
required:
- contracting_provider
- payer
- credentialing_status
- is_enabled
- facility_credentialing_span_id
- service_facility
title: FacilityCredentialingSpan
type_credentialing/v2:FacilityCredentialingSpanPage:
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_credentialing/v2:FacilityCredentialingSpan'
required:
- items
title: FacilityCredentialingSpanPage
type_commons:ProviderCredentialingSpanId:
type: string
format: uuid
title: ProviderCredentialingSpanId
type_credentialing/v2:ProviderCredentialingSpanPage:
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_credentialing/v2:ProviderCredentialingSpan'
required:
- items
title: ProviderCredentialingSpanPage
type_custom-schemas/v1:SchemaField:
type: object
properties:
key:
type: string
type:
$ref: '#/components/schemas/type_commons:Primitive'
required:
- key
- type
title: SchemaField
type_custom-schemas/v1:Schema:
type: object
properties:
id:
$ref: '#/components/schemas/type_commons:SchemaId'
name:
type: string
description:
type: string
fields:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaField'
required:
- id
- name
- fields
title: Schema
type_custom-schemas/v1:SchemaGetMultiResponse:
type: object
properties:
schemas:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:Schema'
required:
- schemas
title: SchemaGetMultiResponse
type_custom-schemas/v1:SchemaValidationError:
oneOf:
- type: object
properties:
type:
type: string
enum:
- schema_name_already_exists
description: 'Discriminator value: schema_name_already_exists'
name:
type: string
id:
$ref: '#/components/schemas/type_commons:SchemaId'
required:
- type
- name
- id
- type: object
properties:
type:
type: string
enum:
- key_name_already_exists
description: 'Discriminator value: key_name_already_exists'
key:
type: string
value_type:
$ref: '#/components/schemas/type_commons:Primitive'
required:
- type
- key
- value_type
discriminator:
propertyName: type
title: SchemaValidationError
type_custom-schemas/v1:SchemaValidationFailure:
type: object
properties:
errors:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaValidationError'
required:
- errors
title: SchemaValidationFailure
type_encounter-attachments/v1:AttachmentId:
type: string
format: uuid
title: AttachmentId
type_commons:LinkUrl:
type: string
title: LinkUrl
type_encounter-attachments/v1:EncounterAttachmentType:
type: string
enum:
- DOCUMENTATION
- EOB
- OTHER
title: EncounterAttachmentType
type_commons:UserId:
type: string
format: uuid
title: UserId
type_users/v2:IdpUserMetadata:
oneOf:
- type: object
properties:
type:
type: string
enum:
- auth_zero_metadata
description: 'Discriminator value: auth_zero_metadata'
auth0_id:
type: string
required:
- type
- auth0_id
- type: object
properties:
type:
type: string
enum:
- google_apps_metadata
description: 'Discriminator value: google_apps_metadata'
google_apps_id:
type: string
required:
- type
- google_apps_id
- type: object
properties:
type:
type: string
enum:
- other_idp_metadata
description: 'Discriminator value: other_idp_metadata'
idp_external_id:
type: string
required:
- type
- idp_external_id
discriminator:
propertyName: type
title: IdpUserMetadata
type_users/v2:UserMetadata:
oneOf:
- type: object
properties:
type:
type: string
enum:
- machine_user_metadata
description: 'Discriminator value: machine_user_metadata'
name:
type: string
required:
- type
- name
- type: object
properties:
type:
type: string
enum:
- human_user_metadata
description: 'Discriminator value: human_user_metadata'
first_name:
type: string
last_name:
type: string
email:
type: string
required:
- type
- first_name
- last_name
- email
discriminator:
propertyName: type
title: UserMetadata
type_users/v2:UserV2:
type: object
properties:
user_id:
$ref: '#/components/schemas/type_commons:UserId'
idp_metadata:
type: array
items:
$ref: '#/components/schemas/type_users/v2:IdpUserMetadata'
primary_organization_id:
$ref: '#/components/schemas/type_commons:OrganizationId'
user_metadata:
$ref: '#/components/schemas/type_users/v2:UserMetadata'
required:
- user_id
- idp_metadata
- user_metadata
title: UserV2
type_encounter-attachments/v1:EncounterAttachment:
type: object
properties:
attachment_id:
$ref: '#/components/schemas/type_encounter-attachments/v1:AttachmentId'
file_name:
type: string
description:
type: string
content_type:
type: string
authed_url:
$ref: '#/components/schemas/type_commons:LinkUrl'
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
attachment_type:
$ref: '#/components/schemas/type_encounter-attachments/v1:EncounterAttachmentType'
created_at:
type: string
format: date-time
created_by:
$ref: '#/components/schemas/type_users/v2:UserV2'
required:
- attachment_id
- file_name
- description
- content_type
- authed_url
- encounter_id
- attachment_type
- created_at
- created_by
title: EncounterAttachment
type_encounter-attachments/v1:ChargeCaptureAttachment:
type: object
properties:
attachment_id:
$ref: '#/components/schemas/type_encounter-attachments/v1:AttachmentId'
file_name:
type: string
description:
type: string
content_type:
type: string
authed_url:
$ref: '#/components/schemas/type_commons:LinkUrl'
attachment_type:
$ref: '#/components/schemas/type_encounter-attachments/v1:EncounterAttachmentType'
required:
- attachment_id
- file_name
- description
- content_type
- authed_url
- attachment_type
title: ChargeCaptureAttachment
type_encounter-providers/v2:ReferringProviderSecondaryIdentification:
type: object
properties:
reference_identification:
type: string
reference_identification_qualifier:
$ref: '#/components/schemas/type_encounter-providers/v2:ReferringProviderSecondaryIdentificationQualifier'
required:
- reference_identification
- reference_identification_qualifier
title: ReferringProviderSecondaryIdentification
type_encounter-providers/v2:ReferringProviderUpdate:
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:StreetAddressLongZip'
secondary_identification:
$ref: '#/components/schemas/type_encounter-providers/v2:ReferringProviderSecondaryIdentification'
title: ReferringProviderUpdate
type_encounter-providers/v2:ProviderId:
type: string
format: uuid
title: ProviderId
type_encounter-providers/v2:ProviderSecondaryIdentification:
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.
required:
- reference_identification
title: ProviderSecondaryIdentification
type_encounter-providers/v2:EncounterProvider:
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
provider_id:
$ref: '#/components/schemas/type_encounter-providers/v2:ProviderId'
address:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
tax_id:
type: string
npi:
type: string
taxonomy_code:
type: string
qualifier:
$ref: '#/components/schemas/type_commons:QualifierCode'
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:ProviderSecondaryIdentification'
description: |-
Only one of provider_commercial_license_type or secondary_identification may be provided
837i Loop2010BB G2
Secondary Identification
required:
- provider_id
- address
- npi
title: EncounterProvider
type_encounter-providers/v2:InitialReferringProviderUpdate:
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:StreetAddressLongZip'
qualifier:
$ref: '#/components/schemas/type_commons:QualifierCode'
secondary_identification:
$ref: '#/components/schemas/type_encounter-providers/v2:ReferringProviderSecondaryIdentification'
title: InitialReferringProviderUpdate
type_encounter-providers/v2:SupervisingProviderSecondaryIdentification:
type: object
properties:
reference_identification:
type: string
reference_identification_qualifier:
$ref: '#/components/schemas/type_encounter-providers/v2:ProviderSecondaryIdentificationQualifier'
required:
- reference_identification
- reference_identification_qualifier
title: SupervisingProviderSecondaryIdentification
type_encounter-providers/v2:SupervisingProviderUpdate:
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:StreetAddressLongZip'
secondary_identification:
$ref: '#/components/schemas/type_encounter-providers/v2:SupervisingProviderSecondaryIdentification'
title: SupervisingProviderUpdate
type_encounter-providers/v2:OrderingProviderUpdate:
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:StreetAddressLongZip'
title: OrderingProviderUpdate
type_encounter-providers/v2:ReferringProvider:
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:StreetAddressLongZip'
secondary_identification:
$ref: '#/components/schemas/type_encounter-providers/v2:ReferringProviderSecondaryIdentification'
required:
- npi
title: ReferringProvider
type_encounter-providers/v2:InitialReferringProvider:
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:StreetAddressLongZip'
qualifier:
$ref: '#/components/schemas/type_commons:QualifierCode'
secondary_identification:
$ref: '#/components/schemas/type_encounter-providers/v2:ReferringProviderSecondaryIdentification'
required:
- npi
title: InitialReferringProvider
type_encounter-providers/v2:SupervisingProvider:
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:StreetAddressLongZip'
secondary_identification:
$ref: '#/components/schemas/type_encounter-providers/v2:SupervisingProviderSecondaryIdentification'
required:
- npi
title: SupervisingProvider
type_encounter-providers/v2:OrderingProvider:
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:StreetAddressLongZip'
required:
- npi
title: OrderingProvider
type_encounter-supplemental-information/v1:SupplementalInformationId:
type: string
format: uuid
title: SupplementalInformationId
type_encounter-supplemental-information/v1:AttachmentInclusion:
type: string
enum:
- not_included
- included_on_next_submission
- included_on_all_submissions
title: AttachmentInclusion
type_encounter-supplemental-information/v1:SupplementalInformation:
type: object
properties:
supplemental_information_id:
$ref: '#/components/schemas/type_encounter-supplemental-information/v1:SupplementalInformationId'
attachment_id:
$ref: '#/components/schemas/type_encounter-attachments/v1:AttachmentId'
attachment_report_type_code:
$ref: '#/components/schemas/type_commons:ReportTypeCode'
attachment_transmission_code:
$ref: '#/components/schemas/type_commons:ReportTransmissionCode'
attachment_control_number:
type: string
attachment_inclusion:
$ref: '#/components/schemas/type_encounter-supplemental-information/v1:AttachmentInclusion'
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
required:
- supplemental_information_id
- attachment_report_type_code
- attachment_transmission_code
- attachment_inclusion
- encounter_id
title: SupplementalInformation
type_encounter-supplemental-information/v1:CreateSupplementalInformationRequest:
type: object
properties:
attachment_id:
$ref: '#/components/schemas/type_encounter-attachments/v1:AttachmentId'
attachment_report_type_code:
$ref: '#/components/schemas/type_commons:ReportTypeCode'
attachment_transmission_code:
$ref: '#/components/schemas/type_commons:ReportTransmissionCode'
attachment_control_number:
type: string
attachment_inclusion:
$ref: '#/components/schemas/type_encounter-supplemental-information/v1:AttachmentInclusion'
required:
- attachment_report_type_code
- attachment_transmission_code
- attachment_inclusion
title: CreateSupplementalInformationRequest
type_encounter-supplemental-information/v1:UpdateSupplementalInformationRequest:
type: object
properties:
attachment_id:
$ref: '#/components/schemas/type_encounter-attachments/v1:AttachmentId'
attachment_report_type_code:
$ref: '#/components/schemas/type_commons:ReportTypeCode'
attachment_transmission_code:
$ref: '#/components/schemas/type_commons:ReportTransmissionCode'
attachment_control_number:
type: string
attachment_inclusion:
$ref: '#/components/schemas/type_encounter-supplemental-information/v1:AttachmentInclusion'
title: UpdateSupplementalInformationRequest
type_encounters/v4:EncounterSortOptions:
type: string
enum:
- created_at:asc
- created_at:desc
- date_of_service:asc
- date_of_service:desc
title: EncounterSortOptions
type_commons:WorkQueueId:
type: string
title: WorkQueueId
type_encounters/v4:EncounterOwnerOfNextActionType:
type: string
enum:
- CANDID
- CUSTOMER
- CODER
- NONE
title: EncounterOwnerOfNextActionType
type_encounters/v4:Medication:
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
required:
- name
title: Medication
type_encounters/v4:Lab:
type: object
properties:
name:
type: string
code:
type: string
code_type:
$ref: '#/components/schemas/type_encounters/v4:LabCodeType'
required:
- name
title: Lab
type_encounters/v4:Intervention:
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:Medication'
description: Required when `type` is `allopathic`.
labs:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:Lab'
description: Required when `type` is `tests`.
required:
- name
- category
title: Intervention
type_encounters/v4:Vitals:
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: Vitals
type_diagnoses:DiagnosisId:
type: string
format: uuid
title: DiagnosisId
type_service-lines/v2:DrugIdentification:
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
required:
- service_id_qualifier
- national_drug_code
- national_drug_unit_count
- measurement_unit_code
title: DrugIdentification
type_service-lines/v2:ServiceLineAdjustment:
type: object
properties:
created_at:
type: string
format: date-time
adjustment_group_code:
type: string
adjustment_reason_code:
type: string
adjustment_amount_cents:
type: integer
adjustment_note:
type: string
required:
- created_at
title: ServiceLineAdjustment
type_service-lines/v2:ServiceLineERAData:
type: object
properties:
service_line_adjustments:
type: array
items:
$ref: '#/components/schemas/type_service-lines/v2:ServiceLineAdjustment'
description: |-
Deprecated. This field aggregates all CARCs across a service line's history
without granular context
(e.g., which CARCs relate to denials vs. payments vs. reversals), making it
unsuitable for denial analysis or operational workflows.
remittance_advice_remark_codes:
type: array
items:
type: string
required:
- service_line_adjustments
- remittance_advice_remark_codes
title: ServiceLineERAData
type_invoices:InvoiceStatus:
type: string
enum:
- draft
- open
- paid
- void
- uncollectible
- held
title: InvoiceStatus
type_invoices:InvoiceItem:
type: object
properties:
service_line_id:
$ref: '#/components/schemas/type_commons:ServiceLineId'
amount_cents:
type: integer
required:
- service_line_id
- amount_cents
title: InvoiceItem
type_invoices:Invoice:
type: object
properties:
id:
$ref: '#/components/schemas/type_commons:InvoiceId'
created_at:
type: string
format: date-time
updated_at:
type: string
format: date-time
organzation_id:
$ref: '#/components/schemas/type_commons:OrganizationId'
source_id:
type: string
source_customer_id:
type: string
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
note:
type: string
due_date:
$ref: '#/components/schemas/type_commons:Date'
status:
$ref: '#/components/schemas/type_invoices:InvoiceStatus'
url:
type: string
customer_invoice_url:
type: string
items:
type: array
items:
$ref: '#/components/schemas/type_invoices:InvoiceItem'
required:
- id
- created_at
- updated_at
- organzation_id
- source_id
- source_customer_id
- patient_external_id
- due_date
- status
- items
title: Invoice
type_invoices/v2:InvoiceDestination:
type: string
enum:
- STRIPE
- CEDAR
- HEALTHIE
- COLLECTLY
- THIRD_PARTY_PAYERS
- INSTAMED
- REVSPRING
title: InvoiceDestination
type_invoices/v2:InvoiceDestinationMetadata:
type: object
properties:
invoice_destination:
$ref: '#/components/schemas/type_invoices/v2:InvoiceDestination'
description: Defines which third-party service this invoice was created in
source_id:
type: string
description: The id of the invoice in the third-party service
source_customer_id:
type: string
description: The id of the customer that the invoice is attributed to in the third-party service
destination_status:
type: string
description: The status of the invoice in the third-party service
required:
- invoice_destination
- source_id
- source_customer_id
title: InvoiceDestinationMetadata
type_invoices/v2:Invoice:
type: object
properties:
amount_cents:
type: integer
description: Total monetary amount (in cents) of all Invoice Items
created_at:
type: string
format: date-time
updated_at:
type: string
format: date-time
organization_id:
$ref: '#/components/schemas/type_commons:OrganizationId'
invoice_destination_metadata:
$ref: '#/components/schemas/type_invoices/v2:InvoiceDestinationMetadata'
description: Contains all relevant information from the third-party service this invoice was created in
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
note:
type: string
due_date:
type: string
format: date
status:
$ref: '#/components/schemas/type_invoices/v2:InvoiceStatus'
url:
type: string
description: Link to the admin view of the invoice in the third-party service
customer_invoice_url:
type: string
description: Link to the patient view of the invoice in the third-party service
items:
$ref: '#/components/schemas/type_invoices/v2:InvoiceItemInfo'
description: The InvoiceItem rollup which contains all claim and service line invoice items
required:
- amount_cents
- created_at
- updated_at
- organization_id
- invoice_destination_metadata
- patient_external_id
- due_date
- status
- items
title: Invoice
type_invoices/v2:InvoiceInfo:
type: object
properties:
id:
$ref: '#/components/schemas/type_commons:InvoiceId'
invoice:
$ref: '#/components/schemas/type_invoices/v2:Invoice'
invoice_type:
$ref: '#/components/schemas/type_invoices/v2:InvoiceDestination'
required:
- id
- invoice
- invoice_type
title: InvoiceInfo
type_service-lines/v2:DenialReasonContent:
type: string
enum:
- Authorization Required
- Referral Required
- Medical Records Requested
- Timely Filing
- Duplicate Claim
- Full Contractual Adjustment
- Incorrect Place of Service
- Incorrect Patient Gender
- Incorrect Patient Info
- Bundled
- Exceeded Billable Time
- Invalid Provider Information
- Invalid Diagnosis Code
- Incorrect Procedure Code
- Invalid Modifier
- Missing NDC Code
- Invalid Insurance Data
- No Active Coverage
- Coordination of Benefits
- Incorrect Payer
- Credentialing
- No Effective Contract
- Missing W-9
- Missing Contract Linkage
- Non-Covered Benefit
- Experimental Procedure
- Not Medically Necessary
- Info Requested from Provider
- Info Requested from Patient
- Billing Error
- Unknown
- Max Benefit Reached
title: DenialReasonContent
type_service-lines/v2:ServiceLineDenialReason:
type: object
properties:
reason:
$ref: '#/components/schemas/type_service-lines/v2:DenialReasonContent'
description: Text of the denial reason
description: |-
The reason a given service line was denied within a given time range.
A service line may be denied for different reasons over time, but only one reason at a time.
title: ServiceLineDenialReason
type_service-lines/v2:TestResult:
type: object
properties:
value:
type: number
format: double
result_type:
$ref: '#/components/schemas/type_service-lines/v2:TestResultType'
required:
- value
- result_type
title: TestResult
type_service-lines/v2:ServiceLine:
type: object
properties:
created_at:
type: string
format: date-time
modifiers:
type: array
items:
$ref: '#/components/schemas/type_commons:ProcedureModifier'
charge_amount_cents:
type: integer
allowed_amount_cents:
type: integer
insurance_balance_cents:
type: integer
patient_balance_cents:
type: integer
paid_amount_cents:
type: integer
primary_paid_amount_cents:
type: integer
secondary_paid_amount_cents:
type: integer
tertiary_paid_amount_cents:
type: integer
patient_responsibility_cents:
type: integer
copay_cents:
type: integer
coinsurance_cents:
type: integer
deductible_cents:
type: integer
diagnosis_id_zero:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_one:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_two:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_three:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
drug_identification:
$ref: '#/components/schemas/type_service-lines/v2:DrugIdentification'
service_line_era_data:
$ref: '#/components/schemas/type_service-lines/v2:ServiceLineERAData'
service_line_manual_adjustments:
type: array
items:
$ref: '#/components/schemas/type_service-lines/v2:ServiceLineAdjustment'
related_invoices:
type: array
items:
$ref: '#/components/schemas/type_invoices:Invoice'
related_invoice_info:
type: array
items:
$ref: '#/components/schemas/type_invoices/v2:InvoiceInfo'
denial_reason:
$ref: '#/components/schemas/type_service-lines/v2:ServiceLineDenialReason'
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).
place_of_service_code_as_submitted:
$ref: '#/components/schemas/type_commons:FacilityTypeCode'
description: >-
837p Loop2300, SV105. 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).
service_line_id:
$ref: '#/components/schemas/type_commons:ServiceLineId'
procedure_code:
type: string
ordering_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:EncounterProvider'
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).
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'
claim_id:
$ref: '#/components/schemas/type_commons:ClaimId'
date_of_service_range:
$ref: '#/components/schemas/type_commons:DateRangeOptionalEnd'
description: |-
A range of dates of service for this service line. If the service line is for a single date, the end date
will be empty.
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
test_results:
type: array
items:
$ref: '#/components/schemas/type_service-lines/v2:TestResult'
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.
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.
note:
type: string
description: Maps to NTE02 loop 2400 on the EDI 837.
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.
required:
- created_at
- service_line_id
- procedure_code
- quantity
- units
- claim_id
- date_of_service_range
- date_of_service
title: ServiceLine
type_eras:EraId:
type: string
format: uuid
title: EraId
type_eras:ERA:
type: object
properties:
check_number:
type: string
check_date:
$ref: '#/components/schemas/type_commons:Date'
era_id:
$ref: '#/components/schemas/type_eras:EraId'
required:
- check_number
- check_date
- era_id
title: ERA
type_claims:Claim:
type: object
properties:
claim_id:
$ref: '#/components/schemas/type_commons:ClaimId'
status:
$ref: '#/components/schemas/type_claims:ClaimStatus'
clearinghouse:
type: string
clearinghouse_claim_id:
type: string
payer_claim_id:
type: string
clia_number:
type: string
service_lines:
type: array
items:
$ref: '#/components/schemas/type_service-lines/v2:ServiceLine'
eras:
type: array
items:
$ref: '#/components/schemas/type_eras:ERA'
required:
- claim_id
- status
- service_lines
- eras
title: Claim
type_individual:IndividualId:
type: string
format: uuid
title: IndividualId
type_commons:PhoneNumber:
type: object
properties:
number:
type: string
type:
$ref: '#/components/schemas/type_commons:PhoneNumberType'
required:
- number
- type
title: PhoneNumber
type_clinical-trials/v1:ClinicalTrialPhase:
type: string
enum:
- Phase 1
- Phase 2
- Phase 3
title: ClinicalTrialPhase
type_clinical-trials/v1:ClinicalTrial:
type: object
properties:
name:
type: string
clinical_trial_number:
type: string
description: Must be 8 characters long
clinical_trial_phase:
$ref: '#/components/schemas/type_clinical-trials/v1:ClinicalTrialPhase'
clinical_trial_id:
$ref: '#/components/schemas/type_commons:ClinicalTrialId'
non_insurance_payer_id:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerId'
is_active:
type: boolean
required:
- name
- clinical_trial_number
- clinical_trial_id
- non_insurance_payer_id
- is_active
title: ClinicalTrial
type_non-insurance-payers/v1:NonInsurancePayer:
type: object
properties:
non_insurance_payer_id:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerId'
name:
type: string
description:
type: string
category:
type: string
enabled:
type: boolean
address:
$ref: '#/components/schemas/type_commons:StreetAddressShortZip'
clinical_trials:
type: array
items:
$ref: '#/components/schemas/type_clinical-trials/v1:ClinicalTrial'
required:
- non_insurance_payer_id
- name
- enabled
- clinical_trials
title: NonInsurancePayer
type_individual:PatientClinicalTrialInfo:
type: object
properties:
clinical_trial_arm:
type: string
clinical_trial:
$ref: '#/components/schemas/type_clinical-trials/v1:ClinicalTrial'
required:
- clinical_trial
title: PatientClinicalTrialInfo
type_individual:PatientNonInsurancePayerInfo:
type: object
properties:
non_insurance_payer:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayer'
member_id:
type: string
clinical_trial_info:
type: array
items:
$ref: '#/components/schemas/type_individual:PatientClinicalTrialInfo'
description: A patient cannot be associated with a given trial more than once
required:
- non_insurance_payer
- clinical_trial_info
title: PatientNonInsurancePayerInfo
type_individual:Patient:
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:StreetAddressShortZip'
description: Box 5 on the CMS-1500 claim form or Form Locator 9 on a UB-04 claim form.
individual_id:
$ref: '#/components/schemas/type_individual:IndividualId'
phone_numbers:
type: array
items:
$ref: '#/components/schemas/type_commons:PhoneNumber'
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:NonInsurancePayer'
non_insurance_payers_info:
type: array
items:
$ref: '#/components/schemas/type_individual:PatientNonInsurancePayerInfo'
required:
- first_name
- last_name
- gender
- external_id
- date_of_birth
- address
- individual_id
- phone_numbers
- phone_consent
- email_consent
- auto_charge_consent
- non_insurance_payers
- non_insurance_payers_info
title: Patient
type_guarantor/v1:GuarantorId:
type: string
format: uuid
title: GuarantorId
type_guarantor/v1:Guarantor:
type: object
properties:
first_name:
type: string
last_name:
type: string
external_id:
type: string
date_of_birth:
type: string
format: date
address:
$ref: '#/components/schemas/type_commons:StreetAddressShortZip'
guarantor_id:
$ref: '#/components/schemas/type_guarantor/v1:GuarantorId'
phone_numbers:
type: array
items:
$ref: '#/components/schemas/type_commons:PhoneNumber'
phone_consent:
type: boolean
email:
$ref: '#/components/schemas/type_commons:Email'
email_consent:
type: boolean
auto_charge_consent:
type: boolean
required:
- first_name
- last_name
- external_id
- address
- guarantor_id
- phone_numbers
- phone_consent
- email_consent
- auto_charge_consent
title: Guarantor
type_x12/v1:TypeOfAdmissionOrVisitCode:
type: string
enum:
- '1'
- '2'
- '3'
- '4'
- '5'
- '9'
title: TypeOfAdmissionOrVisitCode
type_x12/v1:PointOfOriginForAdmissionOrVisitCode:
type: string
enum:
- '1'
- '2'
- '4'
- '5'
- '6'
- '8'
- '9'
- D
- E
- F
- G
title: PointOfOriginForAdmissionOrVisitCode
type_x12/v1:PatientDischargeStatusCode:
type: string
enum:
- '01'
- '02'
- '03'
- '04'
- '05'
- '06'
- '07'
- '09'
- '20'
- '21'
- '30'
- '40'
- '41'
- '42'
- '43'
- '50'
- '51'
- '61'
- '62'
- '63'
- '64'
- '65'
- '66'
- '69'
- '70'
- '81'
- '82'
- '83'
- '84'
- '85'
- '86'
- '87'
- '88'
- '89'
- '90'
- '91'
- '92'
- '93'
- '94'
- '95'
title: PatientDischargeStatusCode
type_encounter-providers/v2:EncounterAdditionalProvider:
type: object
properties:
provider_id:
$ref: '#/components/schemas/type_encounter-providers/v2:ProviderId'
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:StreetAddressLongZip'
tax_id:
type: string
license_type:
$ref: '#/components/schemas/type_organization-providers/v2:LicenseType'
description: The license type of the provider (e.g., MD, NP, PA, LCSW).
required:
- provider_id
- first_name
- last_name
description: >-
A lighter-weight provider type with optional NPI. Used for treating providers and other additional provider
roles that may not have full NPI credentials.
title: EncounterAdditionalProvider
type_related-causes/v1:RelatedCausesInformation:
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
required:
- related_causes_code_1
title: RelatedCausesInformation
type_property-and-casualty/v1:PropertyCasualtyPatientIdentifier:
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
required:
- property_casualty_patient_identifier_qualifier
- property_casualty_patient_identifier
title: PropertyCasualtyPatientIdentifier
type_encounters/v4:EncounterSubmissionExpectation:
type: string
enum:
- TARGET_PROFESSIONAL
- TARGET_INSTITUTIONAL
description: |-
Used to describe the currently expected target form for this encounter. This effects what
validations and queues the form is processed under. Before submission,
this value will be required by some rules or user intervention. It can be changed
at any time, although doing so may incur other rules.
title: EncounterSubmissionExpectation
type_x12/v1:TypeOfFacilityCode:
type: string
enum:
- '1'
- '2'
- '3'
- '4'
- '6'
- '7'
- '8'
title: TypeOfFacilityCode
type_x12/v1:TypeOfCareCode:
type: string
enum:
- '1'
- '2'
- '3'
- '4'
- '5'
- '6'
- '7'
- '8'
- '9'
title: TypeOfCareCode
type_x12/v1:TypeOfBillComposite:
type: object
properties:
type_of_facility:
$ref: '#/components/schemas/type_x12/v1:TypeOfFacilityCode'
description: The FL04 Institutional type of facility code for the bill. The second digit of the composite code.
type_of_care:
$ref: '#/components/schemas/type_x12/v1:TypeOfCareCode'
description: The FL04 Institutional type of care code for the bill. The third digit of the composite code.
frequency_code:
$ref: '#/components/schemas/type_x12/v1:TypeOfBillFrequencyCode'
description: The FL04 Institutional frequency code for the bill. The fourth digit of the composite code.
code:
type: string
description: The composite, 4 digit code of the composite, starting with a padding code 0.
required:
- type_of_facility
- type_of_care
- frequency_code
- code
title: TypeOfBillComposite
type_service-facility:ServiceFacilityId:
type: string
format: uuid
title: ServiceFacilityId
type_service-facility:EncounterServiceFacility:
type: object
properties:
service_facility_id:
$ref: '#/components/schemas/type_service-facility:ServiceFacilityId'
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:StreetAddressLongZip'
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.
required:
- service_facility_id
- organization_name
- address
title: EncounterServiceFacility
type_insurance-cards/v2:InsuranceCardId:
type: string
format: uuid
title: InsuranceCardId
type_insurance-cards/v2:InsuranceCard:
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:StreetAddressLongZip'
insurance_card_id:
$ref: '#/components/schemas/type_insurance-cards/v2:InsuranceCardId'
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
required:
- insurance_card_id
- member_id
- payer_name
- payer_id
title: InsuranceCard
type_individual:Subscriber:
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:StreetAddressShortZip'
individual_id:
$ref: '#/components/schemas/type_individual:IndividualId'
insurance_card:
$ref: '#/components/schemas/type_insurance-cards/v2:InsuranceCard'
required:
- first_name
- last_name
- gender
- patient_relationship_to_subscriber_code
- individual_id
- insurance_card
title: Subscriber
type_diagnoses:Diagnosis:
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.
Should be of the appropriate format for the provided `code_type`.
Must obey the ICD-10 format if an ICD-10 code_type is provided, specifically:
- Letter
- Digit
- Digit or the letter `A` or `B`
- (Optional) Period `.`
- 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.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
diagnosis_id:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
created_at:
type: string
format: date-time
updated_at:
type: string
format: date-time
required:
- code_type
- code
- encounter_id
- diagnosis_id
- created_at
- updated_at
title: Diagnosis
type_encounters/v4:ClinicalNote:
type: object
properties:
text:
type: string
author_name:
type: string
author_npi:
$ref: '#/components/schemas/type_commons:Npi'
timestamp:
type: string
format: date-time
required:
- text
- author_name
- timestamp
title: ClinicalNote
type_encounters/v4:ClinicalNoteCategory:
type: object
properties:
category:
$ref: '#/components/schemas/type_encounters/v4:NoteCategory'
notes:
type: array
items:
type: string
notes_structured:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:ClinicalNote'
required:
- category
- notes
title: ClinicalNoteCategory
type_encounters/v4:IntakeFollowUp:
type: object
properties:
id:
$ref: '#/components/schemas/type_encounters/v4:IntakeFollowUpId'
text:
type: string
response:
type: string
required:
- id
- text
title: IntakeFollowUp
type_encounters/v4:IntakeResponseAndFollowUps:
type: object
properties:
response:
type: string
follow_ups:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:IntakeFollowUp'
title: IntakeResponseAndFollowUps
type_encounters/v4:IntakeQuestion:
type: object
properties:
id:
$ref: '#/components/schemas/type_encounters/v4:IntakeQuestionId'
text:
type: string
responses:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:IntakeResponseAndFollowUps'
required:
- id
- text
title: IntakeQuestion
type_encounters/v4:PatientHistoryCategory:
type: object
properties:
category:
$ref: '#/components/schemas/type_encounters/v4:PatientHistoryCategoryEnum'
questions:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:IntakeQuestion'
description: Must contain at least one item.
required:
- category
- questions
title: PatientHistoryCategory
type_patient-payments/v3:PatientPaymentId:
type: string
title: PatientPaymentId
type_patient-payments/v3:PatientPaymentSource:
type: string
enum:
- MANUAL_ENTRY
- CHARGEBEE_PAYMENTS
- CHARGEBEE MANUALLY VOIDED BY CANDID
- CHARGEBEE_REFUNDS
- SQUARE_REFUNDS
- SQUARE_PAYMENTS
- STRIPE_CHARGES
- STRIPE_REFUNDS
- ELATION_PAYMENTS
title: PatientPaymentSource
type_patient-payments/v3:PatientPaymentStatus:
type: string
enum:
- PENDING
- paid
- CANCELED
- voided
- FAILED
- COMPLETED
- succeeded
- pending
- failed
- requires_action
- canceled
title: PatientPaymentStatus
type_patient-payments/v3:PatientPayment:
type: object
properties:
patient_payment_id:
$ref: '#/components/schemas/type_patient-payments/v3:PatientPaymentId'
organization_id:
$ref: '#/components/schemas/type_commons:OrganizationId'
source_internal_id:
type: string
source:
$ref: '#/components/schemas/type_patient-payments/v3:PatientPaymentSource'
amount_cents:
type: integer
payment_timestamp:
type: string
format: date-time
status:
$ref: '#/components/schemas/type_patient-payments/v3:PatientPaymentStatus'
payment_name:
type: string
payment_note:
type: string
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
encounter_external_id:
$ref: '#/components/schemas/type_commons:EncounterExternalId'
service_line_id:
$ref: '#/components/schemas/type_commons:ServiceLineId'
required:
- patient_payment_id
- organization_id
- source_internal_id
- source
- amount_cents
title: PatientPayment
type_tags:TagColorEnum:
type: string
enum:
- black
- white
- gray
- red
- yellow
- green
- blue
- indigo
- purple
- pink
title: TagColorEnum
type_tags:Tag:
type: object
properties:
tag_id:
$ref: '#/components/schemas/type_tags:TagId'
description:
type: string
color:
$ref: '#/components/schemas/type_tags:TagColorEnum'
creator_id:
type: string
required:
- tag_id
- description
- color
- creator_id
title: Tag
type_encounters/v4:CodingAttributionType:
type: string
enum:
- CANDID
- CUSTOMER
- TCN
- PJF
title: CodingAttributionType
type_encounters/v4:EncounterSubmissionOriginType:
type: string
enum:
- CANDID
- EXTERNAL
title: EncounterSubmissionOriginType
type_encounters/v4:EPSDTReferral:
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'
required:
- condition_indicator1
title: EPSDTReferral
type_encounters/v4:ClaimSupplementalInformation:
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
required:
- attachment_report_type_code
- attachment_transmission_code
title: ClaimSupplementalInformation
type_commons:NextResponsibleParty:
type: string
enum:
- primary
- secondary
- tertiary
- patient
- non_insurance
- none
title: NextResponsibleParty
type_encounters/v4:Encounter:
type: object
properties:
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.
date_of_service must be defined on either the encounter or the service lines but not both.
If there are greater than zero service lines, it is recommended to specify date_of_service on the
service_line instead of on the encounter to prepare for future API versions.
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 there are greater than zero service lines, it is recommended to specify end_date_of_service on the
service_line instead of on the encounter to prepare for future API versions.
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.
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.
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.
appointment_type:
type: string
description: 'Human-readable description of the appointment type (ex: "Acupuncture - Headaches").'
existing_medications:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:Medication'
interventions:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:Intervention'
pay_to_address:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
description: Specifies the address to which payments for the claim should be sent.
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.
vitals:
$ref: '#/components/schemas/type_encounters/v4:Vitals'
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.
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
Required 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.
OR
This date is the onset of acute symptoms for the current illness or condition.
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.
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).
accident_state_or_province_code:
$ref: '#/components/schemas/type_commons:State'
description: 837i-REF1000 -- an optional state indicating where an accident related to the encounter occurred.
claim_creation_id:
$ref: '#/components/schemas/type_commons:ChargeCaptureClaimCreationId'
description: >-
If the encounter was created from ingested charge captures, this is the associated Charge Capture Claim
Creation Id.
patient_control_number:
type: string
description: >-
A patient control number (PCN) is a unique identifier assigned to a patient within a healthcare system or
facility.
It's used to track and manage a patient's medical records, treatments, and other healthcare-related
information.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
claims:
type: array
items:
$ref: '#/components/schemas/type_claims:Claim'
patient:
$ref: '#/components/schemas/type_individual:Patient'
description: Contains the identification information of the individual receiving medical services.
guarantor:
$ref: '#/components/schemas/type_guarantor/v1:Guarantor'
description: Personal and contact info for the guarantor of the patient responsibility.
billing_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:EncounterProvider'
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.
rendering_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:EncounterProvider'
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.
attending_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:EncounterProvider'
description: >-
837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has overall responsibility for
the patient in institutional claims processing.
admission_hour:
type: integer
description: |-
837i Loop 2300 DTP-03
Extension of the admission date with hour (0-23) details.
Required for institutional submission.
admission_type_code:
$ref: '#/components/schemas/type_x12/v1:TypeOfAdmissionOrVisitCode'
description: >-
837i Loop 2300 CL1-01 Code used to indicate the priority of an admission or visit. Equivalent to Form
Locator 14 Priority of Admission on a UB-04 claim, not used on CMS-1500 claim forms.
admission_source_code:
$ref: '#/components/schemas/type_x12/v1:PointOfOriginForAdmissionOrVisitCode'
description: >-
837i Loop 2300 CLI1-02 Code used to indicate the conditions under which an admission occurs. Equivalent to
Form Locator 15 Point of Origin on a UB-04 claim, not used on CMS-1500 claim forms.
discharge_hour:
type: integer
description: |-
837i Loop 2300 DTP-03
Extension of the discharge date with hour (0-23) details.
discharge_status:
$ref: '#/components/schemas/type_x12/v1:PatientDischargeStatusCode'
description: |-
837i CL1-03 or Form Locator 17 on a UB-04 claim form. This is a required field on UB-04 claims.
Code indicating patient status as of the "statement covers through date".
operating_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:EncounterProvider'
description: >-
837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has primary responsibility for
surgical procedures in institutional claims processing.
other_operating_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:EncounterProvider'
description: >-
837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has secondary responsibility
for surgical procedures in institutional claims processing. Only used when operating_provider is also set.
treating_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:EncounterAdditionalProvider'
description: >-
The treating provider is the provider who treats the patient. This is only supported for professional
encounters.
related_causes_information:
$ref: '#/components/schemas/type_related-causes/v1:RelatedCausesInformation'
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:PropertyCasualtyPatientIdentifier'
description: |-
Patient identifier for Property and Casualty claims.
837p Loop2010CA
submission_expectation:
$ref: '#/components/schemas/type_encounters/v4:EncounterSubmissionExpectation'
description: >-
Describes the currently expected target form for this encounter. This effects what validations and queues
the form is processed under. When this value is not set, it should be assumed to be TARGET_PROFESSIONAL.
type_of_bill:
$ref: '#/components/schemas/type_x12/v1:TypeOfBillComposite'
description: >-
Four digit code used in institutional forms to indicate the type of bill (e.g., hospital inpatient, hospital
outpatient). First digit is a leading 0, followed by the type_of_facility, type_of_care, then
frequency_code. Professional forms are not required to submit this attribute. You may send the 4 digit code
via raw_code, or each individual digit separately via composite_codes.
referring_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:EncounterProvider'
initial_referring_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:EncounterProvider'
supervising_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:EncounterProvider'
service_facility:
$ref: '#/components/schemas/type_service-facility:EncounterServiceFacility'
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
subscriber_primary:
$ref: '#/components/schemas/type_individual:Subscriber'
description: >-
Subscriber_primary is required when responsible_party is INSURANCE_PAY (i.e. when the claim should be billed
to insurance).
These are not required fields when responsible_party is SELF_PAY (i.e. when the claim should be billed to
the patient).
However, if you collect this for patients, even self-pay, we recommend including it when sending encounters
to Candid.
Note: Cash Pay is no longer a valid payer_id in v4, please use responsible party to define self-pay claims.
subscriber_secondary:
$ref: '#/components/schemas/type_individual:Subscriber'
description: Contains details of the secondary insurance subscriber.
subscriber_tertiary:
$ref: '#/components/schemas/type_individual:Subscriber'
description: Contains details of the tertiary insurance subscriber.
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.
responsible_party:
$ref: '#/components/schemas/type_encounters/v4:ResponsiblePartyType'
description: Defines the party to be billed with the initial balance owed on the claim.
url:
$ref: '#/components/schemas/type_commons:LinkUrl'
description: URL that links directly to the claim created in Candid.
diagnoses:
type: array
items:
$ref: '#/components/schemas/type_diagnoses:Diagnosis'
description: >-
Contains the primary and other diagnosis health care code information objects associated with this
encounter. For professional claims, these diagnoses correspond with those that are set on service lines
directly, where as for institutional claims these are only associated directly with the claim itself. See
also Health Care Code Information objects and corresponding apis.
clinical_notes:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:ClinicalNoteCategory'
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.
billing_notes:
type: array
items:
$ref: '#/components/schemas/type_billing-notes/v2:BillingNote'
description: |-
Spot to store misc, human-readable, notes about this encounter to be
used in the billing process.
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).
place_of_service_code_as_submitted:
$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).
patient_histories:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:PatientHistoryCategory'
patient_payments:
type: array
items:
$ref: '#/components/schemas/type_patient-payments/v3:PatientPayment'
tags:
type: array
items:
$ref: '#/components/schemas/type_tags:Tag'
coding_attribution:
$ref: '#/components/schemas/type_encounters/v4:CodingAttributionType'
description: The entity that performed the coding of medical services for the claim.
work_queue_id:
$ref: '#/components/schemas/type_commons:WorkQueueId'
work_queue_membership_activated_at:
type: string
format: date-time
owner_of_next_action:
$ref: '#/components/schemas/type_encounters/v4:EncounterOwnerOfNextActionType'
description: >-
The party who is responsible for taking the next action on an Encounter, as defined by ownership of open
Tasks.
submission_origin:
$ref: '#/components/schemas/type_encounters/v4:EncounterSubmissionOriginType'
description: >-
The party who originally submitted the Claim.
For Claims originating in Candid, this will be EncounterSubmissionOriginType.CANDID.
For Encounters created with an external_claim_submission object, this will be
EncounterSubmissionOriginType.EXTERNAL.
schema_instances:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaInstance'
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.
referral_number:
type: string
description: Refers to REF*9F on the 837p. Value cannot be greater than 50 characters.
epsdt_referral:
$ref: '#/components/schemas/type_encounters/v4:EPSDTReferral'
description: Refers to Box 24H on the CMS1500 form and Loop 2300 CRC - EPSDT Referral on the 837P and 837i form
claim_supplemental_information:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:ClaimSupplementalInformation'
description: Refers to Loop 2300 - Segment PWK on the 837P and 837i form. No more than 10 entries are permitted.
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.
last_submitted_at:
type: string
format: date-time
description: The date and time the encounter was last submitted to a payer.
created_at:
type: string
format: date-time
description: The date and time the encounter was created.
next_responsible_party:
$ref: '#/components/schemas/type_commons:NextResponsibleParty'
description: The party (payer, patient, etc.) responsible for the remainder of the balance on the claim.
organization_id:
$ref: '#/components/schemas/type_commons:OrganizationId'
required:
- external_id
- patient_authorized_release
- benefits_assigned_to_provider
- provider_accepts_assignment
- billable_status
- encounter_id
- claims
- patient
- billing_provider
- rendering_provider
- service_facility
- responsible_party
- url
- diagnoses
- clinical_notes
- patient_histories
- patient_payments
- tags
- owner_of_next_action
- submission_origin
- schema_instances
- created_at
title: Encounter
type_encounters/v4:EncounterPage:
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_encounters/v4:Encounter'
required:
- items
title: EncounterPage
type_commons:InternalErrorMessage:
type: object
properties:
message:
type: string
title: InternalErrorMessage
type_individual:PatientClinicalTrialInfoCreate:
type: object
properties:
clinical_trial_arm:
type: string
clinical_trial_id:
$ref: '#/components/schemas/type_commons:ClinicalTrialId'
required:
- clinical_trial_id
title: PatientClinicalTrialInfoCreate
type_individual:PatientNonInsurancePayerInfoCreate:
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:PatientClinicalTrialInfoCreate'
required:
- non_insurance_payer_id
title: PatientNonInsurancePayerInfoCreate
type_individual:PatientCreate:
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:StreetAddressShortZip'
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:PhoneNumber'
phone_consent:
type: boolean
description: Defaults to false
email:
$ref: '#/components/schemas/type_commons:Email'
non_insurance_payers:
type: array
items:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerId'
non_insurance_payers_info:
type: array
items:
$ref: '#/components/schemas/type_individual:PatientNonInsurancePayerInfoCreate'
email_consent:
type: boolean
description: Defaults to false
auto_charge_consent:
type: boolean
description: Defaults to false
required:
- first_name
- last_name
- gender
- external_id
- date_of_birth
- address
title: PatientCreate
type_encounter-providers/v2:TreatingProvider:
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:StreetAddressLongZip'
license_type:
$ref: '#/components/schemas/type_organization-providers/v2:LicenseType'
description: The license type of the treating provider (e.g., MD, NP, PA, LCSW).
required:
- first_name
- last_name
description: >-
The treating provider for professional encounters. Unlike other provider types, the treating provider has an
optional NPI and no organization_name field.
title: TreatingProvider
type_service-facility:EncounterServiceFacilityBase:
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:StreetAddressLongZip'
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.
required:
- organization_name
- address
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.
Note that for an in-network claim to be successfully adjudicated, the service facility address listed on claims
must match what was provided to the payer during the credentialing process.
title: EncounterServiceFacilityBase
type_insurance-cards/v2:InsuranceCardCreate:
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:StreetAddressLongZip'
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 Plan Groups 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 group name here. See Payer
Information documentation for details.
required:
- member_id
- payer_name
- payer_id
title: InsuranceCardCreate
type_individual:SubscriberCreate:
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:StreetAddressShortZip'
insurance_card:
$ref: '#/components/schemas/type_insurance-cards/v2:InsuranceCardCreate'
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.
required:
- first_name
- last_name
- gender
- patient_relationship_to_subscriber_code
- insurance_card
title: SubscriberCreate
type_encounters/v4:ClinicalNoteCategoryCreate:
type: object
properties:
category:
$ref: '#/components/schemas/type_encounters/v4:NoteCategory'
notes:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:ClinicalNote'
required:
- category
- notes
title: ClinicalNoteCategoryCreate
type_billing-notes/v2:BillingNoteBase:
type: object
properties:
text:
type: string
description: Empty string not allowed.
required:
- text
title: BillingNoteBase
type_guarantor/v1:GuarantorCreate:
type: object
properties:
first_name:
type: string
last_name:
type: string
external_id:
type: string
date_of_birth:
type: string
format: date
address:
$ref: '#/components/schemas/type_commons:StreetAddressShortZip'
phone_numbers:
type: array
items:
$ref: '#/components/schemas/type_commons:PhoneNumber'
phone_consent:
type: boolean
description: Defaults to false
email:
$ref: '#/components/schemas/type_commons:Email'
email_consent:
type: boolean
description: Defaults to false
auto_charge_consent:
type: boolean
description: Defaults to false
required:
- first_name
- last_name
- external_id
- address
title: GuarantorCreate
type_claim-submission/v1:ClaimSubmissionRecordCreate:
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.
required:
- submitted_at
description: Data about each external submission.
title: ClaimSubmissionRecordCreate
type_claim-submission/v1:ExternalClaimSubmissionCreate:
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:ClaimSubmissionRecordCreate'
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.
required:
- claim_created_at
- patient_control_number
- submission_records
title: ExternalClaimSubmissionCreate
type_related-causes/v1:RelatedCausesInformationCreate:
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
required:
- related_causes_code_1
title: RelatedCausesInformationCreate
type_property-and-casualty/v1:PropertyCasualtyPatientIdentifierCreate:
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
required:
- property_casualty_patient_identifier_qualifier
- property_casualty_patient_identifier
title: PropertyCasualtyPatientIdentifierCreate
type_encounter-providers/v2:BillingProviderSecondaryIdentification:
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.
required:
- reference_identification
title: BillingProviderSecondaryIdentification
type_encounter-providers/v2:BillingProvider:
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:StreetAddressLongZip'
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:BillingProviderSecondaryIdentification'
description: |-
Only one of provider_commercial_license_type or secondary_identification may be provided
837i Loop2010BB G2
Secondary Identification
required:
- address
- tax_id
- npi
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.
title: BillingProvider
type_encounter-providers/v2:RenderingProvider:
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:StreetAddressLongZip'
secondary_identification:
$ref: '#/components/schemas/type_encounter-providers/v2:ProviderSecondaryIdentification'
description: |-
Only one of provider_commercial_license_type or secondary_identification may be provided
837i Loop2310BB G2
Secondary Identification
required:
- npi
title: RenderingProvider
type_service-lines/v2:UniversalServiceLineCreate:
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.
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.
drug_identification:
$ref: '#/components/schemas/type_service-lines/v2:DrugIdentification'
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:OrderingProvider'
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:TestResult'
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.
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.
diagnosis_pointers:
type: array
items:
type: integer
description: Indices (zero-indexed) of all the diagnoses this service line references
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).
procedure_code:
type: string
required:
- quantity
- units
title: UniversalServiceLineCreate
type_health-care-code-information/v1:PrincipalDiagnosisCodeQualifier:
type: string
enum:
- BK
- ABK
title: PrincipalDiagnosisCodeQualifier
type_health-care-code-information/v1:ICDCode:
type: string
title: ICDCode
type_health-care-code-information/v1:PresentOnAdmissionIndicatorCode:
type: string
enum:
- 'Y'
- 'N'
- U
- W
- '1'
title: PresentOnAdmissionIndicatorCode
type_health-care-code-information/v1:PrincipalDiagnosisNew:
type: object
properties:
principal_diagnosis_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:PrincipalDiagnosisCodeQualifier'
primary_diagnosis_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:ICDCode'
present_on_admission_indicator:
$ref: '#/components/schemas/type_health-care-code-information/v1:PresentOnAdmissionIndicatorCode'
required:
- principal_diagnosis_code_qualifier
- primary_diagnosis_code
description: This corresponds to BK or ABK code qualifier values.
title: PrincipalDiagnosisNew
type_health-care-code-information/v1:OtherDiagnosisInformationCodeQualifier:
type: string
enum:
- BF
- ABF
title: OtherDiagnosisInformationCodeQualifier
type_health-care-code-information/v1:OtherDiagnosisInformationNew:
type: object
properties:
other_diagnosis_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:OtherDiagnosisInformationCodeQualifier'
other_diagnosis:
$ref: '#/components/schemas/type_health-care-code-information/v1:ICDCode'
present_on_admission_indicator:
$ref: '#/components/schemas/type_health-care-code-information/v1:PresentOnAdmissionIndicatorCode'
required:
- other_diagnosis_code_qualifier
- other_diagnosis
description: This corresponds to BF and ABF code qualifier values.
title: OtherDiagnosisInformationNew
type_health-care-code-information/v1:AdmittingDiagnosisCodeQualifier:
type: string
enum:
- BJ
- ABJ
title: AdmittingDiagnosisCodeQualifier
type_health-care-code-information/v1:AdmittingDiagnosisNew:
type: object
properties:
admitting_diagnosis_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:AdmittingDiagnosisCodeQualifier'
admitting_diagnosis_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:ICDCode'
required:
- admitting_diagnosis_code_qualifier
- admitting_diagnosis_code
description: This corresponds to BJ or ABJ code qualifier values.
title: AdmittingDiagnosisNew
type_health-care-code-information/v1:PatientReasonForVisitCodeQualifier:
type: string
enum:
- PR
- APR
title: PatientReasonForVisitCodeQualifier
type_health-care-code-information/v1:PatientReasonForVisitNew:
type: object
properties:
patient_reason_for_visit_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:PatientReasonForVisitCodeQualifier'
patient_reason_for_visit:
$ref: '#/components/schemas/type_health-care-code-information/v1:ICDCode'
required:
- patient_reason_for_visit_code_qualifier
- patient_reason_for_visit
description: This corresponds to PR or APR code qualifier values.
title: PatientReasonForVisitNew
type_health-care-code-information/v1:ExternalCauseOfInjuryCodeQualifier:
type: string
enum:
- BN
- ABN
title: ExternalCauseOfInjuryCodeQualifier
type_health-care-code-information/v1:ExternalCauseOfInjuryNew:
type: object
properties:
external_cause_of_injury_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:ExternalCauseOfInjuryCodeQualifier'
external_cause_of_injury_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:ICDCode'
present_on_admission_indicator:
$ref: '#/components/schemas/type_health-care-code-information/v1:PresentOnAdmissionIndicatorCode'
required:
- external_cause_of_injury_code_qualifier
- external_cause_of_injury_code
description: This corresponds to BN or ABN code qualifier values.
title: ExternalCauseOfInjuryNew
type_health-care-code-information/v1:DiagnosisRelatedGroupCodeQualifier:
type: string
enum:
- DR
title: DiagnosisRelatedGroupCodeQualifier
type_health-care-code-information/v1:MSDRGCode:
type: string
title: MSDRGCode
type_health-care-code-information/v1:DiagnosisRelatedGroupNew:
type: object
properties:
diagnosis_related_group_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:DiagnosisRelatedGroupCodeQualifier'
diagnosis_related_group_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:MSDRGCode'
required:
- diagnosis_related_group_code_qualifier
- diagnosis_related_group_code
description: This corresponds to DR code qualifier values.
title: DiagnosisRelatedGroupNew
type_health-care-code-information/v1:PrincipalProcedureInformationCodeQualifier:
type: string
enum:
- BBR
- BR
- CAH
title: PrincipalProcedureInformationCodeQualifier
type_health-care-code-information/v1:D8Date:
type: string
format: date
title: D8Date
type_health-care-code-information/v1:PrincipalProcedureInformationNew:
type: object
properties:
principal_procedure_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:PrincipalProcedureInformationCodeQualifier'
principal_procedure_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:ICDCode'
procedure_date:
$ref: '#/components/schemas/type_health-care-code-information/v1:D8Date'
description: |-
An [RFC 3339, section 5.6 datetime](https://ijmacd.github.io/rfc3339-iso8601/).
For example, 2017-07-21T17:32:28Z.
In practice, only the date portion of this is used for claim submission, so
midnight time is fine.
required:
- principal_procedure_code_qualifier
- principal_procedure_code
- procedure_date
description: This correspond to BBR, BR, and CAH code qualifier values.
title: PrincipalProcedureInformationNew
type_health-care-code-information/v1:OtherProcedureInformationCodeQualifier:
type: string
enum:
- BBQ
- BQ
title: OtherProcedureInformationCodeQualifier
type_health-care-code-information/v1:OtherProcedureInformationNew:
type: object
properties:
other_procedure_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:OtherProcedureInformationCodeQualifier'
other_procedure_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:ICDCode'
other_procedure_date:
$ref: '#/components/schemas/type_health-care-code-information/v1:D8Date'
description: |-
An [RFC 3339, section 5.6 datetime](https://ijmacd.github.io/rfc3339-iso8601/).
For example, 2017-07-21T17:32:28Z.
In practice, only the date portion of this is used for claim submission, so
midnight time is fine.
required:
- other_procedure_code_qualifier
- other_procedure_code
- other_procedure_date
description: This corresponds to the BBQ or BQ code qualifier values.
title: OtherProcedureInformationNew
type_health-care-code-information/v1:OccurrenceSpanCodeQualifier:
type: string
enum:
- BI
title: OccurrenceSpanCodeQualifier
type_health-care-code-information/v1:OccurrenceSpanCode:
type: string
enum:
- '70'
- '71'
- '72'
- '73'
- '74'
- '75'
- '76'
- '77'
- '78'
- '80'
- '81'
- '82'
- M0
- M1
- M2
- M3
- M4
title: OccurrenceSpanCode
type_health-care-code-information/v1:RD8Date:
type: object
properties:
start:
type: string
format: date
end:
type: string
format: date
required:
- start
- end
title: RD8Date
type_health-care-code-information/v1:OccurrenceSpanInformationNew:
type: object
properties:
occurrence_span_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:OccurrenceSpanCodeQualifier'
occurrence_span_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:OccurrenceSpanCode'
occurrence_span_date:
$ref: '#/components/schemas/type_health-care-code-information/v1:RD8Date'
required:
- occurrence_span_code_qualifier
- occurrence_span_code
- occurrence_span_date
description: This corresponds to the BI code qualifier value.
title: OccurrenceSpanInformationNew
type_health-care-code-information/v1:OccurrenceInformationCodeQualifier:
type: string
enum:
- BH
title: OccurrenceInformationCodeQualifier
type_health-care-code-information/v1:OccurrenceCode:
type: string
enum:
- '01'
- '02'
- '03'
- '04'
- '05'
- '06'
- '09'
- '10'
- '11'
- '12'
- '16'
- '17'
- '18'
- '19'
- '20'
- '21'
- '22'
- '24'
- '25'
- '26'
- '27'
- '28'
- '29'
- '30'
- '31'
- '32'
- '33'
- '34'
- '35'
- '36'
- '37'
- '38'
- '39'
- '40'
- '41'
- '42'
- '43'
- '44'
- '45'
- '46'
- '47'
- '50'
- '51'
- '52'
- '54'
- '55'
- '56'
- '61'
- '62'
- A1
- A2
- A3
- A4
- B1
- B2
- B3
- C1
- C2
- C3
title: OccurrenceCode
type_health-care-code-information/v1:OccurrenceInformationNew:
type: object
properties:
occurrence_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:OccurrenceInformationCodeQualifier'
occurrence_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:OccurrenceCode'
occurrence_date:
$ref: '#/components/schemas/type_health-care-code-information/v1:D8Date'
description: |-
An [RFC 3339, section 5.6 datetime](https://ijmacd.github.io/rfc3339-iso8601/).
For example, 2017-07-21T17:32:28Z.
In practice, only the date portion of this is used for claim submission, so
midnight time is fine.
required:
- occurrence_code_qualifier
- occurrence_code
- occurrence_date
description: This corresponds to the BH code qualifier value.
title: OccurrenceInformationNew
type_health-care-code-information/v1:TreatmentCodeQualifier:
type: string
enum:
- TC
title: TreatmentCodeQualifier
type_health-care-code-information/v1:TreatmentCode:
type: string
title: TreatmentCode
type_health-care-code-information/v1:TreatmentCodeInformationNew:
type: object
properties:
treatment_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:TreatmentCodeQualifier'
treatment_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:TreatmentCode'
required:
- treatment_code_qualifier
- treatment_code
description: This corresponds to the TC code qualifier value.
title: TreatmentCodeInformationNew
type_health-care-code-information/v1:ValueCodeQualifier:
type: string
enum:
- BE
title: ValueCodeQualifier
type_health-care-code-information/v1:ValueCode:
type: string
enum:
- '01'
- '02'
- '04'
- '05'
- '06'
- '08'
- '09'
- '10'
- '11'
- '12'
- '13'
- '14'
- '15'
- '16'
- '21'
- '22'
- '23'
- '24'
- '25'
- '26'
- '27'
- '28'
- '29'
- '30'
- '31'
- '32'
- '33'
- '34'
- '35'
- '37'
- '38'
- '39'
- '40'
- '41'
- '42'
- '43'
- '44'
- '45'
- '46'
- '47'
- '48'
- '49'
- '50'
- '51'
- '52'
- '53'
- '54'
- '55'
- '56'
- '57'
- '58'
- '59'
- '60'
- '61'
- '66'
- '67'
- '68'
- '69'
- '80'
- '81'
- '82'
- '83'
- '84'
- '85'
- '87'
- '89'
- '90'
- '91'
- A0
- A1
- A2
- A3
- A4
- A5
- A6
- A7
- A8
- A9
- AA
- AB
- B1
- B2
- B3
- B7
- BA
- BB
- C1
- C2
- C3
- C7
- CA
- CB
- D3
- D4
- D5
- D6
- FC
- FD
- G8
- P1
- P2
- P3
- Y1
- Y2
- Y3
- Y4
- Y5
title: ValueCode
type_health-care-code-information/v1:ValueInformationNew:
type: object
properties:
value_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:ValueCodeQualifier'
value_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:ValueCode'
value_code_amount:
$ref: '#/components/schemas/type_commons:Decimal'
required:
- value_code_qualifier
- value_code
- value_code_amount
description: This corresponds to the BE code qualifier value.
title: ValueInformationNew
type_health-care-code-information/v1:ConditionInformationCodeQualifier:
type: string
enum:
- BG
title: ConditionInformationCodeQualifier
type_health-care-code-information/v1:ConditionCode:
type: string
enum:
- '01'
- '02'
- '03'
- '04'
- '05'
- '06'
- '07'
- '08'
- '09'
- '10'
- '11'
- '17'
- '18'
- '19'
- '20'
- '21'
- '22'
- '23'
- '24'
- '25'
- '26'
- '27'
- '28'
- '29'
- '30'
- '31'
- '32'
- '33'
- '34'
- '35'
- '36'
- '37'
- '38'
- '39'
- '40'
- '41'
- '42'
- '43'
- '44'
- '45'
- '46'
- '47'
- '48'
- '49'
- '50'
- '51'
- '52'
- '53'
- '54'
- '55'
- '56'
- '57'
- '58'
- '59'
- '60'
- '61'
- '66'
- '67'
- '68'
- '69'
- '70'
- '71'
- '72'
- '73'
- '74'
- '75'
- '76'
- '77'
- '78'
- '79'
- '80'
- '81'
- '82'
- '83'
- '84'
- '85'
- '86'
- '87'
- '88'
- '89'
- '90'
- '91'
- '92'
- A0
- A1
- A2
- A3
- A4
- A5
- A6
- A7
- A9
- AA
- AB
- AC
- AD
- AE
- AF
- AG
- AH
- AI
- AJ
- AK
- AL
- AM
- AN
- B0
- B1
- B2
- B3
- B4
- BP
- C1
- C2
- C3
- C4
- C5
- C6
- C7
- D0
- D1
- D2
- D3
- D4
- D5
- D6
- D7
- D8
- D9
- DR(a)
- E0
- G0
- H0
- H2
- H3
- H4
- H5
- P1
- P7
- R1
- R2
- R3
- R4
- R5
- R6
- R7
- R8
- R9
- W0
- W2
- W3
- W4
- W5
description: |-
FL 18-28 - Condition Codes
Source: UB-04 Manual 2025, Pages 64-81 (FL18-28, Pages 1-18)
Excludes codes designated as "Payer Codes" or "FOR PUBLIC HEALTH DATA REPORTING ONLY"
unless usage on claims is indicated.
title: ConditionCode
type_health-care-code-information/v1:ConditionInformationNew:
type: object
properties:
condition_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:ConditionInformationCodeQualifier'
condition_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:ConditionCode'
required:
- condition_code_qualifier
- condition_code
description: This corresponds to the BG code qualifier value.
title: ConditionInformationNew
type_health-care-code-information/v1:HealthCareCodeInformationCreate:
type: object
properties:
principal_diagnosis:
$ref: '#/components/schemas/type_health-care-code-information/v1:PrincipalDiagnosisNew'
other_diagnosis_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:OtherDiagnosisInformationNew'
admitting_diagnosis:
$ref: '#/components/schemas/type_health-care-code-information/v1:AdmittingDiagnosisNew'
description: This object only applies to 837i institutional claim forms.
patient_reasons_for_visit:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:PatientReasonForVisitNew'
description: This object only applies to 837i institutional claim forms.
external_causes_of_injury:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:ExternalCauseOfInjuryNew'
description: This object only applies to 837i institutional claim forms.
diagnosis_related_groups:
$ref: '#/components/schemas/type_health-care-code-information/v1:DiagnosisRelatedGroupNew'
description: This object only applies to 837i institutional claim forms.
principal_procedure:
$ref: '#/components/schemas/type_health-care-code-information/v1:PrincipalProcedureInformationNew'
description: This object only applies to 837i institutional claim forms.
other_procedure_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:OtherProcedureInformationNew'
description: This object only applies to 837i institutional claim forms.
occurrence_span_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:OccurrenceSpanInformationNew'
description: This object only applies to 837i institutional claim forms.
occurrence_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:OccurrenceInformationNew'
description: This object only applies to 837i institutional claim forms.
treatment_code_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:TreatmentCodeInformationNew'
description: This object only applies to 837i institutional claim forms.
value_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:ValueInformationNew'
description: This object only applies to 837i institutional claim forms.
condition_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:ConditionInformationNew'
description: This object only applies to 837i institutional claim forms.
title: HealthCareCodeInformationCreate
type_x12/v1:TypeOfBillCompositeUpdate:
oneOf:
- type: object
properties:
type:
type: string
enum:
- raw_code
description: 'Discriminator value: raw_code'
value:
type: string
required:
- type
- value
description: Full 4 digit type of bill code, starting with a leading 0.
- type: object
properties:
type:
type: string
enum:
- composite_codes
description: 'Discriminator value: composite_codes'
type_of_facility:
$ref: '#/components/schemas/type_x12/v1:TypeOfFacilityCode'
description: The FL04 Institutional type of facility code for the bill. The second digit of the composite code.
type_of_care:
$ref: '#/components/schemas/type_x12/v1:TypeOfCareCode'
description: The FL04 Institutional type of care code for the bill. The third digit of the composite code.
frequency_code:
$ref: '#/components/schemas/type_x12/v1:TypeOfBillFrequencyCode'
description: The FL04 Institutional frequency code for the bill. The fourth digit of the composite code.
required:
- type
- type_of_facility
- type_of_care
- frequency_code
description: Use composite_codes to send type_of_care, type_of_facility and frequency_code as separate enums.
discriminator:
propertyName: type
description: |-
A type of bill can either be seen as a compositio of structured parts, or as a literal string.
This union represents the potential to express a type of bill either as one of those two shapes.
Passing a string, this update will be seen as a complete 4 digit code, along with a padding code 0, that
should match a valid composition.
Passing as a structure, the update will be seen as three parts and will be joined together by the server
to represent a valid composition for you.
Which you use depends upon whether you are "passing through" coded information or making a decision about its
structure explicitly.
title: TypeOfBillCompositeUpdate
type_encounters-universal:UniversalEncounterCreate:
type: object
properties:
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.
date_of_service must be defined on either the encounter or the service lines but not both.
If there are greater than zero service lines, it is recommended to specify date_of_service on the
service_line instead of on the encounter to prepare for future API versions.
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 there are greater than zero service lines, it is recommended to specify end_date_of_service on the
service_line instead of on the encounter to prepare for future API versions.
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.
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.
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.
appointment_type:
type: string
description: 'Human-readable description of the appointment type (ex: "Acupuncture - Headaches").'
existing_medications:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:Medication'
interventions:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:Intervention'
pay_to_address:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
description: Specifies the address to which payments for the claim should be sent.
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.
vitals:
$ref: '#/components/schemas/type_encounters/v4:Vitals'
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.
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
Required 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.
OR
This date is the onset of acute symptoms for the current illness or condition.
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.
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:
$ref: '#/components/schemas/type_individual:PatientCreate'
description: Contains the identification information of the individual receiving medical services.
referring_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:ReferringProvider'
description: |-
The final provider who referred the services that were rendered.
All physicians who order services or refer Medicare beneficiaries must
report this data.
initial_referring_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:InitialReferringProvider'
description: >-
The second iteration of Loop ID-2310 on an 837P form. 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.
Not used in an 837i claim
supervising_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:SupervisingProvider'
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:TreatingProvider'
description: >-
The treating provider is the provider who treats the patient. This is only supported for professional
encounters.
service_facility:
$ref: '#/components/schemas/type_service-facility:EncounterServiceFacilityBase'
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. This field is mutually exclusive with
service_facility_id — providing both will result in a 422 error.
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.
subscriber_primary:
$ref: '#/components/schemas/type_individual:SubscriberCreate'
description: >-
Subscriber_primary is required when responsible_party is INSURANCE_PAY (i.e. when the claim should be billed
to insurance).
These are not required fields when responsible_party is SELF_PAY (i.e. when the claim should be billed to
the patient).
However, if you collect this for patients, even self-pay, we recommend including it when sending encounters
to Candid.
Note: Cash Pay is no longer a valid payer_id in v4, please use responsible party to define self-pay claims.
subscriber_secondary:
$ref: '#/components/schemas/type_individual:SubscriberCreate'
description: Please always include this when you have it, even for self-pay claims.
subscriber_tertiary:
$ref: '#/components/schemas/type_individual:SubscriberCreate'
description: Please always include this when you have it, even for self-pay claims.
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.
responsible_party:
$ref: '#/components/schemas/type_encounters/v4:ResponsiblePartyType'
description: Defines the party to be billed with the initial balance owed on the claim.
clinical_notes:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:ClinicalNoteCategoryCreate'
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.
billing_notes:
type: array
items:
$ref: '#/components/schemas/type_billing-notes/v2:BillingNoteBase'
description: |-
Spot to store misc, human-readable, notes about this encounter to be used
in the billing process.
patient_histories:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:PatientHistoryCategory'
guarantor:
$ref: '#/components/schemas/type_guarantor/v1:GuarantorCreate'
description: Personal and contact info for the guarantor of the patient responsibility.
external_claim_submission:
$ref: '#/components/schemas/type_claim-submission/v1:ExternalClaimSubmissionCreate'
description: >-
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).
tag_ids:
type: array
items:
$ref: '#/components/schemas/type_tags:TagId'
description: Names of tags that should be on the encounter.
schema_instances:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaInstance'
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.
referral_number:
type: string
description: Refers to REF*9F on the 837p and 837i. Value cannot be greater than 50 characters.
epsdt_referral:
$ref: '#/components/schemas/type_encounters/v4:EPSDTReferral'
description: Refers to Box 24H on the CMS1500 form and Loop 2300 CRC - EPSDT Referral on the 837P and 837i form
claim_supplemental_information:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:ClaimSupplementalInformation'
description: Refers to Loop 2300 - Segment PWK on the 837P and 837i forms. No more than 10 entries are permitted.
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.
related_causes_information:
$ref: '#/components/schemas/type_related-causes/v1:RelatedCausesInformationCreate'
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:PropertyCasualtyPatientIdentifierCreate'
description: |-
Patient identifier for Property and Casualty claims
837p Loop 2010CA
billing_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:BillingProvider'
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.
place_of_service_code:
$ref: '#/components/schemas/type_commons:FacilityTypeCode'
description: >-
Box 24B on the CMS-1500 claim form. 837p Loop2300, CLM-05-1. This box is not used on a UB-04 or 837i claim
form. 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).
rendering_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProvider'
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.
service_lines:
type: array
items:
$ref: '#/components/schemas/type_service-lines/v2:UniversalServiceLineCreate'
health_care_code_information:
$ref: '#/components/schemas/type_health-care-code-information/v1:HealthCareCodeInformationCreate'
description: >-
The health care code information associated with this encounter, which includes things such as diagnoses,
vitals, procedures, occurrences, reason for visit, and numerous other code related fields.
submission_expectation:
$ref: '#/components/schemas/type_encounters/v4:EncounterSubmissionExpectation'
description: >-
Describes the currently expected target form for this encounter. This can change later, but it orients this
encounter in the pipeline and effects reporting.
attending_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProvider'
description: >-
837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has overall responsibility for
the patient in institutional claims processing.
admission_hour:
type: integer
description: |-
837i Loop 2300 DTP-03
Extension of the admission date with hour (0-23 integer) details.
admission_type_code:
$ref: '#/components/schemas/type_x12/v1:TypeOfAdmissionOrVisitCode'
description: >-
837i Loop 2300 CL1-01 Code used to indicate the priority of an admission or visit. Equivalent to Form
Locator 14 Priority of Admission on a UB-04 claim, not used on CMS-1500 claim forms.
admission_source_code:
$ref: '#/components/schemas/type_x12/v1:PointOfOriginForAdmissionOrVisitCode'
description: >-
837i Loop 2300 CLI1-02 Code used to indicate the conditions under which an admission occurs. Equivalent to
Form Locator 15 Point of Origin on a UB-04 claim, not used on CMS-1500 claim forms.
discharge_hour:
type: integer
description: |-
837i Loop 2300 DTP-03
Extension of the discharge date with hour (0-23 integer) details.
discharge_status:
$ref: '#/components/schemas/type_x12/v1:PatientDischargeStatusCode'
description: |-
837i CL1-03 or Form Locator 17 on a UB-04 claim form. This is a required field on UB-04 claims.
Code indicating patient status as of the "statement covers through date" .
operating_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProvider'
description: >-
837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has primary responsibility for
surgical procedures in institutional claims processing.
other_operating_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProvider'
description: >-
837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has secondary responsibility
for surgical procedures in institutional claims processing. Only used when operating_provider is also set.
type_of_bill:
$ref: '#/components/schemas/type_x12/v1:TypeOfBillCompositeUpdate'
description: >-
Four digit code used in institutional forms to indicate the type of bill (e.g., hospital inpatient, hospital
outpatient). First digit is a leading 0, followed by the type_of_facility, type_of_care, then
frequency_code. Professional forms are not required to submit this attribute. You may send the 4 digit code
via raw_code, or each individual digit separately via composite_codes.
accident_state_or_province_code:
$ref: '#/components/schemas/type_commons:State'
description: 837i-REF1000 -- an optional state indicating where an accident related to the encounter occurred.
required:
- external_id
- patient_authorized_release
- benefits_assigned_to_provider
- provider_accepts_assignment
- billable_status
- patient
- responsible_party
- billing_provider
- submission_expectation
title: UniversalEncounterCreate
type_encounters/v4:EncounterExternalIdUniquenessErrorType:
type: object
properties:
external_id:
$ref: '#/components/schemas/type_commons:EncounterExternalId'
title: EncounterExternalIdUniquenessErrorType
type_encounters/v4:EncounterPatientControlNumberUniquenessErrorType:
type: object
properties:
patient_control_number:
type: string
required:
- patient_control_number
title: EncounterPatientControlNumberUniquenessErrorType
type_encounters/v4:EncounterGuarantorMissingContactInfoErrorType:
type: object
properties:
missing_fields:
type: array
items:
type: string
required:
- missing_fields
title: EncounterGuarantorMissingContactInfoErrorType
type_encounters/v4:CashPayPayerErrorMessage:
type: object
properties:
message:
type: string
required:
- message
title: CashPayPayerErrorMessage
type_encounters/v4:InvalidTagNamesErrorType:
type: object
properties:
invalid_tag_names:
type: array
items:
type: string
required:
- invalid_tag_names
title: InvalidTagNamesErrorType
type_encounters/v4:PayerPlanGroupPayerDoesNotMatchInsuranceCardError:
type: object
properties:
payer_plan_group_payer_uuid:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
insurance_card_payer_uuid:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
required:
- payer_plan_group_payer_uuid
title: PayerPlanGroupPayerDoesNotMatchInsuranceCardError
type_encounters/v4:EncounterRenderingOrAttendingProviderRequiredError:
type: object
properties: {}
title: EncounterRenderingOrAttendingProviderRequiredError
type_diagnoses:DiagnosisCreate:
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.
Should be of the appropriate format for the provided `code_type`.
Must obey the ICD-10 format if an ICD-10 code_type is provided, specifically:
- Letter
- Digit
- Digit or the letter `A` or `B`
- (Optional) Period `.`
- 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.
required:
- code_type
- code
title: DiagnosisCreate
type_service-lines/v2:ServiceLineCreate:
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.
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.
drug_identification:
$ref: '#/components/schemas/type_service-lines/v2:DrugIdentification'
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:OrderingProvider'
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:TestResult'
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.
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.
procedure_code:
type: string
diagnosis_pointers:
type: array
items:
type: integer
description: Indices (zero-indexed) of all the diagnoses this service line references
required:
- quantity
- units
- procedure_code
- diagnosis_pointers
title: ServiceLineCreate
type_encounters/v4:EncounterCreate:
type: object
properties:
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.
date_of_service must be defined on either the encounter or the service lines but not both.
If there are greater than zero service lines, it is recommended to specify date_of_service on the
service_line instead of on the encounter to prepare for future API versions.
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 there are greater than zero service lines, it is recommended to specify end_date_of_service on the
service_line instead of on the encounter to prepare for future API versions.
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.
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.
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.
appointment_type:
type: string
description: 'Human-readable description of the appointment type (ex: "Acupuncture - Headaches").'
existing_medications:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:Medication'
interventions:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:Intervention'
pay_to_address:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
description: Specifies the address to which payments for the claim should be sent.
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.
vitals:
$ref: '#/components/schemas/type_encounters/v4:Vitals'
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.
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
Required 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.
OR
This date is the onset of acute symptoms for the current illness or condition.
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.
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:
$ref: '#/components/schemas/type_individual:PatientCreate'
description: Contains the identification information of the individual receiving medical services.
referring_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:ReferringProvider'
description: |-
The final provider who referred the services that were rendered.
All physicians who order services or refer Medicare beneficiaries must
report this data.
initial_referring_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:InitialReferringProvider'
description: >-
The second iteration of Loop ID-2310 on an 837P form. 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.
Not used in an 837i claim
supervising_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:SupervisingProvider'
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:TreatingProvider'
description: >-
The treating provider is the provider who treats the patient. This is only supported for professional
encounters.
service_facility:
$ref: '#/components/schemas/type_service-facility:EncounterServiceFacilityBase'
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. This field is mutually exclusive with
service_facility_id — providing both will result in a 422 error.
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.
subscriber_primary:
$ref: '#/components/schemas/type_individual:SubscriberCreate'
description: >-
Subscriber_primary is required when responsible_party is INSURANCE_PAY (i.e. when the claim should be billed
to insurance).
These are not required fields when responsible_party is SELF_PAY (i.e. when the claim should be billed to
the patient).
However, if you collect this for patients, even self-pay, we recommend including it when sending encounters
to Candid.
Note: Cash Pay is no longer a valid payer_id in v4, please use responsible party to define self-pay claims.
subscriber_secondary:
$ref: '#/components/schemas/type_individual:SubscriberCreate'
description: Please always include this when you have it, even for self-pay claims.
subscriber_tertiary:
$ref: '#/components/schemas/type_individual:SubscriberCreate'
description: Please always include this when you have it, even for self-pay claims.
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.
responsible_party:
$ref: '#/components/schemas/type_encounters/v4:ResponsiblePartyType'
description: Defines the party to be billed with the initial balance owed on the claim.
clinical_notes:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:ClinicalNoteCategoryCreate'
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.
billing_notes:
type: array
items:
$ref: '#/components/schemas/type_billing-notes/v2:BillingNoteBase'
description: |-
Spot to store misc, human-readable, notes about this encounter to be used
in the billing process.
patient_histories:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:PatientHistoryCategory'
guarantor:
$ref: '#/components/schemas/type_guarantor/v1:GuarantorCreate'
description: Personal and contact info for the guarantor of the patient responsibility.
external_claim_submission:
$ref: '#/components/schemas/type_claim-submission/v1:ExternalClaimSubmissionCreate'
description: >-
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).
tag_ids:
type: array
items:
$ref: '#/components/schemas/type_tags:TagId'
description: Names of tags that should be on the encounter.
schema_instances:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaInstance'
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.
referral_number:
type: string
description: Refers to REF*9F on the 837p and 837i. Value cannot be greater than 50 characters.
epsdt_referral:
$ref: '#/components/schemas/type_encounters/v4:EPSDTReferral'
description: Refers to Box 24H on the CMS1500 form and Loop 2300 CRC - EPSDT Referral on the 837P and 837i form
claim_supplemental_information:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:ClaimSupplementalInformation'
description: Refers to Loop 2300 - Segment PWK on the 837P and 837i forms. No more than 10 entries are permitted.
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.
related_causes_information:
$ref: '#/components/schemas/type_related-causes/v1:RelatedCausesInformationCreate'
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:PropertyCasualtyPatientIdentifierCreate'
description: |-
Patient identifier for Property and Casualty claims
837p Loop 2010CA
billing_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:BillingProvider'
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..
diagnoses:
type: array
items:
$ref: '#/components/schemas/type_diagnoses:DiagnosisCreate'
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.
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).
rendering_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProvider'
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.
service_lines:
type: array
items:
$ref: '#/components/schemas/type_service-lines/v2:ServiceLineCreate'
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.
required:
- external_id
- patient_authorized_release
- benefits_assigned_to_provider
- provider_accepts_assignment
- billable_status
- patient
- responsible_party
- billing_provider
- diagnoses
- place_of_service_code
- rendering_provider
title: EncounterCreate
type_encounters-universal:UniversalEncounterCreateFromPreEncounter:
type: object
properties:
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.
date_of_service must be defined on either the encounter or the service lines but not both.
If there are greater than zero service lines, it is recommended to specify date_of_service on the
service_line instead of on the encounter to prepare for future API versions.
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 there are greater than zero service lines, it is recommended to specify end_date_of_service on the
service_line instead of on the encounter to prepare for future API versions.
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.
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.
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.
appointment_type:
type: string
description: 'Human-readable description of the appointment type (ex: "Acupuncture - Headaches").'
existing_medications:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:Medication'
interventions:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:Intervention'
pay_to_address:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
description: Specifies the address to which payments for the claim should be sent.
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.
vitals:
$ref: '#/components/schemas/type_encounters/v4:Vitals'
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.
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
Required 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.
OR
This date is the onset of acute symptoms for the current illness or condition.
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.
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).
pre_encounter_patient_id:
$ref: '#/components/schemas/type_commons:PreEncounterPatientId'
pre_encounter_appointment_ids:
type: array
items:
$ref: '#/components/schemas/type_commons:PreEncounterAppointmentId'
billing_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:BillingProvider'
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.
initial_referring_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:InitialReferringProvider'
description: >-
The second iteration of Loop ID-2310 on an 837P form. 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.
Not used in an 837i claim
supervising_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:SupervisingProvider'
description: >-
Required when the rendering provider is supervised by a physician. If not required by this implementation
guide, do not send.
service_facility:
$ref: '#/components/schemas/type_service-facility:EncounterServiceFacilityBase'
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. This field is mutually exclusive with
service_facility_id — providing both will result in a 422 error.
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.
clinical_notes:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:ClinicalNoteCategoryCreate'
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.
billing_notes:
type: array
items:
$ref: '#/components/schemas/type_billing-notes/v2:BillingNoteBase'
description: |-
Spot to store misc, human-readable, notes about this encounter to be used
in the billing process.
patient_histories:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:PatientHistoryCategory'
external_claim_submission:
$ref: '#/components/schemas/type_claim-submission/v1:ExternalClaimSubmissionCreate'
description: >-
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).
tag_ids:
type: array
items:
$ref: '#/components/schemas/type_tags:TagId'
description: Names of tags that should be on the encounter.
schema_instances:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaInstance'
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.
related_causes_information:
$ref: '#/components/schemas/type_related-causes/v1:RelatedCausesInformationCreate'
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:PropertyCasualtyPatientIdentifierCreate'
description: |-
Patient identifier for Property and Casualty claims
837p Loop 2010CA
submission_expectation:
$ref: '#/components/schemas/type_encounters/v4:EncounterSubmissionExpectation'
description: >-
Describes the currently expected target form for this encounter. This effects what validations and queues
the form is processed under.
rendering_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProvider'
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.
health_care_code_information:
$ref: '#/components/schemas/type_health-care-code-information/v1:HealthCareCodeInformationCreate'
description: >-
The health care code information associated with this encounter, which includes things such as diagnoses,
vitals, procedures, occurrences, reason for visit, and numerous other code related fields.
place_of_service_code:
$ref: '#/components/schemas/type_commons:FacilityTypeCode'
description: >-
Box 24B on the CMS-1500 claim form. 837p Loop2300, CLM-05-1. This box is not used on a UB-04 or 837i claim
form. 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).
service_lines:
type: array
items:
$ref: '#/components/schemas/type_service-lines/v2:UniversalServiceLineCreate'
attending_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProvider'
description: >-
837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has overall responsibility for
the patient in institutional claims processing.
admission_hour:
type: integer
description: |-
837i Loop 2300 DTP-03
Extension of the admission date with hour (0-23 integer) details.
admission_type_code:
$ref: '#/components/schemas/type_x12/v1:TypeOfAdmissionOrVisitCode'
description: >-
837i Loop 2300 CL1-01 Code used to indicate the priority of an admission or visit. Equivalent to Form
Locator 14 Priority of Admission on a UB-04 claim, not used on CMS-1500 claim forms.
admission_source_code:
$ref: '#/components/schemas/type_x12/v1:PointOfOriginForAdmissionOrVisitCode'
description: >-
837i Loop 2300 CLI1-02 Code used to indicate the conditions under which an admission occurs. Equivalent to
Form Locator 15 Point of Origin on a UB-04 claim, not used on CMS-1500 claim forms.
discharge_hour:
type: integer
description: |-
837i Loop 2300 DTP-03
Extension of the discharge date with hour (0-23 integer) details.
discharge_status:
$ref: '#/components/schemas/type_x12/v1:PatientDischargeStatusCode'
description: |-
837i CL1-03 or Form Locator 17 on a UB-04 claim form. This is a required field on UB-04 claims.
Code indicating patient status as of the "statement covers through date" .
operating_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProvider'
description: >-
837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has primary responsibility for
surgical procedures in institutional claims processing.
other_operating_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProvider'
description: >-
837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has secondary responsibility
for surgical procedures in institutional claims processing. Only used when operating_provider is also set.
type_of_bill:
$ref: '#/components/schemas/type_x12/v1:TypeOfBillCompositeUpdate'
description: >-
Four digit code used in institutional forms to indicate the type of bill (e.g., hospital inpatient, hospital
outpatient). First digit is a leading 0, followed by the type_of_facility, type_of_care, then
frequency_code. Professional forms are not required to submit this attribute. You may send the 4 digit code
via raw_code, or each individual digit separately via composite_codes.
accident_state_or_province_code:
$ref: '#/components/schemas/type_commons:State'
description: 837i-REF1000 -- an optional state indicating where an accident related to the encounter occurred.
required:
- external_id
- patient_authorized_release
- benefits_assigned_to_provider
- provider_accepts_assignment
- billable_status
- pre_encounter_patient_id
- pre_encounter_appointment_ids
- billing_provider
- submission_expectation
title: UniversalEncounterCreateFromPreEncounter
type_encounters/v4:EncounterCreateFromPreEncounter:
type: object
properties:
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.
date_of_service must be defined on either the encounter or the service lines but not both.
If there are greater than zero service lines, it is recommended to specify date_of_service on the
service_line instead of on the encounter to prepare for future API versions.
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 there are greater than zero service lines, it is recommended to specify end_date_of_service on the
service_line instead of on the encounter to prepare for future API versions.
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.
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.
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.
appointment_type:
type: string
description: 'Human-readable description of the appointment type (ex: "Acupuncture - Headaches").'
existing_medications:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:Medication'
interventions:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:Intervention'
pay_to_address:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
description: Specifies the address to which payments for the claim should be sent.
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.
vitals:
$ref: '#/components/schemas/type_encounters/v4:Vitals'
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.
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
Required 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.
OR
This date is the onset of acute symptoms for the current illness or condition.
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.
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).
pre_encounter_patient_id:
$ref: '#/components/schemas/type_commons:PreEncounterPatientId'
pre_encounter_appointment_ids:
type: array
items:
$ref: '#/components/schemas/type_commons:PreEncounterAppointmentId'
billing_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:BillingProvider'
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.
initial_referring_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:InitialReferringProvider'
description: >-
The second iteration of Loop ID-2310 on an 837P form. 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.
Not used in an 837i claim
supervising_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:SupervisingProvider'
description: >-
Required when the rendering provider is supervised by a physician. If not required by this implementation
guide, do not send.
service_facility:
$ref: '#/components/schemas/type_service-facility:EncounterServiceFacilityBase'
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. This field is mutually exclusive with
service_facility_id — providing both will result in a 422 error.
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.
clinical_notes:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:ClinicalNoteCategoryCreate'
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.
billing_notes:
type: array
items:
$ref: '#/components/schemas/type_billing-notes/v2:BillingNoteBase'
description: |-
Spot to store misc, human-readable, notes about this encounter to be used
in the billing process.
patient_histories:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:PatientHistoryCategory'
external_claim_submission:
$ref: '#/components/schemas/type_claim-submission/v1:ExternalClaimSubmissionCreate'
description: >-
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).
tag_ids:
type: array
items:
$ref: '#/components/schemas/type_tags:TagId'
description: Names of tags that should be on the encounter.
schema_instances:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaInstance'
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.
related_causes_information:
$ref: '#/components/schemas/type_related-causes/v1:RelatedCausesInformationCreate'
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:PropertyCasualtyPatientIdentifierCreate'
description: |-
Patient identifier for Property and Casualty claims
837p Loop 2010CA
rendering_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProvider'
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.
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).
diagnoses:
type: array
items:
$ref: '#/components/schemas/type_diagnoses:DiagnosisCreate'
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.
service_lines:
type: array
items:
$ref: '#/components/schemas/type_service-lines/v2:ServiceLineCreate'
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.
required:
- external_id
- patient_authorized_release
- benefits_assigned_to_provider
- provider_accepts_assignment
- billable_status
- pre_encounter_patient_id
- pre_encounter_appointment_ids
- billing_provider
- rendering_provider
- place_of_service_code
- diagnoses
title: EncounterCreateFromPreEncounter
type_guarantor/v1:GuarantorUpdate:
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:StreetAddressShortZip'
phone_numbers:
type: array
items:
$ref: '#/components/schemas/type_commons:PhoneNumber'
phone_consent:
type: boolean
email:
$ref: '#/components/schemas/type_commons:Email'
email_consent:
type: boolean
auto_charge_consent:
type: boolean
title: GuarantorUpdate
type_individual:PatientUpdate:
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:StreetAddressShortZip'
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:PhoneNumber'
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:PatientNonInsurancePayerInfoCreate'
description: On update, we will replace the existing list of non-insurance payers with the new list if populated.
title: PatientUpdate
type_encounter-providers/v2:RenderingProviderUpdate:
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:StreetAddressLongZip'
secondary_identification:
$ref: '#/components/schemas/type_encounter-providers/v2:ProviderSecondaryIdentification'
description: |-
Only one of provider_commercial_license_type or secondary_identification may be provided
837i Loop2310BB G2
Secondary Identification
title: RenderingProviderUpdate
type_service-facility:EncounterServiceFacilityUpdate:
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:StreetAddressLongZip'
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: EncounterServiceFacilityUpdate
type_encounter-providers/v2:TreatingProviderUpdate:
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:StreetAddressLongZip'
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. All fields are optional.
title: TreatingProviderUpdate
type_encounter-providers/v2:BillingProviderUpdate:
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:StreetAddressLongZip'
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:BillingProviderSecondaryIdentification'
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.
title: BillingProviderUpdate
type_related-causes/v1:RelatedCausesInformationUpdate:
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
required:
- related_causes_code_1
title: RelatedCausesInformationUpdate
type_property-and-casualty/v1:PropertyCasualtyPatientIdentifierUpdate:
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
required:
- property_casualty_patient_identifier_qualifier
- property_casualty_patient_identifier
title: PropertyCasualtyPatientIdentifierUpdate
type_health-care-code-information/v1:PrincipalDiagnosis:
type: object
properties:
id:
type: string
format: uuid
description: |-
The id of this health care code information if it is already stored.
If this is not set, this is referring to a new health care code information to be added
to the encounter. If it is set, this refers to an update of an existing health care code
information object on the encounter.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
description: |-
The encounter_id of this health care code information if it is already stored.
This will be set by the server in responses, but clients are not expected to set it.
principal_diagnosis_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:PrincipalDiagnosisCodeQualifier'
primary_diagnosis_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:ICDCode'
present_on_admission_indicator:
$ref: '#/components/schemas/type_health-care-code-information/v1:PresentOnAdmissionIndicatorCode'
required:
- principal_diagnosis_code_qualifier
- primary_diagnosis_code
description: This corresponds to BK or ABK code qualifier values.
title: PrincipalDiagnosis
type_health-care-code-information/v1:SetOrClearPrincipalDiagnosis:
type: object
properties:
value:
$ref: '#/components/schemas/type_health-care-code-information/v1:PrincipalDiagnosis'
title: SetOrClearPrincipalDiagnosis
type_health-care-code-information/v1:OtherDiagnosisInformation:
type: object
properties:
id:
type: string
format: uuid
description: |-
The id of this health care code information if it is already stored.
If this is not set, this is referring to a new health care code information to be added
to the encounter. If it is set, this refers to an update of an existing health care code
information object on the encounter.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
description: |-
The encounter_id of this health care code information if it is already stored.
This will be set by the server in responses, but clients are not expected to set it.
other_diagnosis_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:OtherDiagnosisInformationCodeQualifier'
other_diagnosis:
$ref: '#/components/schemas/type_health-care-code-information/v1:ICDCode'
present_on_admission_indicator:
$ref: '#/components/schemas/type_health-care-code-information/v1:PresentOnAdmissionIndicatorCode'
required:
- other_diagnosis_code_qualifier
- other_diagnosis
description: This corresponds to BF and ABF code qualifier values.
title: OtherDiagnosisInformation
type_health-care-code-information/v1:AdmittingDiagnosis:
type: object
properties:
id:
type: string
format: uuid
description: |-
The id of this health care code information if it is already stored.
If this is not set, this is referring to a new health care code information to be added
to the encounter. If it is set, this refers to an update of an existing health care code
information object on the encounter.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
description: |-
The encounter_id of this health care code information if it is already stored.
This will be set by the server in responses, but clients are not expected to set it.
admitting_diagnosis_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:AdmittingDiagnosisCodeQualifier'
admitting_diagnosis_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:ICDCode'
required:
- admitting_diagnosis_code_qualifier
- admitting_diagnosis_code
description: This corresponds to BJ or ABJ code qualifier values.
title: AdmittingDiagnosis
type_health-care-code-information/v1:SetOrClearAdmittingDiagnosis:
type: object
properties:
value:
$ref: '#/components/schemas/type_health-care-code-information/v1:AdmittingDiagnosis'
title: SetOrClearAdmittingDiagnosis
type_health-care-code-information/v1:PatientReasonForVisit:
type: object
properties:
id:
type: string
format: uuid
description: |-
The id of this health care code information if it is already stored.
If this is not set, this is referring to a new health care code information to be added
to the encounter. If it is set, this refers to an update of an existing health care code
information object on the encounter.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
description: |-
The encounter_id of this health care code information if it is already stored.
This will be set by the server in responses, but clients are not expected to set it.
patient_reason_for_visit_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:PatientReasonForVisitCodeQualifier'
patient_reason_for_visit:
$ref: '#/components/schemas/type_health-care-code-information/v1:ICDCode'
required:
- patient_reason_for_visit_code_qualifier
- patient_reason_for_visit
description: This corresponds to PR or APR code qualifier values.
title: PatientReasonForVisit
type_health-care-code-information/v1:ExternalCauseOfInjury:
type: object
properties:
id:
type: string
format: uuid
description: |-
The id of this health care code information if it is already stored.
If this is not set, this is referring to a new health care code information to be added
to the encounter. If it is set, this refers to an update of an existing health care code
information object on the encounter.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
description: |-
The encounter_id of this health care code information if it is already stored.
This will be set by the server in responses, but clients are not expected to set it.
external_cause_of_injury_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:ExternalCauseOfInjuryCodeQualifier'
external_cause_of_injury_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:ICDCode'
present_on_admission_indicator:
$ref: '#/components/schemas/type_health-care-code-information/v1:PresentOnAdmissionIndicatorCode'
required:
- external_cause_of_injury_code_qualifier
- external_cause_of_injury_code
description: This corresponds to BN or ABN code qualifier values.
title: ExternalCauseOfInjury
type_health-care-code-information/v1:DiagnosisRelatedGroup:
type: object
properties:
id:
type: string
format: uuid
description: |-
The id of this health care code information if it is already stored.
If this is not set, this is referring to a new health care code information to be added
to the encounter. If it is set, this refers to an update of an existing health care code
information object on the encounter.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
description: |-
The encounter_id of this health care code information if it is already stored.
This will be set by the server in responses, but clients are not expected to set it.
diagnosis_related_group_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:DiagnosisRelatedGroupCodeQualifier'
diagnosis_related_group_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:MSDRGCode'
required:
- diagnosis_related_group_code_qualifier
- diagnosis_related_group_code
description: This corresponds to DR code qualifier values.
title: DiagnosisRelatedGroup
type_health-care-code-information/v1:SetOrClearDiagnosisRelatedGroup:
type: object
properties:
value:
$ref: '#/components/schemas/type_health-care-code-information/v1:DiagnosisRelatedGroup'
title: SetOrClearDiagnosisRelatedGroup
type_health-care-code-information/v1:PrincipalProcedureInformation:
type: object
properties:
id:
type: string
format: uuid
description: |-
The id of this health care code information if it is already stored.
If this is not set, this is referring to a new health care code information to be added
to the encounter. If it is set, this refers to an update of an existing health care code
information object on the encounter.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
description: |-
The encounter_id of this health care code information if it is already stored.
This will be set by the server in responses, but clients are not expected to set it.
principal_procedure_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:PrincipalProcedureInformationCodeQualifier'
principal_procedure_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:ICDCode'
procedure_date:
$ref: '#/components/schemas/type_health-care-code-information/v1:D8Date'
description: |-
An [RFC 3339, section 5.6 datetime](https://ijmacd.github.io/rfc3339-iso8601/).
For example, 2017-07-21T17:32:28Z.
In practice, only the date portion of this is used for claim submission, so
midnight time is fine.
required:
- principal_procedure_code_qualifier
- principal_procedure_code
- procedure_date
description: This correspond to BBR, BR, and CAH code qualifier values.
title: PrincipalProcedureInformation
type_health-care-code-information/v1:SetOrClearPrincipalProcedureInformation:
type: object
properties:
value:
$ref: '#/components/schemas/type_health-care-code-information/v1:PrincipalProcedureInformation'
title: SetOrClearPrincipalProcedureInformation
type_health-care-code-information/v1:OtherProcedureInformation:
type: object
properties:
id:
type: string
format: uuid
description: |-
The id of this health care code information if it is already stored.
If this is not set, this is referring to a new health care code information to be added
to the encounter. If it is set, this refers to an update of an existing health care code
information object on the encounter.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
description: |-
The encounter_id of this health care code information if it is already stored.
This will be set by the server in responses, but clients are not expected to set it.
other_procedure_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:OtherProcedureInformationCodeQualifier'
other_procedure_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:ICDCode'
other_procedure_date:
$ref: '#/components/schemas/type_health-care-code-information/v1:D8Date'
description: |-
An [RFC 3339, section 5.6 datetime](https://ijmacd.github.io/rfc3339-iso8601/).
For example, 2017-07-21T17:32:28Z.
In practice, only the date portion of this is used for claim submission, so
midnight time is fine.
required:
- other_procedure_code_qualifier
- other_procedure_code
- other_procedure_date
description: This corresponds to the BBQ or BQ code qualifier values.
title: OtherProcedureInformation
type_health-care-code-information/v1:OccurrenceSpanInformation:
type: object
properties:
id:
type: string
format: uuid
description: |-
The id of this health care code information if it is already stored.
If this is not set, this is referring to a new health care code information to be added
to the encounter. If it is set, this refers to an update of an existing health care code
information object on the encounter.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
description: |-
The encounter_id of this health care code information if it is already stored.
This will be set by the server in responses, but clients are not expected to set it.
occurrence_span_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:OccurrenceSpanCodeQualifier'
occurrence_span_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:OccurrenceSpanCode'
occurrence_span_date:
$ref: '#/components/schemas/type_health-care-code-information/v1:RD8Date'
required:
- occurrence_span_code_qualifier
- occurrence_span_code
- occurrence_span_date
description: This corresponds to the BI code qualifier value.
title: OccurrenceSpanInformation
type_health-care-code-information/v1:OccurrenceInformation:
type: object
properties:
id:
type: string
format: uuid
description: |-
The id of this health care code information if it is already stored.
If this is not set, this is referring to a new health care code information to be added
to the encounter. If it is set, this refers to an update of an existing health care code
information object on the encounter.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
description: |-
The encounter_id of this health care code information if it is already stored.
This will be set by the server in responses, but clients are not expected to set it.
occurrence_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:OccurrenceInformationCodeQualifier'
occurrence_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:OccurrenceCode'
occurrence_date:
$ref: '#/components/schemas/type_health-care-code-information/v1:D8Date'
description: |-
An [RFC 3339, section 5.6 datetime](https://ijmacd.github.io/rfc3339-iso8601/).
For example, 2017-07-21T17:32:28Z.
In practice, only the date portion of this is used for claim submission, so
midnight time is fine.
required:
- occurrence_code_qualifier
- occurrence_code
- occurrence_date
description: This corresponds to the BH code qualifier value.
title: OccurrenceInformation
type_health-care-code-information/v1:TreatmentCodeInformation:
type: object
properties:
id:
type: string
format: uuid
description: |-
The id of this health care code information if it is already stored.
If this is not set, this is referring to a new health care code information to be added
to the encounter. If it is set, this refers to an update of an existing health care code
information object on the encounter.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
description: |-
The encounter_id of this health care code information if it is already stored.
This will be set by the server in responses, but clients are not expected to set it.
treatment_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:TreatmentCodeQualifier'
treatment_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:TreatmentCode'
required:
- treatment_code_qualifier
- treatment_code
description: This corresponds to the TC code qualifier value.
title: TreatmentCodeInformation
type_health-care-code-information/v1:ValueInformation:
type: object
properties:
id:
type: string
format: uuid
description: |-
The id of this health care code information if it is already stored.
If this is not set, this is referring to a new health care code information to be added
to the encounter. If it is set, this refers to an update of an existing health care code
information object on the encounter.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
description: |-
The encounter_id of this health care code information if it is already stored.
This will be set by the server in responses, but clients are not expected to set it.
value_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:ValueCodeQualifier'
value_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:ValueCode'
value_code_amount:
$ref: '#/components/schemas/type_commons:Decimal'
required:
- value_code_qualifier
- value_code
- value_code_amount
description: This corresponds to the BE code qualifier value.
title: ValueInformation
type_health-care-code-information/v1:ConditionInformation:
type: object
properties:
id:
type: string
format: uuid
description: |-
The id of this health care code information if it is already stored.
If this is not set, this is referring to a new health care code information to be added
to the encounter. If it is set, this refers to an update of an existing health care code
information object on the encounter.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
description: |-
The encounter_id of this health care code information if it is already stored.
This will be set by the server in responses, but clients are not expected to set it.
condition_code_qualifier:
$ref: '#/components/schemas/type_health-care-code-information/v1:ConditionInformationCodeQualifier'
condition_code:
$ref: '#/components/schemas/type_health-care-code-information/v1:ConditionCode'
required:
- condition_code_qualifier
- condition_code
description: This corresponds to the BG code qualifier value.
title: ConditionInformation
type_health-care-code-information/v1:HealthCareCodeInformationUpdate:
type: object
properties:
principal_diagnosis:
$ref: '#/components/schemas/type_health-care-code-information/v1:SetOrClearPrincipalDiagnosis'
description: >-
Set & Replace semantics. If the id matches the existing principal_diagnosis, that diagnosis is updated in
place. If the entry has no id, it is created newly, its id will be in the response, and any existing
principal_diagnosis is deleted and removed from any service line pointers.
other_diagnosis_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:OtherDiagnosisInformation'
description: >-
Set & Replace semantics. For each entry that has an id, any previous other_diagnosis_information by that id
is updated in place. For each entry without an id, it is created newly and its id will be in the response.
For each existing entry that was not referred to by id, it is deleted, including having it removed from any
service line pointers.
admitting_diagnosis:
$ref: '#/components/schemas/type_health-care-code-information/v1:SetOrClearAdmittingDiagnosis'
description: >-
Set & Replace semantics. If the id matches the existing admitting_diagnosis, that diagnosis is updated in
place. If the entry has no id, it is created newly, its id will be in the response, and any existing
principal_diagnosis is deleted. This object only applies to 837i institutional claim forms.
patient_reasons_for_visit:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:PatientReasonForVisit'
description: >-
Set & Replace semantics. For each entry that has an id, any previous patient_reasons_for_visit by that id
is updated in place. For each entry without an id, it is created newly and its id will be in the response.
For each existing entry that was not referred to by id, it is deleted. This object only applies to 837i
institutional claim forms.
external_causes_of_injury:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:ExternalCauseOfInjury'
description: >-
Set & Replace semantics. For each entry that has an id, any previous external_causes_of_injury by that id
is updated in place. For each entry without an id, it is created newly and its id will be in the response.
For each existing entry that was not referred to by id, it is deleted. This object only applies to 837i
institutional claim forms.
diagnosis_related_groups:
$ref: '#/components/schemas/type_health-care-code-information/v1:SetOrClearDiagnosisRelatedGroup'
description: >-
Set & Replace semantics. If the id matches the existing diagnosis_related_groups, that
diagnosis_related_group is updated in place. If the entry has no id, it is created newly, its id will be in
the response, and any existing diagnosis_related_groups is deleted. This object only applies to 837i
institutional claim forms.
principal_procedure:
$ref: '#/components/schemas/type_health-care-code-information/v1:SetOrClearPrincipalProcedureInformation'
description: >-
Set & Replace semantics. If the id matches the existing principal_procedure, that principal_procedure is
updated in place. If the entry has no id, it is created newly, its id will be in the response, and any
existing principal_procedure is deleted. This object only applies to 837i institutional claim forms.
other_procedure_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:OtherProcedureInformation'
description: >-
Set & Replace semantics. For each entry that has an id, any previous other_procedure_information by that id
is updated in place. For each entry without an id, it is created newly and its id will be in the response.
For each existing entry that was not referred to by id, it is deleted. This object only applies to 837i
institutional claim forms.
occurrence_span_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:OccurrenceSpanInformation'
description: >-
Set & Replace semantics. For each entry that has an id, any previous occurrence_span_information by that id
is updated in place. For each entry without an id, it is created newly and its id will be in the response.
For each existing entry that was not referred to by id, it is deleted. This object only applies to 837i
institutional claim forms.
occurrence_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:OccurrenceInformation'
description: >-
Set & Replace semantics. For each entry that has an id, any previous occurrence_information by that id is
updated in place. For each entry without an id, it is created newly and its id will be in the response.
For each existing entry that was not referred to by id, it is deleted. This object only applies to 837i
institutional claim forms.
treatment_code_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:TreatmentCodeInformation'
description: >-
Set & Replace semantics. For each entry that has an id, any previous treatment_code_information by that id
is updated in place. For each entry without an id, it is created newly and its id will be in the response.
For each existing entry that was not referred to by id, it is deleted. This object only applies to 837i
institutional claim forms.
value_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:ValueInformation'
description: >-
Set & Replace semantics. For each entry that has an id, any previous value_information by that id is
updated in place. For each entry without an id, it is created newly and its id will be in the response.
For each existing entry that was not referred to by id, it is deleted. This object only applies to 837i
institutional claim forms.
condition_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:ConditionInformation'
description: >-
Set & Replace semantics. For each entry that has an id, any previous condition_information by that id is
updated in place. For each entry without an id, it is created newly and its id will be in the response.
For each existing entry that was not referred to by id, it is deleted. This object only applies to 837i
institutional claim forms.
title: HealthCareCodeInformationUpdate
type_encounters-universal:UniversalEncounterUpdate:
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
Required 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.
OR
This date is the onset of acute symptoms for the current illness or condition.
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.
epsdt_referral:
$ref: '#/components/schemas/type_encounters/v4:EPSDTReferral'
description: Refers to Box 24H on the CMS1500 form and Loop 2300 CRC - EPSDT Referral on the 837P and 837i form
clinical_notes:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:ClinicalNoteCategoryCreate'
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:ClaimSupplementalInformation'
description: Refers to Loop 2300 - Segment PWK on the 837P and 837i form. No more than 10 entries are permitted.
schema_instances:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaInstance'
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.
existing_medications:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:Medication'
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:GuarantorUpdate'
description: Personal and contact info for the guarantor of the patient responsibility.
subscriber_primary:
$ref: '#/components/schemas/type_individual:SubscriberCreate'
description: Contains details of the primary insurance subscriber.
subscriber_secondary:
$ref: '#/components/schemas/type_individual:SubscriberCreate'
description: Contains details of the secondary insurance subscriber.
subscriber_tertiary:
$ref: '#/components/schemas/type_individual:SubscriberCreate'
description: Contains details of the tertiary insurance subscriber.
pay_to_address:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
description: Specifies the address to which payments for the claim should be sent.
initial_referring_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:InitialReferringProviderUpdate'
description: >-
The second iteration of Loop ID-2310 on an 837P form. 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.
Not used in an 837i claim
referring_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:ReferringProviderUpdate'
description: |-
The final provider who referred the services that were rendered.
All physicians who order services or refer Medicare beneficiaries must
report this data.
patient:
$ref: '#/components/schemas/type_individual:PatientUpdate'
description: Contains the identification information of the individual receiving medical services.
rendering_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProviderUpdate'
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.
service_facility:
$ref: '#/components/schemas/type_service-facility:EncounterServiceFacilityUpdate'
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
supervising_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:SupervisingProviderUpdate'
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:TreatingProviderUpdate'
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:BillingProviderUpdate'
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.
place_of_service_code_as_submitted:
$ref: '#/components/schemas/type_commons:FacilityTypeCode'
description: >-
Box 24B on the CMS-1500 claim form. 837p Loop2300, CLM-05-1. This box is not used on a UB-04 or 837i claim
form. 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).
related_causes_information:
$ref: '#/components/schemas/type_related-causes/v1:RelatedCausesInformationUpdate'
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:PropertyCasualtyPatientIdentifierUpdate'
description: |-
Patient identifier for Property and Casualty claims
837p Loop 2010CA
health_care_code_information:
$ref: '#/components/schemas/type_health-care-code-information/v1:HealthCareCodeInformationUpdate'
description: >-
The health care code information associated with this encounter, which includes things such as diagnoses,
vitals, procedures, occurrences, reason for visit, and numerous other code related fields.
attending_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProviderUpdate'
description: >-
837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has overall responsibility for
the patient in institutional claims processing.
admission_hour:
type: integer
description: |-
837i Loop 2300 DTP-03
Extension of the admission date with hour (0-23 integer) details.
admission_type_code:
$ref: '#/components/schemas/type_x12/v1:TypeOfAdmissionOrVisitCode'
description: >-
837i Loop 2300 CL1-01 Code used to indicate the priority of an admission or visit. Equivalent to Form
Locator 14 Priority of Admission on a UB-04 claim, not used on CMS-1500 claim forms.
admission_source_code:
$ref: '#/components/schemas/type_x12/v1:PointOfOriginForAdmissionOrVisitCode'
description: >-
837i Loop 2300 CLI1-02 Code used to indicate the conditions under which an admission occurs. Equivalent to
Form Locator 15 Point of Origin on a UB-04 claim, not used on CMS-1500 claim forms.
discharge_hour:
type: integer
description: |-
837i Loop 2300 DTP-03
Extension of the discharge date with hour (0-23 integer) details.
discharge_status:
$ref: '#/components/schemas/type_x12/v1:PatientDischargeStatusCode'
description: |-
837i CL1-03 or Form Locator 17 on a UB-04 claim form. This is a required field on UB-04 claims.
Code indicating patient status as of the "statement covers through date".
operating_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProviderUpdate'
description: >-
837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has primary responsibility for
surgical procedures in institutional claims processing.
other_operating_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProviderUpdate'
description: >-
837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has secondary responsibility
for surgical procedures in institutional claims processing. Only used when operating_provider is also set.
type_of_bill:
$ref: '#/components/schemas/type_x12/v1:TypeOfBillCompositeUpdate'
description: >-
Four digit code used in institutional forms to indicate the type of bill (e.g., hospital inpatient, hospital
outpatient). First digit is a leading 0, followed by the type_of_facility, type_of_care, then
frequency_code. Professional forms are not required to submit this attribute. You may send the 4 digit code
via raw_code, or each individual digit separately via composite_codes.
accident_state_or_province_code:
$ref: '#/components/schemas/type_commons:State'
description: 837i-REF1000 -- an optional state indicating where an accident related to the encounter occurred.
submission_expectation:
$ref: '#/components/schemas/type_encounters/v4:EncounterSubmissionExpectation'
description: >-
Describes the currently expected target form for this encounter. This effects what validations and queues
the form is processed under. When this value is not set, it should be assumed to be TARGET_PROFESSIONAL.
title: UniversalEncounterUpdate
type_encounters/v4:EncounterUpdate:
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
Required 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.
OR
This date is the onset of acute symptoms for the current illness or condition.
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.
epsdt_referral:
$ref: '#/components/schemas/type_encounters/v4:EPSDTReferral'
description: Refers to Box 24H on the CMS1500 form and Loop 2300 CRC - EPSDT Referral on the 837P and 837i form
clinical_notes:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:ClinicalNoteCategoryCreate'
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:ClaimSupplementalInformation'
description: Refers to Loop 2300 - Segment PWK on the 837P and 837i form. No more than 10 entries are permitted.
schema_instances:
type: array
items:
$ref: '#/components/schemas/type_custom-schemas/v1:SchemaInstance'
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.
existing_medications:
type: array
items:
$ref: '#/components/schemas/type_encounters/v4:Medication'
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:GuarantorUpdate'
description: Personal and contact info for the guarantor of the patient responsibility.
subscriber_primary:
$ref: '#/components/schemas/type_individual:SubscriberCreate'
description: Contains details of the primary insurance subscriber.
subscriber_secondary:
$ref: '#/components/schemas/type_individual:SubscriberCreate'
description: Contains details of the secondary insurance subscriber.
subscriber_tertiary:
$ref: '#/components/schemas/type_individual:SubscriberCreate'
description: Contains details of the tertiary insurance subscriber.
pay_to_address:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
description: Specifies the address to which payments for the claim should be sent.
initial_referring_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:InitialReferringProviderUpdate'
description: >-
The second iteration of Loop ID-2310 on an 837P form. 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.
Not used in an 837i claim
referring_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:ReferringProviderUpdate'
description: |-
The final provider who referred the services that were rendered.
All physicians who order services or refer Medicare beneficiaries must
report this data.
patient:
$ref: '#/components/schemas/type_individual:PatientUpdate'
description: Contains the identification information of the individual receiving medical services.
rendering_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:RenderingProviderUpdate'
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.
service_facility:
$ref: '#/components/schemas/type_service-facility:EncounterServiceFacilityUpdate'
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
supervising_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:SupervisingProviderUpdate'
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:TreatingProviderUpdate'
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:BillingProviderUpdate'
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.
place_of_service_code_as_submitted:
$ref: '#/components/schemas/type_commons:FacilityTypeCode'
description: >-
Box 24B on the CMS-1500 claim form. 837p Loop2300, CLM-05-1. This box is not used on a UB-04 or 837i claim
form. 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).
related_causes_information:
$ref: '#/components/schemas/type_related-causes/v1:RelatedCausesInformationUpdate'
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:PropertyCasualtyPatientIdentifierUpdate'
description: |-
Patient identifier for Property and Casualty claims
837p Loop 2010CA
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.
diagnosis_ids:
type: array
items:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
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.
title: EncounterUpdate
type_events/v1:EventId:
type: string
format: uuid
title: EventId
type_events/v1:Event:
type: object
properties:
id:
$ref: '#/components/schemas/type_events/v1:EventId'
created_at:
type: string
format: date-time
timestamp:
type: string
format: date-time
event_type:
type: string
schema_version:
type: string
payload:
description: Any type
required:
- id
- created_at
- timestamp
- event_type
- schema_version
- payload
title: Event
type_events/v1:EventScanPage:
type: object
properties:
next_page_token:
$ref: '#/components/schemas/type_commons:PageToken'
items:
type: array
items:
$ref: '#/components/schemas/type_events/v1:Event'
required:
- items
title: EventScanPage
type_commons:BadRequestErrorMessage:
type: object
properties:
message:
type: string
title: BadRequestErrorMessage
type_exports/v3:GetExportsResponse:
type: object
properties:
name:
type: string
description: Report name; contains date strings representing the start and end date of the export.
created_at:
type: string
format: date-time
authenticated_download_url:
type: string
description: Authenticated URL where a customer's report can be retrieved.
authenticated_download_url_expiration:
type: string
format: date-time
description: Expiration datetime of the authenticated URL. URLs expire after 2 minutes.
required:
- name
- created_at
- authenticated_download_url
- authenticated_download_url_expiration
title: GetExportsResponse
type_commons:ErrorMessage:
type: string
title: ErrorMessage
type_external-payment-account-config/v1:ExternalPaymentAccountConfig:
type: object
properties:
id:
$ref: '#/components/schemas/type_payment-account-configs:PaymentAccountConfigId'
account_name:
type: string
required:
- id
- account_name
title: ExternalPaymentAccountConfig
type_external-payment-account-config/v1:ExternalPaymentAccountConfigPage:
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_external-payment-account-config/v1:ExternalPaymentAccountConfig'
required:
- items
title: ExternalPaymentAccountConfigPage
type_fee-schedules/v3:PayerThreshold:
type: object
properties:
upper_threshold_cents:
type: integer
lower_threshold_cents:
type: integer
disable_paid_incorrectly:
type: boolean
required:
- disable_paid_incorrectly
description: >-
Rate thresholds that determine fee schedule rate matching behavior. When a service line is adjudicated by a
payer Candid determines if the payer's
allowed amount "matches" the rate value. If the allowed amount doesn't equal the rate value, Candid moves the
claim to a PAID_INCORRECTLY state. These
optional thresholds allow a user to set wiggle room to avoid claims moving to PAID_INCORRECTLY and instead have
them move directly to FINALIZED_PAID
when the payer's allowed amount is greater than [rate_cents - lower_threshold_cents] and less than [rate_cents +
upper_threshold_cents].
Additionally, a client can set disable_paid_incorrectly to avoid the PAID_INCORRECTLY claim status entirely.
title: PayerThreshold
type_fee-schedules/v3:ThresholdMatch:
type: object
properties:
threshold:
$ref: '#/components/schemas/type_fee-schedules/v3:PayerThreshold'
rate_cents:
type: integer
match:
type: boolean
explanation:
type: string
required:
- threshold
- rate_cents
- match
- explanation
description: Threshold and dollar amount matching for a service line
title: ThresholdMatch
type_commons:RateId:
type: string
format: uuid
title: RateId
type_fee-schedules/v3:MatchResult:
type: object
properties:
threshold:
$ref: '#/components/schemas/type_fee-schedules/v3:ThresholdMatch'
rate_id:
$ref: '#/components/schemas/type_commons:RateId'
required:
- threshold
- rate_id
title: MatchResult
type_fee-schedules/v3:MatchPayer:
type: object
properties:
value:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
match:
type: boolean
explanation:
type: string
required:
- value
- match
- explanation
description: Match information for a payer
title: MatchPayer
type_fee-schedules/v3:MatchGeo:
type: object
properties:
zip_code:
type: string
state:
$ref: '#/components/schemas/type_commons:State'
match:
type: boolean
explanation:
type: string
required:
- match
- explanation
description: Match information for state or zip code
title: MatchGeo
type_fee-schedules/v3:MatchProvider:
type: object
properties:
value:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderId'
match:
type: boolean
explanation:
type: string
required:
- match
- explanation
description: Match information for a billing provider
title: MatchProvider
type_fee-schedules/v3:MatchDate:
type: object
properties:
value:
type: string
format: date
match:
type: boolean
explanation:
type: string
required:
- match
- explanation
description: Match information for date of service
title: MatchDate
type_fee-schedules/v3:MatchCptCode:
type: object
properties:
value:
type: string
match:
type: boolean
explanation:
type: string
required:
- value
- match
- explanation
description: Match information for a CPT code
title: MatchCptCode
type_fee-schedules/v3:MatchModifiers:
type: object
properties:
value:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_commons:ProcedureModifier'
match:
type: boolean
explanation:
type: string
required:
- value
- match
- explanation
description: Match information for procedure modifiers
title: MatchModifiers
type_fee-schedules/v3:MatchLicenseType:
type: object
properties:
value:
$ref: '#/components/schemas/type_organization-providers/v2:LicenseType'
match:
type: boolean
explanation:
type: string
required:
- match
- explanation
description: Match information for rendering provider license type
title: MatchLicenseType
type_fee-schedules/v3:MatchFacilityTypeCode:
type: object
properties:
value:
$ref: '#/components/schemas/type_commons:FacilityTypeCode'
match:
type: boolean
explanation:
type: string
required:
- match
- explanation
description: Match information for facility type code
title: MatchFacilityTypeCode
type_commons:NetworkType:
type: string
enum:
- '12'
- '13'
- '14'
- '15'
- '16'
- '17'
- AM
- CH
- DS
- HM
- LM
- MA
- MB
- MC
- OF
- TV
- VA
- WC
- ZZ
- CI
- BL
title: NetworkType
type_fee-schedules/v3:MatchNetworkTypes:
type: object
properties:
value:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_commons:NetworkType'
match:
type: boolean
explanation:
type: string
required:
- value
- match
- explanation
description: Match information for network types
title: MatchNetworkTypes
type_fee-schedules/v3:MatchPayerPlanGroups:
type: object
properties:
value:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_commons:PayerPlanGroupId'
match:
type: boolean
explanation:
type: string
required:
- value
- match
- explanation
description: Match information for a payer plan group
title: MatchPayerPlanGroups
type_fee-schedules/v3:DimensionMatch:
type: object
properties:
payer:
$ref: '#/components/schemas/type_fee-schedules/v3:MatchPayer'
geography:
$ref: '#/components/schemas/type_fee-schedules/v3:MatchGeo'
organization_billing_provider:
$ref: '#/components/schemas/type_fee-schedules/v3:MatchProvider'
date_of_service:
$ref: '#/components/schemas/type_fee-schedules/v3:MatchDate'
cpt_code:
$ref: '#/components/schemas/type_fee-schedules/v3:MatchCptCode'
modifiers:
$ref: '#/components/schemas/type_fee-schedules/v3:MatchModifiers'
license_type:
$ref: '#/components/schemas/type_fee-schedules/v3:MatchLicenseType'
facility_type_code:
$ref: '#/components/schemas/type_fee-schedules/v3:MatchFacilityTypeCode'
network_types:
$ref: '#/components/schemas/type_fee-schedules/v3:MatchNetworkTypes'
payer_plan_groups:
$ref: '#/components/schemas/type_fee-schedules/v3:MatchPayerPlanGroups'
required:
- payer
- geography
- organization_billing_provider
- date_of_service
- cpt_code
- modifiers
- license_type
- facility_type_code
- network_types
- payer_plan_groups
description: Dimension matching for a service line
title: DimensionMatch
type_fee-schedules/v3:MatchTestResult:
type: object
properties:
dimensions:
$ref: '#/components/schemas/type_fee-schedules/v3:DimensionMatch'
threshold:
$ref: '#/components/schemas/type_fee-schedules/v3:ThresholdMatch'
required:
- dimensions
- threshold
title: MatchTestResult
type_fee-schedules/v3:Dimensions:
type: object
properties:
payer_uuid:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
organization_billing_provider_id:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderId'
states:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_commons:State'
zip_codes:
type: array
uniqueItems: true
items:
type: string
license_types:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_organization-providers/v2:LicenseType'
facility_type_codes:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_commons:FacilityTypeCode'
network_types:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_commons:NetworkType'
payer_plan_group_ids:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_commons:PayerPlanGroupId'
cpt_code:
type: string
modifiers:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_commons:ProcedureModifier'
required:
- payer_uuid
- organization_billing_provider_id
- states
- zip_codes
- license_types
- facility_type_codes
- network_types
- payer_plan_group_ids
- cpt_code
- modifiers
description: >-
Dimension values that qualify a rate. For the optional dimensions, a null value signifies "all apply". For
set-type dimensions, an empty set signifies "all apply". Only one of, but not both, of `network_types` and
`payer_plan_group_id` may be populated.
title: Dimensions
type_fee-schedules/v3:RateEntry:
type: object
properties:
start_date:
type: string
format: date
end_date:
type: string
format: date
rate_cents:
type: integer
is_deactivated:
type: boolean
required:
- start_date
- rate_cents
- is_deactivated
description: >-
A rate value in cents for a specific time range. Rate entries can be deactivated, which is set by using the
deelte_rate endpoint. Deactivated rate entries are not considered when matching against service lines.
title: RateEntry
type_fee-schedules/v3:Rate:
type: object
properties:
rate_id:
$ref: '#/components/schemas/type_commons:RateId'
dimensions:
$ref: '#/components/schemas/type_fee-schedules/v3:Dimensions'
description: The dimension values that distinguish this rate from others.
version:
type: integer
description: The version of this rate in the system.
updated_at:
type: string
format: date
updated_by:
$ref: '#/components/schemas/type_commons:UserId'
entries:
type: array
items:
$ref: '#/components/schemas/type_fee-schedules/v3:RateEntry'
required:
- rate_id
- dimensions
- version
- updated_at
- updated_by
- entries
description: >-
A comprehensive rate including the current rate value and all values for historic time ranges. The time ranges
specified by each RateEntry are disjoint. A rate must always have at least one entry.
title: Rate
type_fee-schedules/v3:RatesPage:
type: object
properties:
prev_page_token:
$ref: '#/components/schemas/type_commons:PageToken'
next_page_token:
$ref: '#/components/schemas/type_commons:PageToken'
rates:
type: array
items:
$ref: '#/components/schemas/type_fee-schedules/v3:Rate'
required:
- rates
title: RatesPage
type_fee-schedules/v3:DimensionName:
type: string
enum:
- payer_uuid
- organization_billing_provider_id
- cpt_code
description: The name of a dimension.
title: DimensionName
type_fee-schedules/v3:OptionalDimensions:
type: object
properties:
payer_uuid:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
organization_billing_provider_id:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderId'
states:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_commons:State'
zip_codes:
type: array
uniqueItems: true
items:
type: string
license_types:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_organization-providers/v2:LicenseType'
facility_type_codes:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_commons:FacilityTypeCode'
network_types:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_commons:NetworkType'
payer_plan_group_ids:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_commons:PayerPlanGroupId'
cpt_code:
type: string
modifiers:
type: array
uniqueItems: true
items:
$ref: '#/components/schemas/type_commons:ProcedureModifier'
required:
- states
- zip_codes
- license_types
- facility_type_codes
- network_types
- payer_plan_group_ids
- modifiers
description: A dimensions object where all properties are optional.
title: OptionalDimensions
type_fee-schedules/v3:DimensionsPage:
type: object
properties:
prev_page_token:
$ref: '#/components/schemas/type_commons:PageToken'
next_page_token:
$ref: '#/components/schemas/type_commons:PageToken'
dimensions:
type: array
items:
$ref: '#/components/schemas/type_fee-schedules/v3:OptionalDimensions'
required:
- dimensions
title: DimensionsPage
type_fee-schedules/v3:RateUpload:
oneOf:
- type: object
properties:
type:
type: string
enum:
- new_rate
description: 'Discriminator value: new_rate'
dimensions:
$ref: '#/components/schemas/type_fee-schedules/v3:Dimensions'
entries:
type: array
items:
$ref: '#/components/schemas/type_fee-schedules/v3:RateEntry'
required:
- type
- dimensions
- entries
- type: object
properties:
type:
type: string
enum:
- new_version
description: 'Discriminator value: new_version'
rate_id:
$ref: '#/components/schemas/type_commons:RateId'
previous_version:
type: integer
description: >-
New versions of rates must indicate the exact version they modify. When the system attempts to save this
new version, if the latest version in the system does not equal this previos_version, the request will
be rejected with a EntityConflictError.
entries:
type: array
items:
$ref: '#/components/schemas/type_fee-schedules/v3:RateEntry'
required:
- type
- rate_id
- previous_version
- entries
discriminator:
propertyName: type
title: RateUpload
type_fee-schedules/v3:ValidationError:
oneOf:
- type: object
properties:
type:
type: string
enum:
- overlapping_rate_entries
description: 'Discriminator value: overlapping_rate_entries'
message:
type: string
rate_a:
$ref: '#/components/schemas/type_fee-schedules/v3:RateEntry'
rate_b:
$ref: '#/components/schemas/type_fee-schedules/v3:RateEntry'
required:
- type
- message
- rate_a
- rate_b
- type: object
properties:
type:
type: string
enum:
- version_conflict
description: 'Discriminator value: version_conflict'
entity_name:
type: string
required:
- type
- entity_name
- type: object
properties:
type:
type: string
enum:
- organization_provider_not_found
description: 'Discriminator value: organization_provider_not_found'
id:
type: string
required:
- type
- id
- type: object
properties:
type:
type: string
enum:
- duplicate_rate
description: 'Discriminator value: duplicate_rate'
required:
- type
- type: object
properties:
type:
type: string
enum:
- empty_entries
description: 'Discriminator value: empty_entries'
required:
- type
- type: object
properties:
type:
type: string
enum:
- payer_plan_group_not_found
description: 'Discriminator value: payer_plan_group_not_found'
id:
type: string
required:
- type
- id
- type: object
properties:
type:
type: string
enum:
- payer_plan_group_does_not_match_rate_payer
description: 'Discriminator value: payer_plan_group_does_not_match_rate_payer'
rate_payer_uuid:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
payer_plan_group_payer_uuid:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
required:
- type
- rate_payer_uuid
- payer_plan_group_payer_uuid
- type: object
properties:
type:
type: string
enum:
- payer_plan_group_network_type_mutual_exclusion
description: 'Discriminator value: payer_plan_group_network_type_mutual_exclusion'
entity_name:
type: string
required:
- type
- entity_name
discriminator:
propertyName: type
title: ValidationError
type_fee-schedules/v3:RateUploadWithPossibleErrors:
type: object
properties:
rate_upload:
$ref: '#/components/schemas/type_fee-schedules/v3:RateUpload'
existing_rate:
$ref: '#/components/schemas/type_fee-schedules/v3:Rate'
possible_errors:
type: array
items:
$ref: '#/components/schemas/type_fee-schedules/v3:ValidationError'
required:
- rate_upload
- possible_errors
title: RateUploadWithPossibleErrors
type_fee-schedules/v3:PayerThresholdsPage:
type: object
properties:
prev_page_token:
$ref: '#/components/schemas/type_commons:PageToken'
next_page_token:
$ref: '#/components/schemas/type_commons:PageToken'
payer_thresholds:
type: object
additionalProperties:
$ref: '#/components/schemas/type_fee-schedules/v3:PayerThreshold'
required:
- payer_thresholds
title: PayerThresholdsPage
type_guarantor/v1:EncounterHasExistingGuarantorErrorType:
type: object
properties:
message:
type: string
required:
- message
title: EncounterHasExistingGuarantorErrorType
type_health-care-code-information/v1:HealthCareCodeInformationGetAllResponse:
type: object
properties:
principal_diagnosis:
$ref: '#/components/schemas/type_health-care-code-information/v1:PrincipalDiagnosis'
other_diagnosis_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:OtherDiagnosisInformation'
admitting_diagnosis:
$ref: '#/components/schemas/type_health-care-code-information/v1:AdmittingDiagnosis'
description: This object only applies to 837i institutional claim forms.
patient_reasons_for_visit:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:PatientReasonForVisit'
description: This object only applies to 837i institutional claim forms.
external_causes_of_injury:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:ExternalCauseOfInjury'
description: This object only applies to 837i institutional claim forms.
diagnosis_related_groups:
$ref: '#/components/schemas/type_health-care-code-information/v1:DiagnosisRelatedGroup'
description: This object only applies to 837i institutional claim forms.
principal_procedure:
$ref: '#/components/schemas/type_health-care-code-information/v1:PrincipalProcedureInformation'
description: This object only applies to 837i institutional claim forms.
other_procedure_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:OtherProcedureInformation'
description: This object only applies to 837i institutional claim forms.
occurrence_span_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:OccurrenceSpanInformation'
description: This object only applies to 837i institutional claim forms.
occurrence_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:OccurrenceInformation'
description: This object only applies to 837i institutional claim forms.
treatment_code_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:TreatmentCodeInformation'
description: This object only applies to 837i institutional claim forms.
value_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:ValueInformation'
description: This object only applies to 837i institutional claim forms.
condition_information:
type: array
items:
$ref: '#/components/schemas/type_health-care-code-information/v1:ConditionInformation'
description: This object only applies to 837i institutional claim forms.
required:
- other_diagnosis_information
- patient_reasons_for_visit
- external_causes_of_injury
- other_procedure_information
- occurrence_span_information
- occurrence_information
- treatment_code_information
- value_information
- condition_information
title: HealthCareCodeInformationGetAllResponse
type_insurance-adjudications/v1:InsuranceAdjudicationId:
type: string
format: uuid
title: InsuranceAdjudicationId
type_insurance-adjudications/v1:ServiceLineAdjudicationId:
type: string
format: uuid
title: ServiceLineAdjudicationId
type_commons:ClaimAdjustmentGroupCodes:
type: string
enum:
- CO
- CR
- DE
- MA
- OA
- PI
- PR
- RR
- NC
- UNKNOWN
title: ClaimAdjustmentGroupCodes
type_x12/v1:Carc:
type: string
enum:
- '1'
- '2'
- '3'
- '4'
- '5'
- '6'
- '7'
- '8'
- '9'
- '10'
- '11'
- '12'
- '13'
- '14'
- '16'
- '18'
- '19'
- '20'
- '21'
- '22'
- '23'
- '24'
- '26'
- '27'
- '29'
- '31'
- '32'
- '33'
- '34'
- '35'
- '39'
- '40'
- '44'
- '45'
- '49'
- '50'
- '51'
- '53'
- '54'
- '55'
- '56'
- '58'
- '59'
- '60'
- '61'
- '66'
- '69'
- '70'
- '74'
- '75'
- '76'
- '78'
- '85'
- '89'
- '90'
- '91'
- '94'
- '95'
- '96'
- '97'
- '100'
- '101'
- '102'
- '103'
- '104'
- '105'
- '106'
- '107'
- '108'
- '109'
- '110'
- '111'
- '112'
- '114'
- '115'
- '116'
- '117'
- '118'
- '119'
- '121'
- '122'
- '125'
- '128'
- '129'
- '130'
- '131'
- '132'
- '133'
- '134'
- '135'
- '136'
- '137'
- '139'
- '140'
- '142'
- '143'
- '144'
- '146'
- '147'
- '148'
- '149'
- '150'
- '151'
- '152'
- '153'
- '154'
- '155'
- '157'
- '158'
- '159'
- '160'
- '161'
- '163'
- '164'
- '166'
- '167'
- '169'
- '170'
- '171'
- '172'
- '173'
- '174'
- '175'
- '176'
- '177'
- '178'
- '179'
- '180'
- '181'
- '182'
- '183'
- '184'
- '185'
- '186'
- '187'
- '188'
- '189'
- '190'
- '192'
- '193'
- '194'
- '195'
- '197'
- '198'
- '199'
- '200'
- '201'
- '202'
- '203'
- '204'
- '205'
- '206'
- '207'
- '208'
- '209'
- '210'
- '211'
- '212'
- '213'
- '215'
- '216'
- '219'
- '222'
- '223'
- '224'
- '225'
- '226'
- '227'
- '228'
- '229'
- '231'
- '232'
- '233'
- '234'
- '235'
- '236'
- '237'
- '238'
- '239'
- '240'
- '241'
- '242'
- '243'
- '245'
- '246'
- '247'
- '248'
- '249'
- '250'
- '251'
- '252'
- '253'
- '254'
- '256'
- '257'
- '258'
- '259'
- '260'
- '261'
- '262'
- '263'
- '264'
- '265'
- '266'
- '267'
- '268'
- '269'
- '270'
- '271'
- '272'
- '273'
- '274'
- '275'
- '276'
- '277'
- '278'
- '279'
- '280'
- '281'
- '282'
- '283'
- '284'
- '285'
- '286'
- '287'
- '288'
- '289'
- '290'
- '291'
- '292'
- '293'
- '294'
- '295'
- '296'
- '297'
- '298'
- '299'
- '300'
- '301'
- '302'
- '303'
- '304'
- '305'
- A0
- A1
- A5
- A6
- A8
- B1
- B4
- B7
- B8
- B9
- B10
- B11
- B12
- B13
- B14
- B15
- B16
- B20
- B22
- B23
- P1
- P2
- P3
- P4
- P5
- P6
- P7
- P8
- P9
- P10
- P11
- P12
- P13
- P14
- P15
- P16
- P17
- P18
- P19
- P20
- P21
- P22
- P23
- P24
- P25
- P26
- P27
- P28
- P29
- P30
- P31
- P32
- '15'
- '17'
- '25'
- '28'
- '30'
- '36'
- '37'
- '38'
- '41'
- '42'
- '43'
- '46'
- '47'
- '48'
- '52'
- '57'
- '62'
- '63'
- '64'
- '65'
- '67'
- '68'
- '71'
- '72'
- '73'
- '77'
- '79'
- '80'
- '81'
- '82'
- '83'
- '84'
- '86'
- '87'
- '88'
- '92'
- '93'
- '98'
- '99'
- '113'
- '120'
- '123'
- '124'
- '126'
- '127'
- '138'
- '141'
- '145'
- '156'
- '162'
- '165'
- '168'
- '191'
- '196'
- '214'
- '217'
- '218'
- '220'
- '221'
- '230'
- '244'
- '255'
- A2
- A3
- A4
- A7
- B2
- B3
- B5
- B6
- B17
- B18
- B19
- B21
- D1
- D2
- D3
- D4
- D5
- D6
- D7
- D8
- D9
- D10
- D11
- D12
- D14
- D15
- D16
- D17
- D18
- D19
- D20
- D21
- D22
- D23
- W1
- W2
- W3
- W4
- W5
- W6
- W7
- W8
- W9
- Y1
- Y2
- Y3
- UNKNOWN
title: Carc
type_x12/v1:ClaimAdjustmentReasonCode:
type: object
properties:
group_code:
$ref: '#/components/schemas/type_commons:ClaimAdjustmentGroupCodes'
reason_code:
$ref: '#/components/schemas/type_x12/v1:Carc'
amount_cents:
type: integer
required:
- group_code
- reason_code
- amount_cents
title: ClaimAdjustmentReasonCode
type_x12/v1:Rarc:
type: string
enum:
- M1
- M2
- M3
- M4
- M5
- M6
- M7
- M8
- M9
- M10
- M11
- M12
- M13
- M14
- M15
- M16
- M17
- M18
- M19
- M20
- M21
- M22
- M23
- M24
- M25
- M26
- M27
- M28
- M29
- M30
- M31
- M32
- M33
- M34
- M35
- M36
- M37
- M38
- M39
- M40
- M41
- M42
- M43
- M44
- M45
- M46
- M47
- M48
- M49
- M50
- M51
- M52
- M53
- M54
- M55
- M56
- M57
- M58
- M59
- M60
- M61
- M62
- M63
- M64
- M65
- M66
- M67
- M68
- M69
- M70
- M71
- M72
- M73
- M74
- M75
- M76
- M77
- M78
- M79
- M80
- M81
- M82
- M83
- M84
- M85
- M86
- M87
- M88
- M89
- M90
- M91
- M92
- M93
- M94
- M95
- M96
- M97
- M98
- M99
- M100
- M101
- M102
- M103
- M104
- M105
- M106
- M107
- M108
- M109
- M110
- M111
- M112
- M113
- M114
- M115
- M116
- M117
- M118
- M119
- M120
- M121
- M122
- M123
- M124
- M125
- M126
- M127
- M128
- M129
- M130
- M131
- M132
- M133
- M134
- M135
- M136
- M137
- M138
- M139
- M140
- M141
- M142
- M143
- M144
- MA01
- MA02
- MA03
- MA04
- MA05
- MA06
- MA07
- MA08
- MA09
- MA10
- MA11
- MA12
- MA13
- MA14
- MA15
- MA16
- MA17
- MA18
- MA19
- MA20
- MA21
- MA22
- MA23
- MA24
- MA25
- MA26
- MA27
- MA28
- MA29
- MA30
- MA31
- MA32
- MA33
- MA34
- MA35
- MA36
- MA37
- MA38
- MA39
- MA40
- MA41
- MA42
- MA43
- MA44
- MA45
- MA46
- MA47
- MA48
- MA49
- MA50
- MA51
- MA52
- MA53
- MA54
- MA55
- MA56
- MA57
- MA58
- MA59
- MA60
- MA61
- MA62
- MA63
- MA64
- MA65
- MA66
- MA67
- MA68
- MA69
- MA70
- MA71
- MA72
- MA73
- MA74
- MA75
- MA76
- MA77
- MA78
- MA79
- MA80
- MA81
- MA82
- MA83
- MA84
- MA85
- MA86
- MA87
- MA88
- MA89
- MA90
- MA91
- MA92
- MA93
- MA94
- MA95
- MA96
- MA97
- MA98
- MA99
- MA100
- MA101
- MA102
- MA103
- MA104
- MA105
- MA106
- MA107
- MA108
- MA109
- MA110
- MA111
- MA112
- MA113
- MA114
- MA115
- MA116
- MA117
- MA118
- MA119
- MA120
- MA121
- MA122
- MA123
- MA124
- MA125
- MA126
- MA127
- MA128
- MA129
- MA130
- MA131
- MA132
- MA133
- MA134
- N1
- N2
- N3
- N4
- N5
- N6
- N7
- N8
- N9
- N10
- N11
- N12
- N13
- N14
- N15
- N16
- N17
- N18
- N19
- N20
- N21
- N22
- N23
- N24
- N25
- N26
- N27
- N28
- N29
- N30
- N31
- N32
- N33
- N34
- N35
- N36
- N37
- N38
- N39
- N40
- N41
- N42
- N43
- N44
- N45
- N46
- N47
- N48
- N49
- N50
- N51
- N52
- N53
- N54
- N55
- N56
- N57
- N58
- N59
- N60
- N61
- N62
- N63
- N64
- N65
- N66
- N67
- N68
- N69
- N70
- N71
- N72
- N73
- N74
- N75
- N76
- N77
- N78
- N79
- N80
- N81
- N82
- N83
- N84
- N85
- N86
- N87
- N88
- N89
- N90
- N91
- N92
- N93
- N94
- N95
- N96
- N97
- N98
- N99
- N100
- N101
- N102
- N103
- N104
- N105
- N106
- N107
- N108
- N109
- N110
- N111
- N112
- N113
- N114
- N115
- N116
- N117
- N118
- N119
- N120
- N121
- N122
- N123
- N124
- N125
- N126
- N127
- N128
- N129
- N130
- N131
- N132
- N133
- N134
- N135
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- UNKNOWN
title: Rarc
type_x12/v1:RemittanceAdviceRemarkCode:
type: object
properties:
reason_code:
$ref: '#/components/schemas/type_x12/v1:Rarc'
required:
- reason_code
title: RemittanceAdviceRemarkCode
type_insurance-adjudications/v1:ServiceLineAdjudication:
type: object
properties:
service_line_adjudication_id:
$ref: '#/components/schemas/type_insurance-adjudications/v1:ServiceLineAdjudicationId'
denial_reason:
$ref: '#/components/schemas/type_service-lines/v2:DenialReasonContent'
description: Will be treated as a denial if present
insurance_allowed_amount_cents:
type: integer
insurance_paid_amount_cents:
type: integer
deductible_amount_cents:
type: integer
coinsurance_amount_cents:
type: integer
copay_amount_cents:
type: integer
carcs:
type: array
items:
$ref: '#/components/schemas/type_x12/v1:ClaimAdjustmentReasonCode'
rarcs:
type: array
items:
$ref: '#/components/schemas/type_x12/v1:RemittanceAdviceRemarkCode'
required:
- service_line_adjudication_id
- carcs
- rarcs
title: ServiceLineAdjudication
type_insurance-adjudications/v1:ClaimAdjudication:
type: object
properties:
claim_id:
$ref: '#/components/schemas/type_commons:ClaimId'
insurance_allowed_amount_cents:
type: integer
insurance_paid_amount_cents:
type: integer
charge_amount_cents:
type: integer
service_lines:
type: object
additionalProperties:
type: array
items:
$ref: '#/components/schemas/type_insurance-adjudications/v1:ServiceLineAdjudication'
payer_claim_number:
type: string
carcs:
type: array
items:
$ref: '#/components/schemas/type_x12/v1:ClaimAdjustmentReasonCode'
required:
- claim_id
- service_lines
- carcs
title: ClaimAdjudication
type_insurance-adjudications/v1:InsuranceAdjudication:
type: object
properties:
insurance_adjudication_id:
$ref: '#/components/schemas/type_insurance-adjudications/v1:InsuranceAdjudicationId'
payer_uuid:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
post_date:
type: string
format: date
check_number:
type: string
check_date:
type: string
format: date
note:
type: string
claims:
type: object
additionalProperties:
type: array
items:
$ref: '#/components/schemas/type_insurance-adjudications/v1:ClaimAdjudication'
required:
- insurance_adjudication_id
- payer_uuid
- check_date
- claims
title: InsuranceAdjudication
type_insurance-refunds/v1:InsuranceRefundSortField:
type: string
enum:
- amount_cents
- refund_timestamp
- refund_note
- refund_reason
title: InsuranceRefundSortField
type_insurance-refunds/v1:InsuranceRefundId:
type: string
format: uuid
title: InsuranceRefundId
type_insurance-refunds/v1:InsuranceRefund:
type: object
properties:
insurance_refund_id:
$ref: '#/components/schemas/type_insurance-refunds/v1:InsuranceRefundId'
payer:
$ref: '#/components/schemas/type_payers/v3:Payer'
amount_cents:
type: integer
refund_timestamp:
type: string
format: date-time
refund_note:
type: string
allocations:
type: array
items:
$ref: '#/components/schemas/type_financials:Allocation'
refund_reason:
$ref: '#/components/schemas/type_financials:RefundReason'
required:
- insurance_refund_id
- payer
- amount_cents
- allocations
title: InsuranceRefund
type_insurance-refunds/v1:InsuranceRefundsPage:
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_insurance-refunds/v1:InsuranceRefund'
required:
- items
title: InsuranceRefundsPage
type_payers/v3:PayerId:
type: string
title: PayerId
type_payers/v3:PayerName:
type: string
title: PayerName
type_payers/v3:PayerIdentifier:
oneOf:
- type: object
properties:
type:
type: string
enum:
- payer_info
description: 'Discriminator value: payer_info'
payer_id:
$ref: '#/components/schemas/type_payers/v3:PayerId'
payer_name:
$ref: '#/components/schemas/type_payers/v3:PayerName'
required:
- type
- payer_id
- payer_name
- type: object
properties:
type:
type: string
enum:
- payer_uuid
description: 'Discriminator value: payer_uuid'
value:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
required:
- type
- value
discriminator:
propertyName: type
title: PayerIdentifier
type_insurance-refunds/v1:InsuranceRefundCreate:
type: object
properties:
payer_identifier:
$ref: '#/components/schemas/type_payers/v3:PayerIdentifier'
amount_cents:
type: integer
refund_timestamp:
type: string
format: date-time
refund_note:
type: string
allocations:
type: array
items:
$ref: '#/components/schemas/type_financials:AllocationCreate'
refund_reason:
$ref: '#/components/schemas/type_financials:RefundReason'
required:
- payer_identifier
- amount_cents
- allocations
title: InsuranceRefundCreate
type_medication-dispense/v1:MedicationDispenseCreate:
type: object
properties:
medication_dispense_external_id:
type: string
patient_external_id:
type: string
procedure_code:
type: string
quantity:
$ref: '#/components/schemas/type_commons:Decimal'
units:
$ref: '#/components/schemas/type_commons:ServiceLineUnits'
date_of_service:
type: string
format: date
drug_identification:
$ref: '#/components/schemas/type_service-lines/v2:DrugIdentification'
description:
type: string
modifiers:
type: array
items:
$ref: '#/components/schemas/type_commons:ProcedureModifier'
required:
- medication_dispense_external_id
- patient_external_id
- procedure_code
- quantity
- units
- date_of_service
title: MedicationDispenseCreate
type_non-insurance-payer-payments/v1:NonInsurancePayerPaymentSortField:
type: string
enum:
- amount_cents
- payment_timestamp
title: NonInsurancePayerPaymentSortField
type_non-insurance-payer-payments/v1:NonInsurancePayerPaymentId:
type: string
format: uuid
title: NonInsurancePayerPaymentId
type_non-insurance-payer-payments/v1:NonInsurancePayerPayment:
type: object
properties:
non_insurance_payer_payment_id:
$ref: '#/components/schemas/type_non-insurance-payer-payments/v1:NonInsurancePayerPaymentId'
non_insurance_payer:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayer'
amount_cents:
type: integer
check_number:
type: string
payment_timestamp:
type: string
format: date-time
payment_note:
type: string
allocations:
type: array
items:
$ref: '#/components/schemas/type_financials:Allocation'
invoice_id:
$ref: '#/components/schemas/type_commons:InvoiceId'
required:
- non_insurance_payer_payment_id
- non_insurance_payer
- amount_cents
- allocations
title: NonInsurancePayerPayment
type_non-insurance-payer-payments/v1:NonInsurancePayerPaymentsPage:
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_non-insurance-payer-payments/v1:NonInsurancePayerPayment'
required:
- items
title: NonInsurancePayerPaymentsPage
type_non-insurance-payer-payments/v1:NonInsurancePayerPaymentCreate:
type: object
properties:
non_insurance_payer_id:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerId'
amount_cents:
type: integer
payment_timestamp:
type: string
format: date-time
payment_note:
type: string
check_number:
type: string
allocations:
type: array
items:
$ref: '#/components/schemas/type_financials:AllocationCreate'
invoice_id:
$ref: '#/components/schemas/type_commons:InvoiceId'
required:
- non_insurance_payer_id
- amount_cents
- allocations
title: NonInsurancePayerPaymentCreate
type_non-insurance-payer-refunds/v1:NonInsurancePayerRefundSortField:
type: string
enum:
- amount_cents
- refund_timestamp
title: NonInsurancePayerRefundSortField
type_non-insurance-payer-refunds/v1:NonInsurancePayerRefundId:
type: string
format: uuid
title: NonInsurancePayerRefundId
type_non-insurance-payer-refunds/v1:NonInsurancePayerRefund:
type: object
properties:
non_insurance_payer_refund_id:
$ref: '#/components/schemas/type_non-insurance-payer-refunds/v1:NonInsurancePayerRefundId'
non_insurance_payer:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayer'
amount_cents:
type: integer
refund_timestamp:
type: string
format: date-time
refund_note:
type: string
check_number:
type: string
allocations:
type: array
items:
$ref: '#/components/schemas/type_financials:Allocation'
refund_reason:
$ref: '#/components/schemas/type_financials:RefundReason'
invoice_id:
$ref: '#/components/schemas/type_commons:InvoiceId'
required:
- non_insurance_payer_refund_id
- non_insurance_payer
- amount_cents
- allocations
title: NonInsurancePayerRefund
type_non-insurance-payer-refunds/v1:NonInsurancePayerRefundsPage:
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_non-insurance-payer-refunds/v1:NonInsurancePayerRefund'
required:
- items
title: NonInsurancePayerRefundsPage
type_non-insurance-payer-refunds/v1:NonInsurancePayerRefundCreate:
type: object
properties:
non_insurance_payer_id:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerId'
invoice_id:
$ref: '#/components/schemas/type_commons:InvoiceId'
amount_cents:
type: integer
refund_timestamp:
type: string
format: date-time
refund_note:
type: string
check_number:
type: string
allocations:
type: array
items:
$ref: '#/components/schemas/type_financials:AllocationCreate'
refund_reason:
$ref: '#/components/schemas/type_financials:RefundReason'
required:
- non_insurance_payer_id
- amount_cents
- allocations
title: NonInsurancePayerRefundCreate
type_clinical-trials/v1:MutableClinicalTrial:
type: object
properties:
name:
type: string
clinical_trial_number:
type: string
description: Must be 8 characters long
clinical_trial_phase:
$ref: '#/components/schemas/type_clinical-trials/v1:ClinicalTrialPhase'
required:
- name
- clinical_trial_number
title: MutableClinicalTrial
type_non-insurance-payers/v1:CreateNonInsurancePayerRequest:
type: object
properties:
name:
type: string
description: Max 50 characters allowed
description:
type: string
description: Max 255 characters allowed
category:
type: string
description: Max 255 characters allowed
address:
$ref: '#/components/schemas/type_commons:StreetAddressShortZip'
clinical_trials:
type: array
items:
$ref: '#/components/schemas/type_clinical-trials/v1:MutableClinicalTrial'
description: The same name cannot be used across several clinical trials
required:
- name
title: CreateNonInsurancePayerRequest
type_non-insurance-payers/v1:ToggleNonInsurancePayerEnablementRequest:
type: object
properties:
enabled:
type: boolean
required:
- enabled
title: ToggleNonInsurancePayerEnablementRequest
type_non-insurance-payers/v1:NonInsurancePayerSortField:
type: string
enum:
- NAME
- CATEGORY
- ENABLED
- UPDATED_AT
title: NonInsurancePayerSortField
type_non-insurance-payers/v1:NonInsurancePayerPage:
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_non-insurance-payers/v1:NonInsurancePayer'
required:
- items
title: NonInsurancePayerPage
type_non-insurance-payers/v1:NonInsurancePayerCategoriesPage:
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:
type: string
required:
- items
title: NonInsurancePayerCategoriesPage
type_non-insurance-payers/v1:NonInsurancePayerDescriptionUpdate:
oneOf:
- type: object
properties:
type:
type: string
enum:
- remove
description: 'Discriminator value: remove'
required:
- type
- type: object
properties:
type:
type: string
enum:
- set
description: 'Discriminator value: set'
value:
type: string
required:
- type
- value
description: Max 255 characters allowed
discriminator:
propertyName: type
title: NonInsurancePayerDescriptionUpdate
type_non-insurance-payers/v1:NonInsurancePayerCategoryUpdate:
oneOf:
- type: object
properties:
type:
type: string
enum:
- remove
description: 'Discriminator value: remove'
required:
- type
- type: object
properties:
type:
type: string
enum:
- set
description: 'Discriminator value: set'
value:
type: string
required:
- type
- value
description: Max 255 characters allowed
discriminator:
propertyName: type
title: NonInsurancePayerCategoryUpdate
type_non-insurance-payers/v1:NonInsurancePayerAddressUpdate:
oneOf:
- type: object
properties:
type:
type: string
enum:
- remove
description: 'Discriminator value: remove'
required:
- type
- type: object
properties:
type:
type: string
enum:
- set
description: 'Discriminator value: set'
value:
$ref: '#/components/schemas/type_commons:StreetAddressShortZip'
required:
- type
discriminator:
propertyName: type
title: NonInsurancePayerAddressUpdate
type_non-insurance-payers/v1:NonInsurancePayerUpdateRequest:
type: object
properties:
name:
type: string
description: Max 50 characters allowed
description:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerDescriptionUpdate'
category:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerCategoryUpdate'
address:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerAddressUpdate'
title: NonInsurancePayerUpdateRequest
type_organization-providers/v2:OrganizationProviderSortOptions:
type: string
enum:
- provider_name:asc
- provider_name:desc
- npi:asc
- npi:desc
title: OrganizationProviderSortOptions
type_organization-providers/v3:OrganizationProviderPageV2:
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_organization-providers/v3:OrganizationProviderV2'
required:
- items
title: OrganizationProviderPageV2
type_identifiers:IdentifierCreate:
type: object
properties:
period:
$ref: '#/components/schemas/type_commons:DateRangeOptionalEnd'
identifier_code:
$ref: '#/components/schemas/type_identifiers:IdentifierCode'
identifier_value:
$ref: '#/components/schemas/type_identifiers:IdentifierValue'
required:
- identifier_code
- identifier_value
title: IdentifierCreate
type_organization-providers/v3:OrganizationProviderCreateV2:
type: object
properties:
npi:
type: string
description: The NPI of the provider. This must be all digits [0-9] and exactly 10 characters long.
is_rendering:
type: boolean
description: Whether the provider can be used to render services.
is_billing:
type: boolean
description: Whether the provider can be used to bill services.
first_name:
type: string
description: The first name of the provider, if the provider is an individual.
last_name:
type: string
description: The last name of the provider, if the provider is an individual.
organization_name:
type: string
description: The name of the provider, if the provider is an organization.
provider_type:
$ref: '#/components/schemas/type_organization-providers/v2:ProviderType'
description: Whether the provider is an individual (NPPES Type 1) or organization (NPPES Type 2) provider.
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.
taxonomy_code:
type: string
description: A code designating classification and specialization.
license_type:
$ref: '#/components/schemas/type_organization-providers/v2:LicenseType'
description: The type of license that the provider holds.
addresses:
type: array
items:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderAddress'
description: The addresses associated with this provider.
employment_start_date:
type: string
format: date
description: The employment start date for the provider.
employment_termination_date:
type: string
format: date
description: The employment termination date for the provider.
qualifications:
type: array
items:
$ref: '#/components/schemas/type_identifiers:IdentifierCreate'
description: A provider's qualifications such as PTAN, Medicaid Provider Id, etc.
required:
- npi
- is_rendering
- is_billing
- provider_type
- license_type
- qualifications
title: OrganizationProviderCreateV2
type_commons:UpdatesDisabledDueToExternalSystemIntegrationErrorMessage:
type: object
properties:
message:
type: string
title: UpdatesDisabledDueToExternalSystemIntegrationErrorMessage
type_commons:RemovableDateRangeOptionalEnd:
oneOf:
- type: object
properties:
type:
type: string
enum:
- date_range
description: 'Discriminator value: date_range'
start_date:
$ref: '#/components/schemas/type_commons:Date'
end_date:
$ref: '#/components/schemas/type_commons:Date'
required:
- type
- start_date
- type: object
properties:
type:
type: string
enum:
- remove
description: 'Discriminator value: remove'
required:
- type
discriminator:
propertyName: type
title: RemovableDateRangeOptionalEnd
type_identifiers:UpdatableIdentifier:
oneOf:
- type: object
properties:
type:
type: string
enum:
- add
description: 'Discriminator value: add'
period:
$ref: '#/components/schemas/type_commons:DateRangeOptionalEnd'
identifier_code:
$ref: '#/components/schemas/type_identifiers:IdentifierCode'
identifier_value:
$ref: '#/components/schemas/type_identifiers:IdentifierValue'
required:
- type
- identifier_code
- identifier_value
- type: object
properties:
type:
type: string
enum:
- update
description: 'Discriminator value: update'
identifier_id:
$ref: '#/components/schemas/type_identifiers:IdentifierId'
identifier_code:
$ref: '#/components/schemas/type_identifiers:IdentifierCode'
identifier_value:
$ref: '#/components/schemas/type_identifiers:IdentifierValue'
period:
$ref: '#/components/schemas/type_commons:RemovableDateRangeOptionalEnd'
required:
- type
- identifier_id
- type: object
properties:
type:
type: string
enum:
- remove
description: 'Discriminator value: remove'
value:
$ref: '#/components/schemas/type_identifiers:IdentifierId'
required:
- type
- value
discriminator:
propertyName: type
title: UpdatableIdentifier
type_organization-providers/v3:OrganizationProviderUpdateV2:
type: object
properties:
npi:
type: string
description: The NPI of the provider. This must be all digits [0-9] and exactly 10 characters long.
is_rendering:
type: boolean
description: Whether the provider can be used to render services.
is_billing:
type: boolean
description: Whether the provider can be used to bill services.
first_name:
type: string
description: The first name of the provider, if the provider is an individual.
last_name:
type: string
description: The last name of the provider, if the provider is an individual.
organization_name:
type: string
description: The name of the provider, if the provider is an organization.
provider_type:
$ref: '#/components/schemas/type_organization-providers/v2:ProviderType'
description: Whether the provider is an individual (NPPES Type 1) or organization (NPPES Type 2) provider.
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.
taxonomy_code:
type: string
description: A code designating classification and specialization.
license_type:
$ref: '#/components/schemas/type_organization-providers/v2:LicenseType'
description: The type of license that the provider holds.
addresses:
type: array
items:
$ref: '#/components/schemas/type_organization-providers/v2:OrganizationProviderAddress'
description: The addresses associated with this provider.
employment_start_date:
$ref: '#/components/schemas/type_commons:Date'
description: The employment start date for the provider.
employment_termination_date:
$ref: '#/components/schemas/type_commons:Date'
description: The employment termination date for the provider.
qualifications:
type: array
items:
$ref: '#/components/schemas/type_identifiers:UpdatableIdentifier'
description: Provider's qualifications (medicare provider number, medicaid provider number, etc.)
title: OrganizationProviderUpdateV2
type_organization-service-facilities/v2:OrganizationServiceFacilityPage:
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_organization-service-facilities/v2:OrganizationServiceFacility'
required:
- items
title: OrganizationServiceFacilityPage
type_organization-service-facilities/v2:OrganizationServiceFacilityCreate:
type: object
properties:
name:
type: string
description: The name of the service facility.
aliases:
type: array
items:
type: string
description: A list of alternate names for the service facility.
description:
type: string
description: A description of the service facility.
external_id:
type: string
description: >-
An ID for this service facility used in an external system (e.g. your EMR). Service facilities can be
queried by this field.
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.
place_of_service_code:
$ref: '#/components/schemas/type_commons:FacilityTypeCode'
description: The Place of Service (POS) code for this service facility.
clia_number:
type: string
description: The associated CLIA number with this service facility. Can be used to populate CLIA numbers on encounters.
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.
status:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityStatus'
description: The status of the service facility.
operational_status:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityOperationalStatus'
description: The operational status of the service facility.
mode:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityMode'
description: The mode of the service facility.
type:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityType'
description: The type of the service facility.
physical_type:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityPhysicalType'
description: The physical type of the service facility.
telecoms:
type: array
items:
type: string
description: A list of contact methods for the service facility.
address:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
description: The address of the service facility.
required:
- name
- aliases
- telecoms
- address
title: OrganizationServiceFacilityCreate
type_organization-service-facilities/v2:OrganizationServiceFacilityUpdate:
type: object
properties:
name:
type: string
description: The name of the service facility.
aliases:
type: array
items:
type: string
description: A list of alternate names for the service facility.
description:
type: string
description: A description of the service facility.
external_id:
type: string
description: >-
An ID for this service facility used in an external system (e.g. your EMR). Service facilities can be
queried by this field.
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.
place_of_service_code:
$ref: '#/components/schemas/type_commons:FacilityTypeCode'
description: The Place of Service (POS) code for this service facility.
clia_number:
type: string
description: The associated CLIA number with this service facility. Can be used to populate CLIA numbers on encounters.
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.
status:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityStatus'
description: The status of the service facility.
operational_status:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityOperationalStatus'
description: The operational status of the service facility.
mode:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityMode'
description: The mode of the service facility.
type:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityType'
description: The type of the service facility.
physical_type:
$ref: '#/components/schemas/type_organization-service-facilities/v2:ServiceFacilityPhysicalType'
description: The physical type of the service facility.
telecoms:
type: array
items:
type: string
description: A list of contact methods for the service facility.
address:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
description: The address of the service facility.
title: OrganizationServiceFacilityUpdate
type_payer-plan-groups/v1:PayerPlanGroupSortField:
type: string
enum:
- plan_group_name
- plan_type
- created_at
title: PayerPlanGroupSortField
type_payer-plan-groups/v1:PayerPlanGroup:
type: object
properties:
plan_group_name:
type: string
payer_uuid:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
plan_type:
$ref: '#/components/schemas/type_commons:SourceOfPaymentCode'
payer_plan_group_id:
$ref: '#/components/schemas/type_commons:PayerPlanGroupId'
payer:
$ref: '#/components/schemas/type_payers/v3:Payer'
is_active:
type: boolean
required:
- plan_group_name
- payer_uuid
- plan_type
- payer_plan_group_id
- payer
- is_active
title: PayerPlanGroup
type_payer-plan-groups/v1:PayerPlanGroupPage:
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_payer-plan-groups/v1:PayerPlanGroup'
required:
- items
title: PayerPlanGroupPage
type_payer-plan-groups/v1:MutablePayerPlanGroup:
type: object
properties:
plan_group_name:
type: string
payer_uuid:
$ref: '#/components/schemas/type_payers/v3:PayerUuid'
plan_type:
$ref: '#/components/schemas/type_commons:SourceOfPaymentCode'
required:
- plan_group_name
- payer_uuid
- plan_type
title: MutablePayerPlanGroup
type_payer-plan-groups/v1:PayerPlanGroupAlreadyExistsError:
type: object
properties:
message:
type: string
id:
$ref: '#/components/schemas/type_commons:PayerPlanGroupId'
required:
- message
- id
title: PayerPlanGroupAlreadyExistsError
type_payers/v3:PayerPage:
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_payers/v3:Payer'
required:
- items
title: PayerPage
type_payers/v4:PayerUuid:
type: string
format: uuid
title: PayerUuid
type_payers/v4:PrimaryPayerIds:
type: object
properties:
claims_payer_id:
type: string
description: The payer ID for claim submission
eligibility_payer_id:
type: string
description: The payer ID for eligibility
remittance_payer_id:
type: string
description: The payer ID for remittance
required:
- claims_payer_id
title: PrimaryPayerIds
type_payers/v4:PayerCategory:
type: string
enum:
- BCBS
- AETNA_AFFILIATED
- CIGNA_AFFILIATED
- UNITED_AFFILIATED
- MEDICARE
- NON_TRADITIONAL_MEDICARE
- MEDICAID
- HOSPICE
- SNF
- TRICARE
- WORKERS_COMP
- OTHER_GOVERNMENT
- AUTO_TPL
title: PayerCategory
type_payers/v4:PayerIds:
type: object
properties:
claims_payer_id:
type: string
description: The payer ID for claim submission
eligibility_payer_id:
type: string
description: The payer ID for eligibility
remittance_payer_id:
type: string
description: The payer ID for remittance
title: PayerIds
type_payers/v4:SupportState:
type: string
enum:
- NOT_SUPPORTED
- SUPPORTED_ENROLLMENT_NOT_REQUIRED
- SUPPORTED_ENROLLMENT_REQUIRED
title: SupportState
type_payers/v4:ClearinghousePayerInfo:
type: object
properties:
payer_name:
type: string
description: The clearinghouse display name of the payer.
professional_payer_ids:
$ref: '#/components/schemas/type_payers/v4:PayerIds'
description: Payer IDs for professional claims
institutional_payer_ids:
$ref: '#/components/schemas/type_payers/v4:PayerIds'
description: Payer IDs for institutional claims
professional_claims_support:
$ref: '#/components/schemas/type_payers/v4:SupportState'
description: The support state for claims submission
institutional_claims_support:
$ref: '#/components/schemas/type_payers/v4:SupportState'
description: The support state for institutional claims submission
eligibility_support:
$ref: '#/components/schemas/type_payers/v4:SupportState'
description: The support state for eligibility
remittance_support:
$ref: '#/components/schemas/type_payers/v4:SupportState'
description: The support state for remittance
claim_attachment_support:
$ref: '#/components/schemas/type_payers/v4:SupportState'
description: The support state for claim attachment submission
required:
- payer_name
- professional_payer_ids
- institutional_payer_ids
- professional_claims_support
- institutional_claims_support
- eligibility_support
- remittance_support
- claim_attachment_support
title: ClearinghousePayerInfo
type_payers/v4:Payer:
type: object
properties:
payer_uuid:
$ref: '#/components/schemas/type_payers/v4:PayerUuid'
description: Auto-generated ID set on creation.
payer_ids:
$ref: '#/components/schemas/type_payers/v4:PrimaryPayerIds'
description: The primary national payer IDs of the payer.
payer_name:
type: string
description: The primary display name of the payer.
payer_category:
$ref: '#/components/schemas/type_payers/v4:PayerCategory'
description: The category of the payer.
alternate_payer_names:
type: array
items:
type: string
description: The alternate display names of the payer.
clearinghouse_payer_info:
type: object
additionalProperties:
$ref: '#/components/schemas/type_payers/v4:ClearinghousePayerInfo'
street_address:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
alternate_payer_addresses:
type: array
items:
$ref: '#/components/schemas/type_commons:StreetAddressLongZip'
required:
- payer_uuid
- payer_ids
- payer_name
- alternate_payer_names
- clearinghouse_payer_info
- alternate_payer_addresses
title: Payer
type_payers/v4:PayerPage:
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_payers/v4:Payer'
required:
- items
title: PayerPage
type_service-lines/v2:ServiceLineCreateStandalone:
type: object
properties:
modifiers:
type: array
items:
$ref: '#/components/schemas/type_commons:ProcedureModifier'
charge_amount_cents:
type: integer
description: >-
The total amount charged for this service line, factoring in quantity. The system will attempt to set it
based on the chargemaster configuration 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, the system will default to the amount set via this field.
denial_reason:
$ref: '#/components/schemas/type_service-lines/v2:ServiceLineDenialReason'
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).
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'
claim_id:
$ref: '#/components/schemas/type_commons:ClaimId'
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
drug_identification:
$ref: '#/components/schemas/type_service-lines/v2:DrugIdentification'
ordering_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:OrderingProvider'
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:TestResult'
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.
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.
note:
type: string
description: Maps to NTE02 loop 2400 on the EDI 837.
procedure_code:
type: string
diagnosis_id_zero:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_one:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_two:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_three:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
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.
required:
- quantity
- units
- claim_id
- procedure_code
title: ServiceLineCreateStandalone
type_service-lines/v2:UniversalServiceLineCreateStandalone:
type: object
properties:
modifiers:
type: array
items:
$ref: '#/components/schemas/type_commons:ProcedureModifier'
charge_amount_cents:
type: integer
description: >-
The total amount charged for this service line, factoring in quantity. The system will attempt to set it
based on the chargemaster configuration 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, the system will default to the amount set via this field.
denial_reason:
$ref: '#/components/schemas/type_service-lines/v2:ServiceLineDenialReason'
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).
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'
claim_id:
$ref: '#/components/schemas/type_commons:ClaimId'
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
drug_identification:
$ref: '#/components/schemas/type_service-lines/v2:DrugIdentification'
ordering_provider:
$ref: '#/components/schemas/type_encounter-providers/v2:OrderingProvider'
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:TestResult'
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.
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.
note:
type: string
description: Maps to NTE02 loop 2400 on the EDI 837.
diagnosis_id_zero:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_one:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_two:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_three:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
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).
procedure_code:
type: string
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.
required:
- quantity
- units
- claim_id
title: UniversalServiceLineCreateStandalone
type_service-lines/v2:UniversalServiceLineUpdate:
type: object
properties:
edit_reason:
type: string
modifiers:
type: array
items:
$ref: '#/components/schemas/type_commons:ProcedureModifier'
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.
drug_identification:
$ref: '#/components/schemas/type_service-lines/v2:DrugIdentification'
denial_reason:
$ref: '#/components/schemas/type_service-lines/v2:ServiceLineDenialReason'
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).
units:
$ref: '#/components/schemas/type_commons:ServiceLineUnits'
procedure_code:
type: string
description: >-
If `procedure_code` is updated, and `charge_amount_cents` is not, then `charge_amount_cents` will be set by
the system.
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.
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
description: date_of_service must be defined on either the encounter or the service lines but not both.
end_date_of_service:
type: string
format: date
test_results:
type: array
items:
$ref: '#/components/schemas/type_service-lines/v2:TestResult'
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.
Updating test results utilizes PUT semantics, so the test results on the service line will be set to
whatever inputs are provided.
has_epsdt_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. This box is not used on an 837i.
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.
note:
type: string
description: Maps to NTE02 loop 2400 on the EDI 837.
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.
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).
diagnosis_id_zero:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_one:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_two:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_three:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
title: UniversalServiceLineUpdate
type_service-lines/v2:ServiceLineUpdate:
type: object
properties:
edit_reason:
type: string
modifiers:
type: array
items:
$ref: '#/components/schemas/type_commons:ProcedureModifier'
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.
drug_identification:
$ref: '#/components/schemas/type_service-lines/v2:DrugIdentification'
denial_reason:
$ref: '#/components/schemas/type_service-lines/v2:ServiceLineDenialReason'
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).
units:
$ref: '#/components/schemas/type_commons:ServiceLineUnits'
procedure_code:
type: string
description: >-
If `procedure_code` is updated, and `charge_amount_cents` is not, then `charge_amount_cents` will be set by
the system.
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.
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
description: date_of_service must be defined on either the encounter or the service lines but not both.
end_date_of_service:
type: string
format: date
test_results:
type: array
items:
$ref: '#/components/schemas/type_service-lines/v2:TestResult'
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.
Updating test results utilizes PUT semantics, so the test results on the service line will be set to
whatever inputs are provided.
has_epsdt_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. This box is not used on an 837i.
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.
note:
type: string
description: Maps to NTE02 loop 2400 on the EDI 837.
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.
diagnosis_id_zero:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_one:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_two:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
diagnosis_id_three:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
title: ServiceLineUpdate
type_superbills/v1:SuperbillOutputFormat:
type: string
enum:
- DOCX
- PDF
description: Output format for the generated superbill.
title: SuperbillOutputFormat
type_superbills/v1:Superbill:
type: object
properties:
superbill_id:
type: string
description: Primary id of the superbill.
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
description: external_id of the patient.
authed_url:
type: string
description: Authenticated URL for downloading the generated superbill file.
date_range_min:
type: string
format: date
description: Minimum (inclusive) date selected for this superbill.
date_range_max:
type: string
format: date
description: Maximum (inclusive) date selected for this superbill.
file_name:
type: string
description: Original filename of the superbill.
required:
- superbill_id
- patient_external_id
- authed_url
- date_range_min
- date_range_max
- file_name
title: Superbill
type_superbills/v1:SuperbillResponse:
type: object
properties:
superbills:
type: array
items:
$ref: '#/components/schemas/type_superbills/v1:Superbill'
description: Each object represents a single Superbill for a single billing provider.
required:
- superbills
title: SuperbillResponse
type_commons:TaskId:
type: string
format: uuid
title: TaskId
type_tasks/v3:TaskActionExecutionMethod:
oneOf:
- type: object
properties:
type:
type: string
enum:
- close_task
description: 'Discriminator value: close_task'
required:
- type
discriminator:
propertyName: type
title: TaskActionExecutionMethod
type_tasks/v3:TaskActionType:
type: string
enum:
- close_task
- close_task_and_reprocess
title: TaskActionType
type_tasks/v3:TaskAction:
type: object
properties:
display_name:
type: string
execution_method:
$ref: '#/components/schemas/type_tasks/v3:TaskActionExecutionMethod'
type:
$ref: '#/components/schemas/type_tasks/v3:TaskActionType'
required:
- display_name
- execution_method
- type
title: TaskAction
type_tasks/v3:TaskActions:
type: object
properties:
actions:
type: array
items:
$ref: '#/components/schemas/type_tasks/v3:TaskAction'
required:
- actions
title: TaskActions
type_tasks/commons:TaskStatus:
type: string
enum:
- finished
- addressed_by_provider_group
- sent_to_provider_group
- open
- blocked
- waiting_for_review
- in_progress
title: TaskStatus
type_tasks/commons:TaskType:
type: string
enum:
- CUSTOMER_DATA_REQUEST
- CLAIM_SUBMISSION_RUN_VALIDATIONS_FAILURE
- CLAIM_SUBMISSION_SUBMIT_CLAIM_FAILURE
- CLAIM_SUBMISSION_TRANSFORM_FAILURE
- CODE_CLAIM
- CODE_CLAIM_REVIEW
- ELIGIBILITY
- CLAIM_FOLLOW_UP
- REJECTION_RESOLUTION
- PAYER_CONFIGURATION_ERROR
- DENIAL_RESOLUTION
- MISSING_ENROLLMENT
- CHARGE_CAPTURE_UPDATE
title: TaskType
type_tasks/v3:TaskSortOptions:
type: string
enum:
- updated_at:asc
- updated_at:desc
- patient_name:asc
- patient_name:desc
- patient_external_id:asc
- patient_external_id:desc
- payer_name:asc
- payer_name:desc
- payer_id:asc
- payer_id:desc
- status:asc
- status:desc
- task_type:asc
- task_type:desc
- category:asc
- category:desc
- agg_updated_at:asc
- agg_updated_at:desc
- date_of_service:asc
- date_of_service:desc
- blocks_claim_submission:asc
- blocks_claim_submission:desc
title: TaskSortOptions
type_commons:TaskNoteId:
type: string
format: uuid
title: TaskNoteId
type_tasks/v3:TaskNote:
type: object
properties:
task_note_id:
$ref: '#/components/schemas/type_commons:TaskNoteId'
text:
type: string
created_at:
type: string
format: date-time
author_name:
type: string
author_organization_name:
type: string
required:
- task_note_id
- text
- created_at
- author_name
- author_organization_name
title: TaskNote
type_commons:TaskAssignmentId:
type: string
format: uuid
title: TaskAssignmentId
type_tasks/v3:TaskAssignment:
type: object
properties:
task_assignment_id:
$ref: '#/components/schemas/type_commons:TaskAssignmentId'
assignee_user_id:
$ref: '#/components/schemas/type_commons:UserId'
required:
- task_assignment_id
title: TaskAssignment
type_tasks/commons:TaskCategory:
type: string
enum:
- other
- provider_credentialing
- authorization_required
- inactive_coverage
- unknown_eligibility_or_patient_not_found
- incorrect_member_id
- documentation_addendum_request
- coordination_of_benefits
- missing_or_incorrect_gender
- incorrect_date_of_birth
- incorrect_payer
- incorrect_name
- invalid_diagnosis_code
- non_covered_diagnosis_codes
- information_requested_from_patient
- incorrect_rendering_provider_info
- missing_or_incorrect_modifier
- coding_frequency_error
- incorrect_patient_address
- multiple_em_claims
- missing_or_incorrect_charge_amount
- medical_records_request
- provider_enrollment_or_contracting
- missing_or_incorrect_group_number
- missing_diagnosis_codes
- missing_patient_authorization
- incorrect_billing_provider_info
- incorrect_procedure_code
- incorrect_quantity
- incorrect_place_of_service_code
- incorrect_service_facility_info
- incorrect_date_of_service
- missing_or_incorrect_ndc
- patient_collections
- submit_to_secondary
- transient_server_error
- missing_remittance_enrollment
- missing_claims_enrollment
- held_by_customer
- pending_manual_remit_posting
- incorrect_referring_provider_info
- payer_configuration_error
title: TaskCategory
type_pipeline-commons:ConfigurableRuleId:
type: string
format: uuid
title: ConfigurableRuleId
type_tasks/v3:Task:
type: object
properties:
task_id:
$ref: '#/components/schemas/type_commons:TaskId'
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
task_type:
$ref: '#/components/schemas/type_tasks/commons:TaskType'
description:
type: string
blocks_claim_submission:
type: boolean
external_id:
type: string
patient_name:
type: string
patient_external_id:
type: string
payer_name:
type: string
payer_id:
type: string
status:
$ref: '#/components/schemas/type_tasks/commons:TaskStatus'
notes:
type: array
items:
$ref: '#/components/schemas/type_tasks/v3:TaskNote'
created_at:
type: string
format: date-time
updated_at:
type: string
format: date-time
description: The time of most recent update to the task only
agg_updated_at:
type: string
format: date-time
description: The time of most recent update to the task or any of its notes
date_of_service:
type: string
format: date
assignments:
type: array
items:
$ref: '#/components/schemas/type_tasks/v3:TaskAssignment'
category:
$ref: '#/components/schemas/type_tasks/commons:TaskCategory'
configurable_rule_id:
$ref: '#/components/schemas/type_pipeline-commons:ConfigurableRuleId'
required:
- task_id
- encounter_id
- task_type
- description
- blocks_claim_submission
- external_id
- patient_name
- patient_external_id
- status
- notes
- created_at
- updated_at
- agg_updated_at
- date_of_service
- assignments
title: Task
type_tasks/v3:TaskPage:
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_tasks/v3:Task'
required:
- items
title: TaskPage
type_tasks/v3:TaskCreateV3:
type: object
properties:
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
task_type:
$ref: '#/components/schemas/type_tasks/commons:TaskType'
description:
type: string
blocks_claim_submission:
type: boolean
assignee_user_id:
$ref: '#/components/schemas/type_commons:UserId'
category:
$ref: '#/components/schemas/type_tasks/commons:TaskCategory'
work_queue_id:
$ref: '#/components/schemas/type_commons:WorkQueueId'
required:
- encounter_id
- task_type
- description
- work_queue_id
title: TaskCreateV3
type_tasks/v3:TaskUpdateV3:
type: object
properties:
status:
$ref: '#/components/schemas/type_tasks/commons:TaskStatus'
assignee_user_id:
$ref: '#/components/schemas/type_commons:UserId'
blocks_claim_submission:
type: boolean
title: TaskUpdateV3
type_tasks/v3:TaskUpdatedToDeprecatedStatusErrorType:
type: object
properties:
deprecated_status:
$ref: '#/components/schemas/type_tasks/commons:TaskStatus'
title: TaskUpdatedToDeprecatedStatusErrorType
type_write-offs/v1:WriteOffSortField:
type: string
enum:
- amount_cents
- write_off_timestamp
- write_off_note
title: WriteOffSortField
type_financials:AccountType:
type: string
enum:
- PATIENT
- INSURANCE
- THIRD_PARTY_PAYER
title: AccountType
type_write-offs/v1:WriteOffId:
type: string
format: uuid
title: WriteOffId
type_write-offs/v1:PatientWriteOffReason:
type: string
enum:
- SMALL_BALANCE
- CHARITY_OR_FINANCIAL_ASSISTANCE
- PATIENT_EXPERIENCE_OR_SERVICE_RECOVERY
- OON_COURTESY_ADJUSTMENT
- PROMPT_PAY_DISCOUNT
- BAD_DEBT
- COLLECTION_AGENCY
- OTHER
- UNKNOWN
- UNCOLLECTIBLE_OR_NON_BILLABLE
- DECEASED
- BANKRUPTCY
title: PatientWriteOffReason
type_write-offs/v1:InsuranceWriteOffTarget:
oneOf:
- type: object
properties:
type:
type: string
enum:
- service_line_id
description: 'Discriminator value: service_line_id'
value:
$ref: '#/components/schemas/type_commons:ServiceLineId'
required:
- type
- value
- type: object
properties:
type:
type: string
enum:
- claim_id
description: 'Discriminator value: claim_id'
value:
$ref: '#/components/schemas/type_commons:ClaimId'
required:
- type
- value
- type: object
properties:
type:
type: string
enum:
- billing_provider_id
description: 'Discriminator value: billing_provider_id'
value:
$ref: '#/components/schemas/type_commons:ProviderId'
required:
- type
- value
discriminator:
propertyName: type
title: InsuranceWriteOffTarget
type_write-offs/v1:InsuranceWriteOffReason:
type: string
enum:
- SMALL_BALANCE
- NO_AUTHORIZATION_REFERRAL
- TIMELY_FILING
- STALE_DATE
- TIMELY_FILING_LATE_ENCOUNTER
- CREDENTIALING_OR_CONTRACTING
- NON_COVERED_MAX_BENEFIT
- NOT_MEDICALLY_NECESSARY
- BUNDLED_OR_INCLUSIVE
- UNCOLLECTIBLE_OR_NON_BILLABLE
- EFFORTS_EXHAUSTED
- ADMINISTRATIVE_WRITE_OFF
- CASE_RATE_OR_CAPITATED
- OTHER
- UNKNOWN
- CONTRACTUAL_ADJUSTMENT
- PRIMARY_PAID_MAX_BENEFITS
- INTEREST
title: InsuranceWriteOffReason
type_write-offs/v1:WriteOff:
oneOf:
- type: object
properties:
type:
type: string
enum:
- patient
description: 'Discriminator value: patient'
write_off_id:
$ref: '#/components/schemas/type_write-offs/v1:WriteOffId'
write_off_timestamp:
type: string
format: date-time
write_off_note:
type: string
write_off_reason:
$ref: '#/components/schemas/type_write-offs/v1:PatientWriteOffReason'
patient_external_id:
$ref: '#/components/schemas/type_commons:PatientExternalId'
claim_id:
$ref: '#/components/schemas/type_commons:ClaimId'
service_line_id:
$ref: '#/components/schemas/type_commons:ServiceLineId'
reverts_write_off_id:
$ref: '#/components/schemas/type_write-offs/v1:WriteOffId'
reverted_by_write_off_id:
$ref: '#/components/schemas/type_write-offs/v1:WriteOffId'
amount_cents:
type: integer
required:
- type
- write_off_id
- write_off_timestamp
- write_off_reason
- patient_external_id
- claim_id
- service_line_id
- amount_cents
- type: object
properties:
type:
type: string
enum:
- insurance
description: 'Discriminator value: insurance'
write_off_id:
$ref: '#/components/schemas/type_write-offs/v1:WriteOffId'
payer:
$ref: '#/components/schemas/type_payers/v3:Payer'
write_off_target:
$ref: '#/components/schemas/type_write-offs/v1:InsuranceWriteOffTarget'
write_off_timestamp:
type: string
format: date-time
write_off_note:
type: string
write_off_reason:
$ref: '#/components/schemas/type_write-offs/v1:InsuranceWriteOffReason'
reverts_write_off_id:
$ref: '#/components/schemas/type_write-offs/v1:WriteOffId'
reverted_by_write_off_id:
$ref: '#/components/schemas/type_write-offs/v1:WriteOffId'
amount_cents:
type: integer
required:
- type
- write_off_id
- payer
- write_off_target
- write_off_timestamp
- write_off_reason
- amount_cents
- type: object
properties:
type:
type: string
enum:
- non_insurance_payer
description: 'Discriminator value: non_insurance_payer'
write_off_id:
$ref: '#/components/schemas/type_write-offs/v1:WriteOffId'
non_insurance_payer:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayer'
service_line_id:
$ref: '#/components/schemas/type_commons:ServiceLineId'
write_off_timestamp:
type: string
format: date-time
write_off_note:
type: string
write_off_reason:
$ref: '#/components/schemas/type_write-offs/v1:InsuranceWriteOffReason'
reverts_write_off_id:
$ref: '#/components/schemas/type_write-offs/v1:WriteOffId'
reverted_by_write_off_id:
$ref: '#/components/schemas/type_write-offs/v1:WriteOffId'
amount_cents:
type: integer
required:
- type
- write_off_id
- non_insurance_payer
- service_line_id
- write_off_timestamp
- write_off_reason
- amount_cents
discriminator:
propertyName: type
title: WriteOff
type_write-offs/v1:WriteOffsPage:
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_write-offs/v1:WriteOff'
required:
- items
title: WriteOffsPage
type_write-offs/v1:WriteOffCreate:
oneOf:
- type: object
properties:
type:
type: string
enum:
- patient
description: 'Discriminator value: patient'
write_off_timestamp:
type: string
format: date-time
write_off_note:
type: string
write_off_reason:
$ref: '#/components/schemas/type_write-offs/v1:PatientWriteOffReason'
service_line_id:
$ref: '#/components/schemas/type_commons:ServiceLineId'
amount_cents:
type: integer
required:
- type
- write_off_timestamp
- write_off_reason
- service_line_id
- amount_cents
- type: object
properties:
type:
type: string
enum:
- insurance
description: 'Discriminator value: insurance'
payer_identifier:
$ref: '#/components/schemas/type_payers/v3:PayerIdentifier'
write_off_target:
$ref: '#/components/schemas/type_write-offs/v1:InsuranceWriteOffTarget'
write_off_timestamp:
type: string
format: date-time
write_off_note:
type: string
write_off_reason:
$ref: '#/components/schemas/type_write-offs/v1:InsuranceWriteOffReason'
amount_cents:
type: integer
required:
- type
- payer_identifier
- write_off_target
- write_off_timestamp
- write_off_reason
- amount_cents
- type: object
properties:
type:
type: string
enum:
- non_insurance_payer
description: 'Discriminator value: non_insurance_payer'
non_insurance_payer_id:
$ref: '#/components/schemas/type_non-insurance-payers/v1:NonInsurancePayerId'
service_line_id:
$ref: '#/components/schemas/type_commons:ServiceLineId'
write_off_timestamp:
type: string
format: date-time
write_off_note:
type: string
write_off_reason:
$ref: '#/components/schemas/type_write-offs/v1:InsuranceWriteOffReason'
amount_cents:
type: integer
required:
- type
- non_insurance_payer_id
- service_line_id
- write_off_timestamp
- write_off_reason
- amount_cents
discriminator:
propertyName: type
title: WriteOffCreate
type_write-offs/v1:CreateWriteOffsResponse:
type: object
properties:
write_offs:
type: array
items:
$ref: '#/components/schemas/type_write-offs/v1:WriteOff'
required:
- write_offs
title: CreateWriteOffsResponse
type_commons:AdjustmentId:
type: string
format: uuid
title: AdjustmentId
type_diagnoses:StandaloneDiagnosisCreate:
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.
Should be of the appropriate format for the provided `code_type`.
Must obey the ICD-10 format if an ICD-10 code_type is provided, specifically:
- Letter
- Digit
- Digit or the letter `A` or `B`
- (Optional) Period `.`
- 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.
encounter_id:
$ref: '#/components/schemas/type_commons:EncounterId'
required:
- code_type
- code
- encounter_id
title: StandaloneDiagnosisCreate
type_diagnoses:DiagnosisNotFoundError:
type: object
properties:
diagnosis_id:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
message:
type: string
required:
- message
title: DiagnosisNotFoundError
type_diagnoses:DisallowMultiplePrimaryDiagnosisError:
type: object
properties:
existing_primary_diagnosis_id:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
new_primary_diagnosis_id:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
message:
type: string
required:
- existing_primary_diagnosis_id
- new_primary_diagnosis_id
- message
title: DisallowMultiplePrimaryDiagnosisError
type_diagnoses:ServiceLinesMustHaveAtLeastOneDiagnosisError:
type: object
properties:
diagnosis_id:
$ref: '#/components/schemas/type_diagnoses:DiagnosisId'
service_line_id:
$ref: '#/components/schemas/type_commons:ServiceLineId'
message:
type: string
required:
- diagnosis_id
- service_line_id
- message
title: ServiceLinesMustHaveAtLeastOneDiagnosisError
securitySchemes:
OAuthScheme:
type: http
scheme: bearer
description: OAuth 2.0 authentication