openapi: 3.2.0 info: title: Reference V4 API version: 1.0.0 servers: - url: https://pre-api.joincandidhealth.com description: Production - url: https://pre-api-staging.joincandidhealth.com description: Staging - url: https://sandbox-pre-api.joincandidhealth.com description: CandidSandbox - url: https://staging-pre-api.joincandidhealth.com description: CandidStaging - url: http://localhost:4000 description: Local - url: https://api.joincandidhealth.com description: Production - url: https://api-staging.joincandidhealth.com description: Staging - url: https://sandbox-api.joincandidhealth.com description: CandidSandbox - url: https://staging-api.joincandidhealth.com description: CandidStaging - url: http://localhost:5050 description: Local tags: - name: v4 paths: /api/patient-payments/v4: get: operationId: getMulti 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: - 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: - 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 allocation_restrictions: type: array items: $ref: '#/components/schemas/type_financials_AllocationRestrictionCreate' description: 'Optional restrictions constraining which claims this payment''s credit can be auto-allocated to (e.g. billing provider NPI). Restriction (type, value) pairs must be unique. When omitted, the payment is unrestricted.' 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: - 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: - 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: - 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/encounters/v4: get: operationId: getAll summary: Get all encounters tags: - 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: billing_provider_npis in: query description: Filter to encounters whose billing provider matches any of these NPIs. required: false schema: $ref: '#/components/schemas/type_commons_Npi' - 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: - 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: - 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: - 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: - 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\npatients and appointments in the pre-encounter service and is currently under development. Consumers who are not taking advantage\nof the pre-encounter service should use the standard create endpoint.\n\nThe endpoint will create an encounter from the provided fields, pulling information from the provided patient and appointment objects\nwhere applicable. In particular, the following fields are populated from the patient and appointment objects:\n - Patient\n - Referring Provider\n - Subscriber Primary\n - Subscriber Secondary\n - Referral Number\n - Responsible Party\n - Guarantor\n\nUtilizing this endpoint opts you into automatic updating of the encounter when the patient or appointment is updated, assuming the\nencounter has not already been submitted or adjudicated.\n\nNotice: The UB-04 Data File, 2025, is copyrighted by American Hospital Association (AHA), Chicago, Illinois.\nNo portion of the THE UB-04 Data File, may be reproduced, stored in a retrieval system, or transmitted,\nin any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior\nexpress, written consent of AHA." tags: - 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\npatients and appointments in the pre-encounter service and is currently under development. Consumers who are not taking advantage\nof the pre-encounter service should use the standard create endpoint.\n\nThe endpoint will create an encounter from the provided fields, pulling information from the provided patient and appointment objects\nwhere applicable. In particular, the following fields are populated from the patient and appointment objects:\n - Patient\n - Referring Provider\n - Subscriber Primary\n - Subscriber Secondary\n - Referral Number\n - Responsible Party\n - Guarantor\n\nUtilizing this endpoint opts you into automatic updating of the encounter when the patient or appointment is updated, assuming the\nencounter has not already been submitted or adjudicated." tags: - 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: - 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/payers/v4/{payer_uuid}: get: operationId: get summary: Get payer tags: - 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: getAll summary: Get all payers tags: - 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' components: schemas: type_encounter-providers_v2_ReferringProviderSecondaryIdentificationQualifier: type: string enum: - 0B - 1G - G2 title: ReferringProviderSecondaryIdentificationQualifier type_commons_EncounterId: type: string format: uuid title: EncounterId type_commons_UnprocessableEntityErrorMessage: type: object properties: message: type: string title: UnprocessableEntityErrorMessage 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_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_commons_EPSDTReferralConditionIndicatorCode: type: string enum: - AV - NU - S2 - ST title: EPSDTReferralConditionIndicatorCode 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_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_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_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_organization-service-facilities_v2_OrganizationServiceFacilityId: type: string format: uuid title: OrganizationServiceFacilityId type_diagnoses_DiagnosisTypeCode: type: string enum: - ABF - ABJ - ABK - APR - BF - BJ - BK - PR - DR - LOI title: DiagnosisTypeCode 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_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 composition 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_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_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_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_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_guarantor_v1_GuarantorId: type: string format: uuid title: GuarantorId type_health-care-code-information_v1_OtherDiagnosisInformationCodeQualifier: type: string enum: - BF - ABF title: OtherDiagnosisInformationCodeQualifier 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_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_commons_Email: type: string title: Email 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_commons_Decimal: type: string description: String representation of a Decimal that can be parsed by most libraries. title: Decimal type_commons_Date: type: string description: ISO 8601 date; formatted YYYY-MM-DD (i.e. 2012-02-01) title: Date 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_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-lines_v2_ServiceIdQualifier: type: string enum: - EN - EO - HI - N4 - 'ON' - UK - UP title: ServiceIdQualifier 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_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_health-care-code-information_v1_SetOrClearPrincipalDiagnosis: type: object properties: value: $ref: '#/components/schemas/type_health-care-code-information_v1_PrincipalDiagnosis' title: SetOrClearPrincipalDiagnosis 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_commons_InvoiceId: type: string format: uuid title: InvoiceId 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_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_encounters_v4_IntakeResponseAndFollowUps: type: object properties: response: type: string follow_ups: type: array items: $ref: '#/components/schemas/type_encounters_v4_IntakeFollowUp' title: IntakeResponseAndFollowUps type_encounter-providers_v2_ProviderId: type: string format: uuid title: ProviderId 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_encounters_v4_EncounterSubmissionOriginType: type: string enum: - CANDID - EXTERNAL title: EncounterSubmissionOriginType type_commons_UnauthorizedErrorMessage: type: object properties: message: type: string title: UnauthorizedErrorMessage 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_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_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_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_encounters_v4_LabCodeType: type: string enum: - quest - labcorp title: LabCodeType type_commons_SortDirection: type: string enum: - asc - desc title: SortDirection 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_patient-payments_v3_PatientPaymentStatus: type: string enum: - PENDING - paid - CANCELED - voided - FAILED - COMPLETED - succeeded - pending - failed - requires_action - canceled title: PatientPaymentStatus 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_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_x12_v1_TypeOfFacilityCode: type: string enum: - '1' - '2' - '3' - '4' - '6' - '7' - '8' title: TypeOfFacilityCode 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_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_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' provider_info: $ref: '#/components/schemas/type_patient-payments_v4_PaymentMethodProviderInfo' required: - payment_method title: PaymentMethodDetailCreate 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_TreatmentCode: type: string title: TreatmentCode 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_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_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_encounters_v4_SynchronicityType: type: string enum: - Synchronous - Asynchronous title: SynchronicityType type_patient-payments_v4_PatientPaymentSortField: type: string enum: - payment_source - amount_cents - payment_timestamp - payment_note title: PatientPaymentSortField type_commons_AppointmentId: type: string title: AppointmentId 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_Npi: type: string title: Npi type_health-care-code-information_v1_ValueCodeQualifier: type: string enum: - BE title: ValueCodeQualifier 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_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_encounters_v4_PriorAuthorizationNumber: type: string title: PriorAuthorizationNumber type_service-facility_ServiceFacilityId: type: string format: uuid title: ServiceFacilityId type_health-care-code-information_v1_TreatmentCodeQualifier: type: string enum: - TC title: TreatmentCodeQualifier 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_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_commons_ProcedureModifier: type: string enum: - AV - AU - AW - AY - '07' - 08 - 09 - '10' - '11' - '12' - '13' - '14' - '15' - '16' - '22' - '23' - '24' - '25' - '26' - '27' - '28' - '32' - '33' - '47' - '50' - '51' - '52' - '53' - '54' - '55' - '56' - '57' - '58' - '59' - '62' - '63' - '66' - '73' - '74' - '76' - '77' - '78' - '79' - '80' - '81' - '82' - '90' - '91' - '92' - '93' - '95' - '96' - '97' - '99' - A1 - A2 - A3 - A4 - A5 - A6 - A7 - A8 - A9 - AA - AB - AD - AE - AF - AG - AH - AI - AJ - AK - AM - AO - AP - AQ - AR - AS - AT - AZ - BA - BL - BO - BP - BR - BU - CA - CB - CC - CD - CE - CF - CG - CH - CI - CJ - CK - CL - CM - CN - CR - CS - CT - CO - CQ - DA - E1 - E2 - E3 - E4 - EA - EB - EC - ED - EE - EJ - EM - EP - ER - ET - EV - EX - EY - F1 - F2 - F3 - F4 - F5 - F6 - F7 - F8 - F9 - FA - FB - FC - FP - FQ - FR - FS - FT - FX - FY - G0 - G1 - G2 - G3 - G4 - G5 - G6 - G7 - G8 - G9 - GA - GB - GC - GE - GF - GG - GH - GJ - GK - GL - GM - GN - GO - GP - GQ - GR - GS - GT - GU - GV - GW - GX - GY - GZ - HA - HB - HC - HD - HE - HF - HG - HH - HI - HJ - HK - HL - HM - HN - HO - HP - HQ - HR - HS - HT - HU - HV - HW - HX - HY - HZ - J1 - J2 - J3 - J4 - J5 - JA - JB - JC - JD - JE - JG - JW - JZ - K0 - K1 - K2 - K3 - K4 - KA - KB - KC - KD - KE - KF - KG - KH - KI - KJ - KK - KL - KM - KN - KO - KP - KQ - KR - KS - KT - KU - KV - KW - KX - KY - KZ - LC - LD - LL - LM - LR - LS - LT - LU - M2 - MA - MB - MC - MD - ME - MF - MG - MH - MS - N1 - N2 - N3 - NB - NR - NU - P1 - P2 - P3 - P4 - P5 - P6 - PA - PB - PC - PD - PI - PL - PM - PN - PO - PS - PT - Q0 - Q1 - Q2 - Q3 - Q4 - Q5 - Q6 - Q7 - Q8 - Q9 - QA - QB - QC - QD - QE - QF - QG - QH - QJ - QK - QL - QM - QN - QP - QQ - QR - QS - QT - QW - QX - QY - QZ - RA - RB - RC - RD - RE - RI - RR - RT - SA - SB - SC - SD - SE - SF - SG - SH - SJ - SL - SM - SN - SQ - SS - ST - SU - SV - SW - SY - T1 - T2 - T3 - T4 - T5 - T6 - T7 - T8 - T9 - TA - TB - TC - TD - TE - TF - TG - TH - TJ - TK - TL - TM - TN - TP - TQ - TR - TS - TT - TU - TV - TW - U1 - U2 - U3 - U4 - U5 - U6 - U7 - U8 - U9 - UA - UB - UC - UD - UE - UF - UG - UH - UJ - UK - UN - UP - UQ - UR - US - V1 - V2 - V3 - W1 - W2 - W3 - X4 - XE - XP - XS - XU - XY - ZZ title: ProcedureModifier type_health-care-code-information_v1_SetOrClearDiagnosisRelatedGroup: type: object properties: value: $ref: '#/components/schemas/type_health-care-code-information_v1_DiagnosisRelatedGroup' title: SetOrClearDiagnosisRelatedGroup 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_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_health-care-code-information_v1_ICDCode: type: string title: ICDCode type_health-care-code-information_v1_ExternalCauseOfInjuryCodeQualifier: type: string enum: - BN - ABN title: ExternalCauseOfInjuryCodeQualifier 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_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_billing-notes_v2_BillingNoteId: type: string format: uuid title: BillingNoteId type_health-care-code-information_v1_PatientReasonForVisitCodeQualifier: type: string enum: - PR - APR title: PatientReasonForVisitCodeQualifier 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_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_encounters_v4_EncounterSubmissionExpectation: type: string enum: - TARGET_PROFESSIONAL - TARGET_INSTITUTIONAL description: 'Used to describe the currently expected target form for this encounter. This affects 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_encounters_v4_CodingAttributionType: type: string enum: - CANDID - CUSTOMER - TCN - PJF title: CodingAttributionType type_commons_PhoneNumber: type: object properties: number: type: string type: $ref: '#/components/schemas/type_commons_PhoneNumberType' required: - number - type title: PhoneNumber 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_commons_EncounterExternalId: type: string title: EncounterExternalId 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_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_commons_NextResponsibleParty: type: string enum: - primary - secondary - tertiary - patient - non_insurance - none title: NextResponsibleParty 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_commons_EmrPayerCrosswalk: type: string enum: - HEALTHIE - CANVAS - WAYSTAR - PAYER_PLAN_GROUP title: EmrPayerCrosswalk 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_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_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_encounters_v4_BillableStatusType: type: string enum: - BILLABLE - NOT_BILLABLE title: BillableStatusType 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_invoices_v2_InvoiceStatus: type: string enum: - DRAFT - OPEN - PAID - VOID - UNCOLLECTIBLE - HELD title: InvoiceStatus type_invoices_v2_UnattributedInvoiceItem: type: object properties: amount_cents: type: integer required: - amount_cents title: UnattributedInvoiceItem 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_x12_v1_PointOfOriginForAdmissionOrVisitCode: type: string enum: - '1' - '2' - '4' - '5' - '6' - '8' - '9' - D - E - F - G title: PointOfOriginForAdmissionOrVisitCode type_related-causes_v1_RelatedCausesCode: type: string enum: - AA - AB - AP - EM - OA - ZZ title: RelatedCausesCode 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_encounters_v4_IntakeFollowUpId: type: string title: IntakeFollowUpId 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_health-care-code-information_v1_OtherProcedureInformationCodeQualifier: type: string enum: - BBQ - BQ title: OtherProcedureInformationCodeQualifier type_invoices_v2_InvoiceDestination: type: string enum: - STRIPE - CEDAR - HEALTHIE - COLLECTLY - THIRD_PARTY_PAYERS - INSTAMED - REVSPRING title: InvoiceDestination type_health-care-code-information_v1_SetOrClearPrincipalProcedureInformation: type: object properties: value: $ref: '#/components/schemas/type_health-care-code-information_v1_PrincipalProcedureInformation' title: SetOrClearPrincipalProcedureInformation 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\nRequired for the initial medical service or visit performed in response to a medical emergency when the date is available and is different than the date of service.\nOR\nThis date is the onset of acute symptoms for the current illness or condition.\n For UB-04 claims, this is populated separately via occurrence codes." last_menstrual_period_date: type: string format: date description: '837p Loop2300 DTP*484, CMS-1500 Box 14 Required when, in the judgment of the provider, the services on this claim are related to the patient''s pregnancy. 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_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_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_commons_ServiceLineId: type: string format: uuid title: ServiceLineId type_health-care-code-information_v1_PrincipalProcedureInformationCodeQualifier: type: string enum: - BBR - BR - CAH title: PrincipalProcedureInformationCodeQualifier 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_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_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_ProviderSecondaryIdentificationQualifier: type: string enum: - 0B - 1G - G2 - LU title: ProviderSecondaryIdentificationQualifier type_financials_AllocationRestrictionCreate: type: object properties: restriction_type: $ref: '#/components/schemas/type_financials_AllocationRestrictionType' restriction_value: type: string description: For billing_provider_npi, the NPI. For service_facility_id, the organization service facility ID. required: - restriction_type - restriction_value description: 'Constrains which claims a payment''s credit can be auto-allocated to. Restrictions of the same restriction_type are OR''d together (any value may match); different restriction_types are AND''d (every type present must match). A payment with no restrictions can be allocated to any claim.' title: AllocationRestrictionCreate 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\nRequired for the initial medical service or visit performed in response to a medical emergency when the date is available and is different than the date of service.\nOR\nThis date is the onset of acute symptoms for the current illness or condition.\n For UB-04 claims, this is populated separately via occurrence codes." last_menstrual_period_date: type: string format: date description: '837p Loop2300 DTP*484, CMS-1500 Box 14 Required when, in the judgment of the provider, the services on this claim are related to the patient''s pregnancy. 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 affects 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_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_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_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 payer_uuid: $ref: '#/components/schemas/type_payers_v4_PayerUuid' required: - insurance_card_id - member_id - payer_name - payer_id title: InsuranceCard 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_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_billing-notes_v2_BillingNoteBase: type: object properties: text: type: string description: Empty string not allowed. required: - text title: BillingNoteBase type_health-care-code-information_v1_PresentOnAdmissionIndicatorCode: type: string enum: - Y - N - U - W - '1' title: PresentOnAdmissionIndicatorCode type_commons_InternalErrorMessage: type: object properties: message: type: string title: InternalErrorMessage 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_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_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_OccurrenceSpanCode: type: string enum: - '70' - '71' - '72' - '73' - '74' - '75' - '76' - '77' - '78' - '80' - '81' - '82' - M0 - M1 - M2 - M3 - M4 title: OccurrenceSpanCode 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_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_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_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_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_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_service-lines_v2_TestResultType: type: string enum: - HEMATOCRIT - HEMOGLOBIN - LDL - VITAMIN_D title: TestResultType type_insurance-cards_v2_InsuranceCardId: type: string format: uuid title: InsuranceCardId 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_commons_RequestValidationError: type: object properties: fieldName: type: string humanReadableMessage: type: string required: - fieldName title: RequestValidationError 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_encounters_v4_IntakeQuestionId: type: string title: IntakeQuestionId 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_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_individual_Gender: type: string enum: - male - female - other - not_given - unknown title: Gender type_commons_LinkUrl: type: string title: LinkUrl 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_IntakeFollowUp: type: object properties: id: $ref: '#/components/schemas/type_encounters_v4_IntakeFollowUpId' text: type: string response: type: string required: - id - text title: IntakeFollowUp 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_health-care-code-information_v1_AdmittingDiagnosisCodeQualifier: type: string enum: - BJ - ABJ title: AdmittingDiagnosisCodeQualifier 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_PrincipalDiagnosisCodeQualifier: type: string enum: - BK - ABK title: PrincipalDiagnosisCodeQualifier 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_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_commons_PhoneNumberType: type: string enum: - Home - Mobile - Work title: PhoneNumberType 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_individual_IndividualId: type: string format: uuid title: IndividualId type_health-care-code-information_v1_DiagnosisRelatedGroupCodeQualifier: type: string enum: - DR title: DiagnosisRelatedGroupCodeQualifier 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_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' authorization_number: type: string 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_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_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_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_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_commons_ClaimSubmissionPayerResponsibilityType: type: string enum: - primary - secondary title: ClaimSubmissionPayerResponsibilityType type_commons_PageToken: type: string title: PageToken type_billing-notes_v2_BillingNoteType: type: string enum: - manual - system - queue_added - queue_moved - task_created title: BillingNoteType 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_commons_QualifierCode: type: string enum: - DQ - DN - DK - P3 title: QualifierCode type_tags_TagColorEnum: type: string enum: - black - white - gray - red - yellow - green - blue - indigo - purple - pink title: TagColorEnum 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_property-and-casualty_v1_PropertyCasualtyPatientIdentifierQualifier: type: string enum: - 1W - SY title: PropertyCasualtyPatientIdentifierQualifier 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_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.\nShould be of the appropriate format for the provided `code_type`.\nMust obey the ICD-10 format if an ICD-10 code_type is provided, specifically:\n - Letter\n - Digit\n - Digit or the letter `A` or `B`\n - (Optional) Period `.`\n - Up to 4 (or as few as 0) letters and digits" present_on_admission_indicator: $ref: '#/components/schemas/type_yes-no-indicator_YesNoIndicator' description: 'For Institutional claims only. A "Y" indicates that the onset occurred prior to admission to the hospital. An "N" indicates that the onset did NOT occur prior to admission to the hospital. A "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not.' 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_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\nRequired for the initial medical service or visit performed in response to a medical emergency when the date is available and is different than the date of service.\nOR\nThis date is the onset of acute symptoms for the current illness or condition.\n For UB-04 claims, this is populated separately via occurrence codes." last_menstrual_period_date: type: string format: date description: '837p Loop2300 DTP*484, CMS-1500 Box 14 Required when, in the judgment of the provider, the services on this claim are related to the patient''s pregnancy.de This field is populated separately via occurrence codes for UB-04 claim forms.' delay_reason_code: $ref: '#/components/schemas/type_commons_DelayReasonCode' description: 'Code indicating the reason why a claim submission was delayed. Corresponds to CLM-20 in the 837 specification (both professional and institutional).' patient_authorized_release: type: boolean description: 'Whether this patient has authorized the release of medical information for billing purpose. Box 12 on the CMS-1500 claim form or Form Locator 52 on a UB-04 claim form.' referral_number: type: string description: Refers to REF*9F on the 837p. Value cannot be greater than 50 characters. secondary_payer_carrier_code: type: string description: When Medicaid is billed as the secondary payer the Carrier Code is used to identify the primary payer. This is required for certain states. 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_commons_PayerPlanGroupId: type: string format: uuid title: PayerPlanGroupId type_commons_PreEncounterAppointmentId: type: string format: uuid title: PreEncounterAppointmentId type_commons_OrganizationId: type: string format: uuid title: OrganizationId type_patient-payments_v4_PatientPaymentId: type: string format: uuid title: PatientPaymentId type_health-care-code-information_v1_MSDRGCode: type: string title: MSDRGCode 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_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_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_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_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.\nShould be of the appropriate format for the provided `code_type`.\nMust obey the ICD-10 format if an ICD-10 code_type is provided, specifically:\n - Letter\n - Digit\n - Digit or the letter `A` or `B`\n - (Optional) Period `.`\n - Up to 4 (or as few as 0) letters and digits" present_on_admission_indicator: $ref: '#/components/schemas/type_yes-no-indicator_YesNoIndicator' description: 'For Institutional claims only. A "Y" indicates that the onset occurred prior to admission to the hospital. An "N" indicates that the onset did NOT occur prior to admission to the hospital. A "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not.' required: - code_type - code title: DiagnosisCreate 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_encounters_v4_InterventionCategory: type: string enum: - allopathic - naturopathic - tests - lifestyle title: InterventionCategory 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_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_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_patient-payments_v3_PatientPaymentId: type: string title: PatientPaymentId 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_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_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\nRequired for the initial medical service or visit performed in response to a medical emergency when the date is available and is different than the date of service.\nOR\nThis date is the onset of acute symptoms for the current illness or condition.\n For UB-04 claims, this is populated separately via occurrence codes." last_menstrual_period_date: type: string format: date description: '837p Loop2300 DTP*484, CMS-1500 Box 14 Required when, in the judgment of the provider, the services on this claim are related to the patient''s pregnancy. 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 affects 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_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_commons_AllocationId: type: string format: uuid title: AllocationId 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_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 Plans for automatic payer resolution. See Payer Information documentation for details. payer_plan_group_name: type: string description: When using emr_payer_crosswalk set to PAYER_PLAN_GROUP, specify the payer plan name here. See Payer Information documentation for details. required: - member_id - payer_name - payer_id title: InsuranceCardCreate type_patient-payments_v4_PaymentMethodProviderInfo: type: object properties: npi: $ref: '#/components/schemas/type_commons_Npi' first_name: type: string last_name: type: string title: PaymentMethodProviderInfo 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_payers_v4_PayerUuid: type: string format: uuid title: PayerUuid 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' provider_info: $ref: '#/components/schemas/type_patient-payments_v4_PaymentMethodProviderInfo' required: - payment_method title: PaymentMethodDetail 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_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 - LIEN - HUMANA - MOLINA - OTHER_FACILITY title: PayerCategory 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_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_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\nRequired for the initial medical service or visit performed in response to a medical emergency when the date is available and is different than the date of service.\nOR\nThis date is the onset of acute symptoms for the current illness or condition.\n For UB-04 claims, this is populated separately via occurrence codes." last_menstrual_period_date: type: string format: date description: '837p Loop2300 DTP*484, CMS-1500 Box 14 Required when, in the judgment of the provider, the services on this claim are related to the patient''s pregnancy. 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_v4_RxCui: type: string title: RxCui 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_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\nRequired for the initial medical service or visit performed in response to a medical emergency when the date is available and is different than the date of service.\nOR\nThis date is the onset of acute symptoms for the current illness or condition.\n For UB-04 claims, this is populated separately via occurrence codes." last_menstrual_period_date: type: string format: date description: '837p Loop2300 DTP*484, CMS-1500 Box 14 Required when, in the judgment of the provider, the services on this claim are related to the patient''s pregnancy.de This field is populated separately via occurrence codes for UB-04 claim forms.' delay_reason_code: $ref: '#/components/schemas/type_commons_DelayReasonCode' description: 'Code indicating the reason why a claim submission was delayed. Corresponds to CLM-20 in the 837 specification (both professional and institutional).' patient_authorized_release: type: boolean description: 'Whether this patient has authorized the release of medical information for billing purpose. Box 12 on the CMS-1500 claim form or Form Locator 52 on a UB-04 claim form.' referral_number: type: string description: Refers to REF*9F on the 837p. Value cannot be greater than 50 characters. secondary_payer_carrier_code: type: string description: When Medicaid is billed as the secondary payer the Carrier Code is used to identify the primary payer. This is required for certain states. 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 affects 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_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_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_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_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_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_commons_ClinicalTrialId: type: string format: uuid title: ClinicalTrialId 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_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_EncounterSortOptions: type: string enum: - created_at:asc - created_at:desc - date_of_service:asc - date_of_service:desc title: EncounterSortOptions type_commons_EntityNotFoundErrorMessage: type: object properties: id: type: string required: - id title: EntityNotFoundErrorMessage type_health-care-code-information_v1_D8Date: type: string format: date title: D8Date 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_eras_EraId: type: string format: uuid title: EraId type_health-care-code-information_v1_OccurrenceSpanCodeQualifier: type: string enum: - BI title: OccurrenceSpanCodeQualifier type_encounters_v4_ResponsiblePartyType: type: string enum: - INSURANCE_PAY - SELF_PAY - UNKNOWN title: ResponsiblePartyType 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_commons_ChargeCaptureClaimCreationId: type: string format: uuid title: ChargeCaptureClaimCreationId 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_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_PatientHistoryCategoryEnum: type: string enum: - present_illness - medical - family - social title: PatientHistoryCategoryEnum 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_commons_PreEncounterPatientId: type: string format: uuid title: PreEncounterPatientId type_commons_WorkQueueId: type: string title: WorkQueueId type_x12_v1_TypeOfCareCode: type: string enum: - '1' - '2' - '3' - '4' - '5' - '6' - '7' - '8' - '9' title: TypeOfCareCode type_x12_v1_TypeOfAdmissionOrVisitCode: type: string enum: - '1' - '2' - '3' - '4' - '5' - '9' title: TypeOfAdmissionOrVisitCode 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_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_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_commons_SchemaId: type: string format: uuid title: SchemaId 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_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_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_financials_AllocationRestrictionType: type: string enum: - billing_provider_npi - service_facility_id description: The dimension along which a payment's auto-allocation can be restricted. title: AllocationRestrictionType 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_encounters_v4_EncounterOwnerOfNextActionType: type: string enum: - CANDID - CUSTOMER - CODER - NONE title: EncounterOwnerOfNextActionType type_health-care-code-information_v1_ConditionInformationCodeQualifier: type: string enum: - BG title: ConditionInformationCodeQualifier 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\nRequired for the initial medical service or visit performed in response to a medical emergency when the date is available and is different than the date of service.\nOR\nThis date is the onset of acute symptoms for the current illness or condition.\n For UB-04 claims, this is populated separately via occurrence codes." last_menstrual_period_date: type: string format: date description: '837p Loop2300 DTP*484, CMS-1500 Box 14 Required when, in the judgment of the provider, the services on this claim are related to the patient''s pregnancy. 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 affects 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_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_encounter-providers_v2_BillingProviderSecondaryIdentificationQualifier: type: string enum: - G2 - LU title: BillingProviderSecondaryIdentificationQualifier type_payers_v4_SupportState: type: string enum: - NOT_SUPPORTED - SUPPORTED_ENROLLMENT_NOT_REQUIRED - SUPPORTED_ENROLLMENT_REQUIRED title: SupportState type_diagnoses_DiagnosisId: type: string format: uuid title: DiagnosisId type_payers_v3_PayerUuid: type: string format: uuid title: PayerUuid type_invoices_InvoiceStatus: type: string enum: - draft - open - paid - void - uncollectible - held title: InvoiceStatus type_commons_ReportTransmissionCode: type: string enum: - AA - BM - EL - FX title: ReportTransmissionCode type_non-insurance-payers_v1_NonInsurancePayerId: type: string format: uuid title: NonInsurancePayerId 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_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_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_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_commons_ServiceLineUnits: type: string enum: - MJ - UN title: ServiceLineUnits 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' authorization_number: type: string 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_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_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_clinical-trials_v1_ClinicalTrialPhase: type: string enum: - Phase 1 - Phase 2 - Phase 3 title: ClinicalTrialPhase type_commons_PatientExternalId: type: string title: PatientExternalId type_financials_PatientTransactionSource: type: string enum: - MANUAL_ENTRY - CHARGEBEE - SQUARE - STRIPE - ELATION - CEDAR - HEALTHIE - REALLOCATION - PHREESIA - INSTAMED - SHERPA_HEALTH title: PatientTransactionSource type_service-lines_v2_MeasurementUnitCode: type: string enum: - ML - UN - GR - F2 - ME title: MeasurementUnitCode 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_yes-no-indicator_YesNoIndicator: type: string enum: - 'YES' - 'NO' - UNKNOWN - NOT_APPLICABLE title: YesNoIndicator type_health-care-code-information_v1_OccurrenceInformationCodeQualifier: type: string enum: - BH title: OccurrenceInformationCodeQualifier 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_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_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_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_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_tags_TagId: type: string title: TagId type_encounters_v4_EncounterRenderingOrAttendingProviderRequiredError: type: object properties: {} title: EncounterRenderingOrAttendingProviderRequiredError 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_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_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_commons_ClaimId: type: string format: uuid title: ClaimId type_commons_ProviderId: type: string format: uuid title: ProviderId type_organization-providers_v2_LicenseType: type: string enum: - MD - NP - PA - LMFT - LCPC - LCSW - PMHNP - FNP - LPCC - DO - RD - SLP - APRN - LPC - PHD - PSYD - LMSW - LMHC - OTHER_MASTERS - BCBA - UNKNOWN - RPH - PHT - LAC - LMT - DC - ND - MA - PT - IBCLC - RN - DPT - LCMHC - CNM - RNFA - ACSW - APC - BCABA - BHA - OD - DPM - DA - DDS - DEH - DMD - PTA - LCADC - LCAT - LCMHCS - LCMHCA - LCSWA - LICSW - LISW - LMFTS - LMFTA - LPCI - LSCSW - MHCA - MHT - RBT - RCSWI - RHMCI - LPN - OTD - OMS - MFTA - APCC - DNP - AGNPBC - ANP - FNPPP - LCSWR - ALC - RMFTI - LAMFT - LPCA - LSWI - CSW - CPC - LGMFT - LLPC - PLPC - PLMFT - LMHCA - CIT - CT - MFT - LSW - PLMHP - PCMSW - LMHP - OTR/L - RPA - COTA - CRNP - SLP-CF - NP-C - PA-C - AMFT - CDN - CGC - CNS - MDPHD - AuD - ATC - LAT - OTA - LSSP - SLPA title: LicenseType type_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_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_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_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_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_commons_BillingProviderCommercialLicenseType: type: string enum: - '0' - A - B - C - D - E - F - G - H - I title: BillingProviderCommercialLicenseType securitySchemes: OAuthScheme: type: http scheme: bearer description: OAuth 2.0 authentication