openapi: 3.0.1
info:
  title: Medical Network Institutional Claims V1
  description: 837 Institutional Claim
  version: V1
servers:
- url: https://sandbox-apigw.optum.com
  description: Optum
tags:
- name: Health Check
  description: Health Check
- name: Institutional Claims
  description: Institutional Claims
paths:
  /medicalnetwork/institutionalclaims/v1/validation:
    post:
      tags:
      - Institutional Claims
      summary: Claim Validation
      operationId: validateClaim
      parameters:
      - name: x-chng-trace-id
        in: header
        required: false
        schema:
          type: string
      - name: USERNAME
        in: query
        required: true
        schema:
          type: string
      - name: Authorization
        in: header
        description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
        required: true
        schema:
          type: string
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/InstitutionalClaimsRequest'
        required: true
      responses:
        '200':
          description: OK
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Response'
  /medicalnetwork/institutionalclaims/v1/submission:
    post:
      tags:
      - Institutional Claims
      summary: Claim Submission
      operationId: processClaim
      parameters:
      - name: x-chng-trace-id
        in: header
        required: false
        schema:
          type: string
      - name: Authorization
        in: header
        description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
        required: true
        schema:
          type: string
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/InstitutionalClaimsRequest'
        required: true
      responses:
        '200':
          description: OK
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Response'
  /medicalnetwork/institutionalclaims/v1/healthcheck:
    get:
      tags:
      - Health Check
      summary: Health Check
      operationId: healthCheck
      parameters:
      - name: Authorization
        in: header
        description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
        required: true
        schema:
          type: string
      responses:
        '200':
          description: OK
          content:
            application/json:
              schema:
                type: object
                additionalProperties:
                  type: string
  /medicalnetwork/institutionalclaims/v1/raw-x12-submission:
    post:
      tags:
      - Institutional Claims
      summary: Claim Submission x12
      operationId: processClaim_1
      parameters:
      - name: x-chng-trace-id
        in: header
        required: false
        schema:
          type: string
      - name: Authorization
        in: header
        description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
        required: true
        schema:
          type: string
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/RawX12Request'
        required: true
      responses:
        '200':
          description: OK
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Response'
  /medicalnetwork/institutionalclaims/v1/raw-x12-validation:
    post:
      tags:
      - Institutional Claims
      summary: Claim Validation x12
      operationId: validateRawX12
      parameters:
      - name: x-chng-trace-id
        in: header
        required: false
        schema:
          type: string
      - name: Authorization
        in: header
        description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
        required: true
        schema:
          type: string
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/RawX12Request'
        required: true
      responses:
        '200':
          description: OK
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Response'
components:
  schemas:
    billing:
      required:
      - providerType
      type: object
      properties:
        providerType:
          type: string
          description: Type of Provider, sets properties to map to Loop 2000A for BillingProvider or 2310A
            for AttendingProvider or 2310D RenderingProvider or 2310F ReferringProvider
          example: BillingProvider
          enum:
          - BillingProvider
          - AttendingProvider
          - ReferringProvider
          - RenderingProvider
        npi:
          type: string
          description: 'Segment: NM1, Element:NM109 where NM108=XX'
          example: '1760854442'
        secondaryIdentificationQualifierCode:
          type: string
          description: 'Segment: REF, Element: REF01, Notes: Allowed Values are: ''0B'' State License
            Number, ''1G'' Provider UPIN Number, ''G2'' Provider Commercial Number,''LU'' Location Number'
          enum:
          - 0B
          - 1G
          - G2
          - LU
        secondaryIdentifier:
          type: string
          description: 'Segment: REF, Element: REF02'
        employerId:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=EI'
        commercialNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=G2, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        locationNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=LU, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        stateLicenseNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=0B, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        providerUpinNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=1G, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        taxonomyCode:
          type: string
          description: 'Segment: PRV03, Element: PRV03 where PRV02=PXC'
        firstName:
          type: string
          description: 'Segment: NM1, Element: NM104'
          example: johntwo
        lastName:
          type: string
          description: 'Segment: NM1, Element: NM103'
          example: doetwo
        middleName:
          type: string
          description: 'Segment: NM1, Element: NM105'
          example: middletwo
        suffix:
          type: string
          description: 'Segment: NM1, Element: NM107'
        organizationName:
          type: string
          description: 'Segment: NM1, Element:NM103'
          example: HAPPY DOCTORS GROUPPRACTICE
        address:
          $ref: '#/components/schemas/Address'
        contactInformation:
          $ref: '#/components/schemas/ContactInformation'
      description: 'Loop: 2000A'
    referring:
      required:
      - providerType
      type: object
      properties:
        providerType:
          type: string
          description: Type of Provider, sets properties to map to Loop 2000A for BillingProvider or 2310A
            for AttendingProvider or 2310D RenderingProvider or 2310F ReferringProvider
          example: BillingProvider
          enum:
          - BillingProvider
          - AttendingProvider
          - ReferringProvider
          - RenderingProvider
        npi:
          type: string
          description: 'Segment: NM1, Element:NM109 where NM108=XX'
          example: '1760854442'
        secondaryIdentificationQualifierCode:
          type: string
          description: 'Segment: REF, Element: REF01, Notes: Allowed Values are: ''0B'' State License
            Number, ''1G'' Provider UPIN Number, ''G2'' Provider Commercial Number,''LU'' Location Number'
          enum:
          - 0B
          - 1G
          - G2
          - LU
        secondaryIdentifier:
          type: string
          description: 'Segment: REF, Element: REF02'
        employerId:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=EI'
        commercialNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=G2, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        locationNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=LU, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        stateLicenseNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=0B, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        providerUpinNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=1G, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        taxonomyCode:
          type: string
          description: 'Segment: PRV03, Element: PRV03 where PRV02=PXC'
        firstName:
          type: string
          description: 'Segment: NM1, Element: NM104'
          example: johntwo
        lastName:
          type: string
          description: 'Segment: NM1, Element: NM103'
          example: doetwo
        middleName:
          type: string
          description: 'Segment: NM1, Element: NM105'
          example: middletwo
        suffix:
          type: string
          description: 'Segment: NM1, Element: NM107'
        organizationName:
          type: string
          description: 'Segment: NM1, Element:NM103'
          example: HAPPY DOCTORS GROUPPRACTICE
        address:
          $ref: '#/components/schemas/Address'
        contactInformation:
          $ref: '#/components/schemas/ContactInformation'
      description: 'Loop: 2310F'
    rendering:
      required:
      - providerType
      type: object
      properties:
        providerType:
          type: string
          description: Type of Provider, sets properties to map to Loop 2000A for BillingProvider or 2310A
            for AttendingProvider or 2310D RenderingProvider or 2310F ReferringProvider
          example: BillingProvider
          enum:
          - BillingProvider
          - AttendingProvider
          - ReferringProvider
          - RenderingProvider
        npi:
          type: string
          description: 'Segment: NM1, Element:NM109 where NM108=XX'
          example: '1760854442'
        secondaryIdentificationQualifierCode:
          type: string
          description: 'Segment: REF, Element: REF01, Notes: Allowed Values are: ''0B'' State License
            Number, ''1G'' Provider UPIN Number, ''G2'' Provider Commercial Number,''LU'' Location Number'
          enum:
          - 0B
          - 1G
          - G2
          - LU
        secondaryIdentifier:
          type: string
          description: 'Segment: REF, Element: REF02'
        employerId:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=EI'
        commercialNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=G2, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        locationNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=LU, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        stateLicenseNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=0B, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        providerUpinNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=1G, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        taxonomyCode:
          type: string
          description: 'Segment: PRV03, Element: PRV03 where PRV02=PXC'
        firstName:
          type: string
          description: 'Segment: NM1, Element: NM104'
          example: johntwo
        lastName:
          type: string
          description: 'Segment: NM1, Element: NM103'
          example: doetwo
        middleName:
          type: string
          description: 'Segment: NM1, Element: NM105'
          example: middletwo
        suffix:
          type: string
          description: 'Segment: NM1, Element: NM107'
        organizationName:
          type: string
          description: 'Segment: NM1, Element:NM103'
          example: HAPPY DOCTORS GROUPPRACTICE
        address:
          $ref: '#/components/schemas/Address'
        contactInformation:
          $ref: '#/components/schemas/ContactInformation'
      description: 'Loop: 2310D'
    attending:
      required:
      - providerType
      type: object
      properties:
        providerType:
          type: string
          description: Type of Provider, sets properties to map to Loop 2000A for BillingProvider or 2310A
            for AttendingProvider or 2310D RenderingProvider or 2310F ReferringProvider
          example: BillingProvider
          enum:
          - BillingProvider
          - AttendingProvider
          - ReferringProvider
          - RenderingProvider
        npi:
          type: string
          description: 'Segment: NM1, Element:NM109 where NM108=XX'
          example: '1760854442'
        secondaryIdentificationQualifierCode:
          type: string
          description: 'Segment: REF, Element: REF01, Notes: Allowed Values are: ''0B'' State License
            Number, ''1G'' Provider UPIN Number, ''G2'' Provider Commercial Number,''LU'' Location Number'
          enum:
          - 0B
          - 1G
          - G2
          - LU
        secondaryIdentifier:
          type: string
          description: 'Segment: REF, Element: REF02'
        employerId:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=EI'
        commercialNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=G2, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        locationNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=LU, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        stateLicenseNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=0B, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        providerUpinNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=1G, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        taxonomyCode:
          type: string
          description: 'Segment: PRV03, Element: PRV03 where PRV02=PXC'
        firstName:
          type: string
          description: 'Segment: NM1, Element: NM104'
          example: johntwo
        lastName:
          type: string
          description: 'Segment: NM1, Element: NM103'
          example: doetwo
        middleName:
          type: string
          description: 'Segment: NM1, Element: NM105'
          example: middletwo
        suffix:
          type: string
          description: 'Segment: NM1, Element: NM107'
        organizationName:
          type: string
          description: 'Segment: NM1, Element:NM103'
          example: HAPPY DOCTORS GROUPPRACTICE
        address:
          $ref: '#/components/schemas/Address'
        contactInformation:
          $ref: '#/components/schemas/ContactInformation'
      description: 'Loop: 2310A'
    operatingPhysician:
      required:
      - lastName
      type: object
      properties:
        organizationName:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM103 where NM102=1 and NM101=72'
        identificationQualifierCode:
          type: string
          description: 'Loop: 2310B, Segment: REF, Element: REF01, Notes: Allowable values: ''0B'' State
            License Number, ''1G'' Provider UPIN Number, ''G2'' Provider Commercial Number, ''LU'' Location
            Number'
          enum:
          - 0B
          - 1G
          - G2
          - LU
        secondaryIdentifier:
          type: string
          description: 'Loop: 2310B, Segment: REF, Element: REF02'
        firstName:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM104'
        lastName:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM103 where NM102=1'
        middleName:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM105'
        suffix:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM107'
        npi:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM109 when NM108=XX'
      description: Loop 2310B
    otherOperatingPhysician:
      required:
      - lastName
      type: object
      properties:
        organizationName:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM103 where NM102=1 and NM101=72'
        identificationQualifierCode:
          type: string
          description: 'Loop: 2310B, Segment: REF, Element: REF01, Notes: Allowable values: ''0B'' State
            License Number, ''1G'' Provider UPIN Number, ''G2'' Provider Commercial Number, ''LU'' Location
            Number'
          enum:
          - 0B
          - 1G
          - G2
          - LU
        secondaryIdentifier:
          type: string
          description: 'Loop: 2310B, Segment: REF, Element: REF02'
        firstName:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM104'
        lastName:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM103 where NM102=1'
        middleName:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM105'
        suffix:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM107'
        npi:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM109 when NM108=XX'
      description: 'LOOP: 2310C'
    Address:
      required:
      - address1
      - city
      type: object
      properties:
        address1:
          type: string
          description: N301
          example: 000 address1
        address2:
          type: string
          description: N302
        city:
          type: string
          description: N401
          example: city1
        state:
          type: string
          description: N402
          example: tn
        postalCode:
          type: string
          description: N403
          example: '372030000'
        countryCode:
          type: string
          description: N404
        countrySubDivisionCode:
          type: string
          description: N407
      description: N3 and N4
    AdmittingDiagnosis:
      required:
      - admittingDiagnosisCode
      - qualifierCode
      type: object
      properties:
        qualifierCode:
          type: string
          description: 'LOOP 2300, HI01-01, Notes: ''ABJ'' International Classification of Diseases Clinical
            Modification (ICD-10-CM) Admitting Diagnosis and''BJ'' International Classification of Diseases
            Clinical Modification (ICD-9-CM) Admitting Diagnosis'
          enum:
          - ABJ
          - BJ
        admittingDiagnosisCode:
          type: string
          description: LOOP 2300, HI01-02
    ClaimAdjustment:
      required:
      - adjustmentGroupCode
      type: object
      properties:
        adjustmentGroupCode:
          type: string
          description: 'Loop: 2320, Segment: CAS, Element: CAS01, Notes: Allowed Values are ''CO'' Contractual
            Obligations, ''CR'' Correction and Reversals, ''OA'' Other adjustments, ''PI'' Payor Initiated
            Reductions, ''PR'' Patient Responsibility'
          enum:
          - CO
          - CR
          - OA
          - PI
          - PR
        claimAdjustmentDetails:
          maxItems: 6
          minItems: 1
          type: array
          items:
            $ref: '#/components/schemas/ClaimAdjustmentDetails'
    ClaimAdjustmentDetails:
      required:
      - adjustmentAmount
      - adjustmentReasonCode
      type: object
      properties:
        adjustmentReasonCode:
          type: string
          description: 'Loop: 2420, Segment: CAS, Element: CAS02, Notes: Code identifying the detailed
            reason the adjustment was made'
        adjustmentAmount:
          type: string
          description: 'Loop: 2420, Segment: CAS, Element: CAS03, Notes: Monetary amount'
        adjustmentQuantity:
          type: string
          description: 'Loop: 2420, Segment: CAS, Element: CAS03, Notes: Monetary amount'
      description: 'Loop: 2420, Segment: CAS'
    ClaimCodeInformation:
      required:
      - admissionTypeCode
      - patientStatusCode
      type: object
      properties:
        admissionTypeCode:
          type: string
          description: 'Loop 2300; Segment: CL1; Element: CL101; Notes: Code indicating the priority type
            of this admission.'
          example: '1'
        admissionSourceCode:
          type: string
          description: 'Loop 2300; Segment: CL1; Element: CL102; Notes: Point of origin for admission
            or visit.'
        patientStatusCode:
          type: string
          description: 'Loop 2300; Segment: CL1; Element: CL103'
          example: '10'
    ClaimContractInformation:
      required:
      - contractCode
      - contractTypeCode
      - contractVersionIdentifier
      - termsDiscountPercentage
      type: object
      properties:
        contractTypeCode:
          type: string
          description: 'Loop 2300; Segment: CN1; Element: CN101, Notes:Allowable values ''01'' Diagnosis
            Related Group (DRG), ''02'' Per Diem, ''03'' Variable Per Diem, ''04'' Flat, ''05'' Capitated,
            ''06'' Percent, and ''09'' Other'
          enum:
          - '01'
          - '02'
          - '03'
          - '04'
          - '05'
          - '06'
          - 09
        contractAmount:
          type: string
          description: 'Loop 2300; Segment: CN1; Element: CN102-Monetary Amount'
        contractPercentage:
          type: string
          description: 'Loop 2300; Segment: CN1; Element: CN103-Contract Percentage'
        contractCode:
          type: string
          description: 'Loop 2300; Segment: CN1; Element: CN104-Contract Code'
        termsDiscountPercentage:
          type: string
          description: 'Loop 2300; Segment: CN1; Element: CN105-Terms Discount Percentage'
        contractVersionIdentifier:
          type: string
          description: 'Loop 2300; Segment: CN1; Element: CN106-Contract Version Identifier'
    ClaimDateInformation:
      required:
      - statementBeginDate
      - statementEndDate
      type: object
      properties:
        admissionDateAndHour:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03, Notes: Code D8 or DT in DTP03. Can express
            range of dates or single date.'
        statementBeginDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03, Notes: DTP03=434, Can express range
            of dates or single date.'
        statementEndDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03, Notes: DTP03=434, Can express range
            of dates or single date.'
        dischargeHour:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03, Notes: Date, time, or range of dates'
        repricerReceivedDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03, Notes: DTP01=505 DTP02=D8'
    ClaimInformation:
      required:
      - benefitsAssignmentCertificationIndicator
      - claimChargeAmount
      - claimCodeInformation
      - claimFilingCode
      - claimFrequencyCode
      - patientControlNumber
      - placeOfServiceCode
      - planParticipationCode
      - principalDiagnosis
      - releaseInformationCode
      - serviceLines
      type: object
      properties:
        claimFilingCode:
          type: string
          description: 'Loop 2000B, Segment: SBR, Element: SBR09, Notes: Claim filing indicator code,
            Allowed Values are: ''11'' Other Non-Federal Programs, ''12'' Preferred Provider Organization
            (PPO), ''13'' Point of Service (POS), ''14'' Exclusive Provider Organization (EPO), ''15''
            Indemnity Insurance, ''16'' Health Maintenance Organization (HMO) Medicare Risk, ''17'' Dental
            Maintenance Organization, ''AM'' Automobile Medical, ''BL'' Blue Cross/Blue Shield, ''CH''
            Champus, ''CI'' Commercial Insurance Co., ''DS'' Disability, ''FI'' Federal Employees Program,
            ''HM'' Health Maintenance Organization, ''LM'' Liability Medical, ''MA'' Medicare Part A,
            ''MB'' Medicare Part B, ''MC'' Medicaid, ''OF'' Other Federal Program, ''TV'' Title V, ''VA''
            Veterans Affairs Plan, ''WC'' Workers'' Compensation Health Claim, ''ZZ'' Mutually Defined.'
          example: '11'
          enum:
          - '11'
          - '12'
          - '13'
          - '14'
          - '15'
          - '16'
          - '17'
          - AM
          - BL
          - CH
          - CI
          - DS
          - FI
          - HM
          - LM
          - MA
          - MB
          - MC
          - OF
          - TV
          - VA
          - WC
          - ZZ
        propertyCasualtyClaimNumber:
          type: string
          description: 'Loop: 2000C Segment: REF, Element: REF02 where REF01=Y4'
        patientWeight:
          type: string
          description: Deprecated PAT08
          deprecated: true
        patientControlNumber:
          type: string
          description: 'Loop: 2300, Segment: CLM, Element: CLM01, Notes: Used to track claim by the healthcare
            provider through payment. Also known as Claim Submitter''s Identifier'
          example: '12345'
        claimChargeAmount:
          type: string
          description: 'Loop: 2300, Segment: CLM, Element: CLM02, Notes: Total amount of all submitted
            charges of service segments. Must balance to the sum of all service line charge amounts (line
            SV2)'
          example: '375'
        placeOfServiceCode:
          type: string
          description: 'Loop: 2300, Segment: CLM, Element: CLM05-01, Notes: Code identifying where services
            were, or may be, performed.'
          example: '11'
        claimFrequencyCode:
          type: string
          description: 'Loop: 2300, Segment: CLM, Element: CLM05-03, Notes: Specifies the frequency of
            the claim.'
          example: '1'
        signatureIndicator:
          type: string
          deprecated: true
        planParticipationCode:
          type: string
          description: 'Loop: 2300, Segment: CLM, Element: CLM07, Notes: Code indicating whether the provider
            accepts assignment.Allowed Values are: ''A'' Assigned, ''B'' Assignment Accepted on Clinical
            Lab Services Only, ''C'' Not Assigned.'
          example: A
          enum:
          - A
          - B
          - C
        benefitsAssignmentCertificationIndicator:
          type: string
          description: 'Loop: 2300, Segment: CLM, Element: CLM08, Notes: Code indicating a Yes/No Response,
            Allowed Values are: ''N'' No, ''W'' Assignment Not Applicable, ''Y'' Yes.'
          example: N
          enum:
          - N
          - W
          - Y
        releaseInformationCode:
          type: string
          description: 'Loop: 2300, Segment: CLM, Element: CLM09, Notes: Indicates whether the provider
            has on file a signed statement by patient authorizing the release of medical data to other
            organizations. Allowable Values are: ''I'' Informed Consent to Release Medical Information
            for Conditions or Diagnoses Regulated by Federal Statutes, ''Y'' Yes, Provider has a Signed
            Statement Permitting Release of Medical Billing Data Related to a Claim.'
          example: I
          enum:
          - I, Y
        delayReasonCode:
          type: string
          description: 'Loop: 2300, Segment: CLM, Element: CLM20, Notes: Required when the claim is submitted
            late. If not required by this guide, do not send. Allowable Values are: ''1'' Proof of Eligibility
            Unknown or Unavailable, ''2'' Litigation, ''3'' Authorization Delays, ''4'' Delay in Certifying
            Provider, ''5'' Delay in Supplying Billing Forms, ''6'' Delay in Delivery of Custom-made Appliances,
            ''7'' Third Party Processing Delay, ''8'' Delay in Eligibility Determination, ''9'' Original
            Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation Rules, ''10''
            Administration Delay in the Prior Approval Process, ''11'' Other, ''15 Natural Disaster'
          enum:
          - '1'
          - '2'
          - '3'
          - '4'
          - '5'
          - '6'
          - '7'
          - '8'
          - '9'
          - '10'
          - '11'
          - '15'
        patientAmountPaid:
          type: string
          description: Deprecated AMT02
          deprecated: true
        patientEstimatedAmountDue:
          type: string
          description: 'Loop 2300, Segment: AMT, Element: AMT02 where AMT01=F3, Notes: Estimated patient
            responsibility amount due.'
        fileInformation:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300, Segment: K3, Element: K301'
        billingNote:
          type: string
          description: 'Loop 2300, Segment: NTE, Element: NTE02 where NTE01=ADD'
        claimNotes:
          $ref: '#/components/schemas/ClaimNotes'
        claimDateInformation:
          $ref: '#/components/schemas/ClaimDateInformation'
        claimContractInformation:
          $ref: '#/components/schemas/ClaimContractInformation'
        claimSupplementalInformation:
          $ref: '#/components/schemas/ClaimSupplementalInformation'
        conditionCodes:
          maxItems: 12
          minItems: 1
          type: array
          description: 'Loop 2300, Segment: CRC, Element: CRC03, CRC04, CRC05, Notes: Allowed Values are:
            ''AV'' Available-Not Used, ''NU'' Not Used, ''S2'' Under Treatment, ''ST'' New Services Requested.'
          example: 1
          items:
            type: string
            enum:
            - AV
            - NU
            - S2
            - ST
        principalDiagnosis:
          $ref: '#/components/schemas/PrincipalDiagnosis'
        admittingDiagnosis:
          $ref: '#/components/schemas/AdmittingDiagnosis'
        patientReasonForVisits:
          maxItems: 3
          minItems: 0
          type: array
          items:
            $ref: '#/components/schemas/PatientReasonForVisit'
        externalCauseOfInjuries:
          maxItems: 12
          minItems: 0
          type: array
          items:
            $ref: '#/components/schemas/ExternalCauseOfInjury'
        diagnosisRelatedGroupInformation:
          $ref: '#/components/schemas/DiagnosisRelatedGroupInformation'
        otherDiagnosisInformationList:
          maxItems: 2
          minItems: 0
          type: array
          items:
            type: array
            items:
              $ref: '#/components/schemas/OtherDiagnosisInformation'
        principalProcedureInformation:
          $ref: '#/components/schemas/PrincipalProcedureInformation'
        otherProcedureInformationList:
          maxItems: 2
          minItems: 0
          type: array
          items:
            type: array
            items:
              $ref: '#/components/schemas/OtherProcedureInformation'
        occurrenceSpanInformations:
          maxItems: 2
          minItems: 0
          type: array
          items:
            type: array
            items:
              $ref: '#/components/schemas/OccurrenceSpanInformation'
        valueInformationList:
          maxItems: 2
          minItems: 0
          type: array
          items:
            type: array
            items:
              $ref: '#/components/schemas/ValueInformation'
        occurrenceInformationList:
          maxItems: 2
          minItems: 0
          type: array
          items:
            type: array
            items:
              $ref: '#/components/schemas/OccurrenceInformation'
        treatmentCodeInformationList:
          maxItems: 2
          minItems: 0
          type: array
          items:
            type: array
            description: 'Loop: 2300, Segment: HI, Element: HI01-02, HI02-02, HI03-02, HI04-02, HI05-02,
              HI06-02, HI07-02, HI08-02, HI09-02, HI10-02, HI11-02, HI12-02'
            items:
              type: string
              description: 'Loop: 2300, Segment: HI, Element: HI01-02, HI02-02, HI03-02, HI04-02, HI05-02,
                HI06-02, HI07-02, HI08-02, HI09-02, HI10-02, HI11-02, HI12-02'
        conditionCodesList:
          maxItems: 2
          minItems: 0
          type: array
          items:
            type: array
            items:
              $ref: '#/components/schemas/ConditionInformation'
        claimPricingInformation:
          $ref: '#/components/schemas/ClaimPricingInformation'
        serviceFacilityLocation:
          $ref: '#/components/schemas/ServiceFacilityLocation'
        otherSubscriberInformation:
          $ref: '#/components/schemas/OtherSubscriberInformation'
        serviceLines:
          type: array
          items:
            $ref: '#/components/schemas/ServiceLine'
        claimCodeInformation:
          $ref: '#/components/schemas/ClaimCodeInformation'
        epsdtReferral:
          $ref: '#/components/schemas/EpsdtReferral'
      description: 'Loop: 2000B, 2000C and 2300'
    ClaimNotes:
      type: object
      properties:
        goalRehabOrDischargePlans:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300; Segment: NTE; Element: NTE02 where NTE01=DCP'
        diagnosisDescription:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300; Segment: NTE; Element: NTE02 where NTE01=DGN'
        allergies:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300; Segment: NTE; Element: NTE02 where NTE01=ALG'
        dme:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300; Segment: NTE; Element: NTE02 where NTE01=DME'
        medications:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300; Segment: NTE; Element: NTE02 where NTE01=MED'
        nutritionalRequirments:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300; Segment: NTE; Element: NTE02 where NTE01=NTR'
        ordersForDiscipLinesAndTreatments:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300; Segment: NTE; Element: NTE02 where NTE01=ODT'
        functionalLimitsOrReasonHomebound:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300; Segment: NTE; Element: NTE02 where NTE01=RHB'
        reasonsPatientLeavesHome:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300; Segment: NTE; Element: NTE02 where NTE01=RLH'
        timesAndReasonsPatientNotAtHome:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300; Segment: NTE; Element: NTE02 where NTE01=RNH'
        unusualHomeOrSocialEnv:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300; Segment: NTE; Element: NTE02 where NTE01=SET'
        safetyMeasures:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300; Segment: NTE; Element: NTE02 where NTE01=SFM'
        supplementalPlanOfTreatment:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300; Segment: NTE; Element: NTE02 where NTE01=SPT'
        updatedInformation:
          maxItems: 10
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop 2300; Segment: NTE; Element: NTE02 where NTE01=UPI'
        additionalInformation:
          type: array
          items:
            type: string
            description: Deprecated
            deprecated: true
      description: 'Loop 2300; Segment: NTE'
    ClaimPricingInformation:
      required:
      - pricingMethodologyCode
      - repricedAllowedAmount
      type: object
      properties:
        pricingMethodologyCode:
          type: string
          description: 'Loop: 2300 and 2400, Segment: HCP, Element: HCP01, Notes: Allowed Values are:
            ''00'' Zero Pricing (Not Covered Under Contract), ''01'' Priced as Billed at 100%, ''02''
            Priced at the Standard Fee Schedule, ''03'' Not Priced at a Contractual Percentage, ''04''
            Bundled Pricing, ''05'' Peer Review Pricing, ''06'' Per Diem Pricing, ''07'' Flat Rate Pricing,
            ''08'' Combination Pricing, ''09'' Maternity Pricing, ''10'' Other Pricing, ''11'' Lower of
            Cost, ''12'' Ratio of Cost, ''13'' Cost Reimbursed, ''14'' Adjustment Pricing.'
          enum:
          - '00'
          - '01'
          - '02'
          - '03'
          - '04'
          - '05'
          - '06'
          - '07'
          - 08
          - 09
          - '10'
          - '11'
          - '12'
          - '13'
          - '14'
        repricedAllowedAmount:
          type: string
          description: 'Loop: 2300 and 2400, Segment: HCP, Element: HCP02'
        repricedSavingAmount:
          type: string
          description: 'Loop: 2300 and 2400, Segment: HCP, Element: HCP03'
        repricedOrgIdentifier:
          type: string
          description: 'Loop: 2300 and 2400, Segment: HCP, Element: HCP04'
        repricedPerDiem:
          type: string
          description: 'Loop: 2300 and 2400, Segment: HCP, Element: HCP05'
        repricedApprovedDRGCode:
          type: string
          description: 'Loop: 2300 and 2400, Segment: HCP, Element: HCP06'
        repricedApprovedAmount:
          type: string
          description: 'Loop: 2300 and 2400, Segment: HCP, Element: HCP07'
        repricedApprovedRevenueCode:
          type: string
          description: 'Loop: 2300 and 2400, Segment: HCP, Element: HCP08'
        repricedApprovedServiceUnitCode:
          type: string
          description: 'Loop: 2300 and 2400, Segment: HCP, Element: HCP11, Notes: Allowed Values are:
            ''DA'' Days, ''UN'' Unit.'
          enum:
          - DA
          - UN
        repricedApprovedServiceUnitCount:
          type: string
          description: 'Loop: 2300 and 2400, Segment: HCP, Element: HCP12'
        rejectReasonCode:
          type: string
          description: 'Loop: 2300 and 2400, Segment: HCP, Element: HCP13, Notes: Allowed Values are:
            ''T1'' Cannot Identify Provider as TPO (Third Party Organization) Participant, ''T2'' Cannot
            Identify Payer as TPO (Third Party Organization) Participant, ''T3'' Cannot Identify Insured
            as TPO (Third Party Organization) Participant, ''T4'' Payer Name or Identifier Missing, ''T5''
            Certification Information Missing, ''T6'' Claim does not contain enough information for re-pricing.'
          enum:
          - T1
          - T2
          - T3
          - T4
          - T5
          - T6
        policyComplianceCode:
          type: string
          description: 'Loop: 2300 and 2400, Segment: HCP, Element: HCP14, Notes: Allowed Values are:
            ''1'' Procedure Followed (Compliance), ''2'' Not Followed - Call Not Made (Non-Compliance
            Call Not Made), ''3'' Not Medically Necessary (Non-Compliance Non-Medically Necessary), ''4''
            Not Followed Other (Non-Compliance Other), ''5'' Emergency Admit to Non-Network Hospital.'
          enum:
          - '1'
          - '2'
          - '3'
          - '4'
          - '5'
        exceptionCode:
          type: string
          description: 'Loop: 2300 and 2400, Segment: HCP, Element: HCP15, Notes: Allowed Values are:
            ''1'' Non-Network Professional Provider in Network Hospital, ''2'' Emergency Care, ''3'' Services
            or Specialist not in Network, ''4'' Out-of-Service Area, ''5'' State Mandates, ''6'' Other.'
          enum:
          - '1'
          - '2'
          - '3'
          - '4'
          - '5'
          - '6'
        productOrServiceIDQualifier:
          type: string
          description: 'Loop: 2400, Segment: HCP, Element: HCP09, Notes: Allowed Values are: ''ER'' Jurisdiction
            Specific Procedure and Supply Codes, ''HC'' Health Care Financing Administration Common Procedural
            Coding System (HCPCS) Codes, ''HP'' Health Insurance Prospective Payment System (HIPPS) Skilled
            Nursing Facility Rate Code,  ''IV'' Home Infusion EDI Coalition (HIEC) Product/Service Code,
            ''WK'' Advanced Billing Concepts (ABC) Codes'
          enum:
          - ER
          - HC
          - HP
          - IV
          - WK
        repricedApprovedHCPCSCode:
          type: string
          description: 'Loop: 2400, Segment: HCP, Element: HCP10'
      description: 'Loop 2400, Segment: HCP'
    ClaimSupplementalInformation:
      type: object
      properties:
        reportInformation:
          $ref: '#/components/schemas/ReportInformation'
        priorAuthorizationNumber:
          type: string
          description: 'Loop 2300; Segment: REF; Element: REF02 when REF01 = G1'
        referralNumber:
          type: string
          description: 'Loop 2300; Segment: REF; Element: REF02 when REF01 = 9F'
        claimControlNumber:
          type: string
          description: 'Loop 2300; Segment: REF; Element: REF02 when REF01 = F8'
        repricedClaimNumber:
          type: string
          description: 'Loop 2300; Segment: REF; Element: REF02 when REF01 = 9A'
        investigationalDeviceExemptionNumber:
          type: string
          description: 'Loop 2300; Segment: REF; Element: REF02 when REF01 = LX'
        claimNumber:
          type: string
          description: 'Loop 2300; Segment: REF; Element: REF02 when REF01 = D9'
        medicalRecordNumber:
          type: string
          description: 'Loop 2300; Segment: REF; Element: REF02 when REF01 = EA'
        demoProjectIdentifier:
          type: string
          description: 'Loop 2300; Segment: REF; Element: REF02 when REF01 = P4'
        serviceAuthorizationExceptionCode:
          type: string
          description: 'Loop 2300; Segment: REF; Element: REF02 when REF01 = 4N, Allowed Values are: ''1''
            Immediate/Urgent Care , ''2'' Services Rendered in a Retroactive Period , ''3'' Emergency
            Care, ''4'' Client has Temporary Medicaid, ''5'' Request from County for Second Opinion to
            Determine if Recipient Can Work , ''6'' Request for Override Pending , ''7'' Special Handling'
          enum:
          - '1'
          - '2'
          - '3'
          - '4'
          - '5'
          - '6'
          - '7'
        autoAccidentState:
          type: string
          description: 'Loop 2300; Segment: REF; Element: REF02 when REF01 = LU'
        peerReviewAuthorizationNumber:
          type: string
          description: 'Loop 2300; Segment: REF; Element: REF02 when REF01 = G4'
        adjustedRepricedClaimRefNumber:
          type: string
          description: 'Loop 2300; Segment: REF; Element: REF02 when REF01 = 9C'
      description: 'Loop: 2400, Segment: PWK'
    ConditionInformation:
      required:
      - conditionCode
      type: object
      properties:
        conditionCode:
          type: string
          description: 'LOOP: 2300, Segment: HI, Element: HI01-02'
    ContactInformation:
      required:
      - name
      type: object
      properties:
        name:
          type: string
          description: 'Loop: 1000A, Segment: PER, Element: PER02'
          example: janetwo doetwo
        phoneNumber:
          type: string
          description: 'Loop: 1000A, Segment: PER, Element: PER04, Notes: PER04-6-8 where PER03-5-7=TE'
          example: '0000000001'
        faxNumber:
          type: string
          description: 'Loop: 1000A, Segment: PER, Element: PER04, Notes:PER04-6-8 where PER03-5-7=FX'
          example: '0000000002'
        email:
          type: string
          description: 'Loop: 1000A, Segment: PER, Element: PER04, Notes:PER04-6-8 where PER03-5-7=EM'
          example: email@email.com
        validContact:
          type: boolean
      description: PER
    Dependent:
      required:
      - dateOfBirth
      - firstName
      - gender
      - lastName
      - relationshipToSubscriberCode
      type: object
      properties:
        firstName:
          type: string
          description: 'Loop: 2010CA, Segment: NM1, Element: NM104'
          example: janeOne
        lastName:
          type: string
          description: 'Loop: 2010CA, Segment: NM1, Element: NM103 where NM102=1'
          example: doeOne
        middleName:
          type: string
          description: 'Loop: 2010CA, Segment: NM1, Element: NM105'
        suffix:
          type: string
          description: 'Loop: 2010CA, Segment: NM1, Element: NM107'
          example: Jr
        gender:
          type: string
          description: 'Loop: 2010CA, Segment: DMG, Element: DMG03, Notes: Allowed Values are: ''M'' Male,
            ''F'' Female, ''U'' Unknown.'
          example: F
          enum:
          - M
          - F
          - U
        dateOfBirth:
          type: string
          description: 'Loop: 2010CA, Segment: DMG, Element: DMG02 where DMG01=D8 YYYYMMDD'
        ssn:
          type: string
          description: 'Loop: 2010CA, Segment: REF, Element: REF02 where REF01=SY'
        relationshipToSubscriberCode:
          type: string
          description: 'Loop: 2000C, Segment: PAT, Element: PAT01, Notes: Allowed Values are: ''01'' Spouse,
            ''19'' Child, ''20'' Employee, ''21'' Unknown, ''39'' Organ Donor, ''40'' Cadaver Donor, ''53''
            Life Partner, ''G8'' Other Relationship.'
          example: '01'
          enum:
          - '01'
          - '19'
          - '20'
          - '39'
          - '40'
          - '53'
          - G8
        address:
          $ref: '#/components/schemas/Address'
      description: 'Loop: 2000B and 2000C'
    DiagnosisRelatedGroupInformation:
      required:
      - drugRelatedGroupCode
      type: object
      properties:
        drugRelatedGroupCode:
          type: string
          description: 'LOOP: 2300, Segment: HI, Element:HI01-02'
    DrugIdentification:
      required:
      - measurementUnitCode
      - nationalDrugCode
      - nationalDrugUnitCount
      type: object
      properties:
        nationalDrugCode:
          type: string
          description: 'Loop: 2410, Segment: LIN, Element: LIN03, Notes: Identifying number for a product
            or service'
        nationalDrugUnitCount:
          type: string
          description: 'Loop: 2410, Segment: CTP, Element: CTP04, Notes: Numeric value of quantity'
        measurementUnitCode:
          type: string
          description: 'Loop: 2410, Segment: CTP, Element: CTP05-01, Notes: To Identify a composite unit
            of measure, Allowed Values are: ''F2'' International Unit, ''GR'' Gram, ''ME'' Milligram,
            ''ML'' Milliliter, ''UN'' Unit.'
          enum:
          - F2
          - GR
          - ME
          - ML
          - UN
        linkSequenceNumber:
          type: string
          description: 'Loop: 2410, Segment: REF, Element: REF02 when REF01=VY, Notes: Can only set one
            of linkSequenceNumber and pharmacyPrescriptionNumber but not both.'
        pharmacyPrescriptionNumber:
          type: string
          description: 'Loop: 2410, Segment: REF, Element: REF02 when REF01=XZ, Notes: Can only set one
            of linkSequenceNumber and pharmacyPrescriptionNumber but not both'
      description: 'Loop 2410, Segment: LIN'
    EpsdtReferral:
      required:
      - certificationConditionCodeAppliesIndicator
      - conditionCodes
      type: object
      properties:
        certificationConditionCodeAppliesIndicator:
          type: string
          description: 'Loop: 2300, Segment: CRC, Element: CRC02 when CRC01 = ZZ, Notes: Allowable values
            ''Y'' Yes and ''N'' No - if no then choose NU in CRC02 indicating no referral given'
          enum:
          - N
          - Y
        conditionCodes:
          maxItems: 3
          minItems: 1
          type: array
          description: 'Loop: 2300, Segment: CRC, Element: CRC03, CRC04, CRC05, Notes: Allowed Values
            are: ''AV'' Available- Not Used,''NU'' Not Used, ''S2'' Under Treatment, ''ST'' New Services
            Requested '
          items:
            type: string
            enum:
            - AV
            - NU
            - S2
            - ST
    ExternalCauseOfInjury:
      required:
      - externalCauseOfInjury
      - qualifierCode
      type: object
      properties:
        qualifierCode:
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01-01, Notes:Allowed Values are: ''ABN'' International
            Classification of Diseases Clinical Modification External Cause of Injury Code, ''BN'' International
            Classification of Diseases Clinical Modification External Cause of Injury Code'
          enum:
          - ABN
          - BN
        externalCauseOfInjury:
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01-02'
        presentOnAdmissionIndicator:
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01-09, Notes: Allowed Values are: ''N'' NO,
            ''Y'' Yes, ''U'' Unknown, ''W'' Not Applicable.'
          enum:
          - N
          - U
          - Y
          - W
    InstitutionalClaimsRequest:
      required:
      - billing
      - claimInformation
      - controlNumber
      - receiver
      - submitter
      - subscriber
      type: object
      properties:
        controlNumber:
          type: string
          description: Interchange Control Number ISA13 GS06 ST02
          example: '000000001'
        tradingPartnerServiceId:
          type: string
          description: 'Loop: 2010BB NM109 where NM108=PI'
          example: '9496'
        submitter:
          $ref: '#/components/schemas/Submitter'
        receiver:
          $ref: '#/components/schemas/Receiver'
        subscriber:
          $ref: '#/components/schemas/Subscriber'
        dependent:
          $ref: '#/components/schemas/Dependent'
        providers:
          maxItems: 2147483647
          minItems: 1
          type: array
          description: 'Another way to set billing, referring, rendering and attending provider, this
            will overwrite anything you send in billing, referring, rendering, attending.  Loop: 2000A,2310F,2310D,2310A'
          items:
            $ref: '#/components/schemas/attending'
        billingPayToPlanName:
          $ref: '#/components/schemas/PayToPlanName'
        billingPayToAddressName:
          $ref: '#/components/schemas/PayToAddressName'
        operatingPhysician:
          $ref: '#/components/schemas/operatingPhysician'
        otherOperatingPhysician:
          $ref: '#/components/schemas/otherOperatingPhysician'
        claimInformation:
          $ref: '#/components/schemas/ClaimInformation'
        payerAddress:
          $ref: '#/components/schemas/Address'
        usageIndicator:
          type: string
          description: Interchange Usage Indicator ISA15; T-Test Data, P-Production Data
          example: T
        billing:
          $ref: '#/components/schemas/billing'
        referring:
          $ref: '#/components/schemas/referring'
        rendering:
          $ref: '#/components/schemas/rendering'
        attending:
          $ref: '#/components/schemas/attending'
        tradingPartnerName:
          type: string
          description: 'Loop: 2010BB NM103 where NM101=PR and NM102=2. Notes: Required'
      description: InstitutionalClaimsRequest
    InstitutionalService:
      required:
      - lineItemChargeAmount
      - measurementUnit
      - serviceLineRevenueCode
      - serviceUnitCount
      type: object
      properties:
        serviceLineRevenueCode:
          type: string
          description: 'Loop: 2400, Segment: SV2, Element: SV201, Notes: Product or service revenue code'
        procedureIdentifier:
          type: string
          description: 'Loop: 2400, Segment: SV2, Element: SV202-01, Note: Allowed Values are: ''ER''
            Jurisdiction Specific Procedure and Supply Codes, ''HC'' Health Care Financing Administration
            Common Procedural Coding System (HCPCS) Codes, ''HP'' Health Insurance Prospective Payment
            System (HIPPS) Skilled Nursing Facility Rate Code, ''IV'' Home Infusion EDI Coalition (HIEC)
            Product/Service Code, ''WK'' Advanced Billing Concepts (ABC) Codes'
          enum:
          - ER
          - HC
          - HP
          - IV
          - WK
        procedureCode:
          type: string
          description: 'Loop: 2400, Segment: SV2, Element: SV202-02, Notes: Product or Service ID'
          example: '80199'
        procedureModifiers:
          maxItems: 4
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop: 2400, Segment: SV2, Element: SV202-03 through SV202-06, Notes: Procedure
              Modifier Codes'
            example: '1234'
        description:
          type: string
          description: 'Loop: 2400, Segment: SV2, Element: SV202-07, Notes: Freeform description'
          example: Some description text about the procedure
        lineItemChargeAmount:
          type: string
          description: 'Loop: 2400, Segment: SV2, Element: SV203, Notes: Submitted service line item amount'
        measurementUnit:
          type: string
          description: 'Loop: 2400, Segment: SV2, Element: SV204, Notes: Allowed Values are: ''DA'' Days,
            ''UN'' Unit'
          enum:
          - DA, UN
        serviceUnitCount:
          type: string
          description: 'Loop: 2400, Segment: SV2, Element: SV205, Notes: Numeric value of the quantity'
        nonCoveredChargeAmount:
          type: string
          description: 'Loop: 2400, Segment: SV2, Element: SV207, Notes: Non-covered service amount'
      description: 'Loop: 2400, Segment: SV2'
    LineAdjudicationInformation:
      required:
      - adjudicationOrPaymentDate
      - otherPayerPrimaryIdentifier
      - paidServiceUnitCount
      - serviceLinePaidAmount
      - serviceLineRevenueCode
      type: object
      properties:
        otherPayerPrimaryIdentifier:
          type: string
          description: 'Loop: 2430 , Segment: SVD, Element:SVD01 , Notes: Payer Identification Code'
        serviceLinePaidAmount:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD02, Notes: Amount paid for this service
            line'
        productOrServiceIDQualifier:
          type: string
          description: 'Loop: 2430: Segment: SVD, Element: SVD03-01, Notes: Allowed Values are: ''ER''
            Jurisdiction Specific Procedure and Supply Codes, ''HC'' Health Care Financing Administration
            Common Procedural Coding System (HCPCS) Codes, ''HP'' Health Insurance Prospective Payment
            System (HIPPS) Skilled Nursing Facility Rate Code, ''IV'' Home Infusion EDI Coalition (HIEC)
            Product/Service Code, ''WK'' Advanced Billing Concepts (ABC) Codes'
          enum:
          - ER
          - HC
          - HP
          - IV
          - WK
        procedureCode:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SDV03-02, Notes: Identifying Number for product
            or service'
        procedureModifier:
          maxItems: 4
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop: 2430, Segment: SVD, Element: SVD03-03 to SVD03-06, Notes: Identifies special
              circumstance related to the performance of the service'
        serviceLineRevenueCode:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD04, Notes: Revenue Code'
        procedureCodeDescription:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD03-07, Notes: Freeform Description'
        paidServiceUnitCount:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD05, Notes: Paid units of service'
        bundledLineNumber:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD06, Notes: Number assigned for differentiation
            within a transaction set'
        adjudicationOrPaymentDate:
          type: string
          description: 'Loop: 2430, Segment: DTP, Element: DTP03, Notes: Date'
        remainingPatientLiability:
          type: string
          description: 'Loop:2430 , Segment: AMT, Element: AMT02, Notes: Monetary amount'
        lineAdjustment:
          type: array
          items:
            $ref: '#/components/schemas/ClaimAdjustment'
    LineAdjustmentInformation:
      required:
      - claimPaidDate
      - otherPayerPrimaryIdentifier
      - paidServiceUnitCount
      - procedureCode
      - remainingPatientLiability
      - serviceIdQualifier
      - serviceLinePaidAmount
      type: object
      properties:
        otherPayerPrimaryIdentifier:
          type: string
        serviceLinePaidAmount:
          type: string
        serviceIdQualifier:
          type: string
        procedureCode:
          type: string
        procedureModifiers:
          maxItems: 4
          minItems: 0
          type: array
          items:
            type: string
        procedureCodeDescription:
          type: string
        paidServiceUnitCount:
          type: string
        bundledOrUnbundledLineNumber:
          type: string
        remainingPatientLiability:
          type: string
        claimPaidDate:
          type: string
        claimAdjustment:
          $ref: '#/components/schemas/ClaimAdjustment'
      description: 'Loop 2430, Segment: CAS'
      deprecated: true
    LinePricingInformation:
      required:
      - pricingMethodologyCode
      - repricedAllowedAmount
      type: object
      properties:
        pricingMethodologyCode:
          type: string
        repricedAllowedAmount:
          type: string
        repricedSavingAmount:
          type: string
        repricedOrganizationIdentifier:
          type: string
        flatRateAmount:
          type: string
        apgCode:
          type: string
        apgAmount:
          type: string
        serviceIdQualifier:
          type: string
        repricedApprovedHCPCSCode:
          type: string
        measurementUnitCode:
          type: string
        repricedApprovedServiceUnitCount:
          type: string
        rejectReasonCode:
          type: string
        policyComplianceCode:
          type: string
        exceptionCode:
          type: string
      description: 'Loop 2400, Segment: HCP'
      deprecated: true
    MedicareInpatientAdjudication:
      required:
      - coveredDaysOrVisitsCount
      type: object
      properties:
        coveredDaysOrVisitsCount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA01, Notes: Number of days covered'
        lifetimePsychiatricDaysCount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA03, Notes: Lifetime of psychiatric days '
        claimDRGAmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA04, Notes: Diagnosis Related Group (DRG)
            amount'
        claimPaymentRemarkCode:
          maxItems: 5
          minItems: 0
          type: array
          description: 'Loop: 2320, Segment: MIA, Element: MIA05, Notes: Claim payment remark code'
          items:
            type: string
        claimDisproportionateShareAmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA06, Notes: Disproportionate share amount'
        claimMspPassThroughAmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA07, Notes: Medicare Secondary Payer (MSP)
            pass-through amount'
        claimPpsCapitalAmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA08, Notes: Prospective Payment System (PPS)
            capital amount.'
        ppsCapitalHspDrgAmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA09, Notes: Prospective Payment System (PPS)
            capital, federal specific portion, Diagnosis Related Group (DRG) amount.'
        capitalHSPDRGAmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA10, Notes: Prospective Payment System (PPS)
            capital, hospital specific portion, Diagnosis Related Group (DRG) amount.'
        ppsCapitalDshDrgAmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA11, Notes: Prospective Payment System (PPS)
            capital, disproportionate share, hospital Diagnosis Related Group (DRG) amount.'
        oldCapitalAmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA12, Notes: The old capital amount'
        ppsCapitalImeAmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA13, Notes: Prospective Payment System (PPS)
            capital Indirect Medical Education (IME) claim amount'
        ppsOperatingHospitalSpecificDrgAmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA14, Notes: Hospital specific Diagnosis Related
            Group (DRG) amount'
        costReportDayCount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA15, Notes: Cost report days'
        ppsOperatingFederalSpecificDrgAmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA16, Notes: Federal specific Diagnosis Related
            Group (DRG) amount'
        claimPpsCapitalOutlierAmmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA17, Notes: Prospective Payment System (PPS)
            capital outlier amount'
        claimIndirectTeachingAmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA18, Notes: Indirect teaching amount'
        nonPayableProfessionalComponentBilledAmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA19, Notes: The professional component amount
            billed but not payable'
        capitalExceptionAmount:
          type: string
          description: 'Loop: 2320, Segment: MIA, Element: MIA24, Notes: The capital exception amount'
      description: 'Loop: 2320, Segment: MIA, Notes: Medical inpatient claim information'
    MedicareOutpatientAdjudication:
      type: object
      properties:
        reimbursementRate:
          type: string
          description: 'Loop: 2320, Segment: MOA, Element: MOA01, Notes: The reimbursement rate'
        hcpcsPayableAmount:
          type: string
          description: 'Loop: 2320, Segment: MOA, Element: MOA02, Notes: The claim Health Care Financing
            Administration Common Procedural Coding System (HCPCS) payable amount.'
        claimPaymentRemarkCode:
          maxItems: 5
          minItems: 0
          type: array
          description: 'Loop: 2320, Segment: MOA, Element: MOA03 through MOA07, Notes: The claim payment
            remark code'
          items:
            type: string
        endStageRenalDiseasePaymentAmount:
          type: string
          description: 'Loop: 2320, Segment: MOA, Element: MOA08, Notes: The End Stage Renal Disease (ESRD)
            payment amount'
        nonPayableProfessionalComponentBilledAmount:
          type: string
          description: 'Loop: 2320, Segment: MOA, Element: MOA09, Notes: The professional component amount
            billed but not payable'
      description: 'Loop: 2320, Segment: MOA, Notes: Medical outpatient claim information'
    OccurrenceInformation:
      required:
      - occurrenceSpanCode
      - occurrenceSpanCodeDate
      type: object
      properties:
        occurrenceSpanCode:
          type: string
          description: 'LOOP:2300, Segment: HI, Element: HI01-02, Notes: Code indicates that a code is
            from a specific industry code list'
        occurrenceSpanCodeDate:
          type: string
          description: 'LOOP: 2300, Segment: HI, Element: HI01-04, Notes: Date as expressed by CCYYMMDD'
    OccurrenceSpanInformation:
      required:
      - occurrenceSpanCode
      - occurrenceSpanCodeEndDate
      - occurrenceSpanCodeStartDate
      type: object
      properties:
        occurrenceSpanCode:
          type: string
          description: 'LOOP: 2300, Segment: HI, Element: HI01-02, Notes: Code indicates that a code is
            from a specific industry code list'
        occurrenceSpanCodeStartDate:
          type: string
          description: 'LOOP: 2300, Segment: HI, Element: HI01-04, Notes: Start Date in a range expressed
            in CCYYMMDD'
        occurrenceSpanCodeEndDate:
          type: string
          description: 'LOOP: 2300, Segment: HI, Element: HI01-04, Notes: End Date expressed in CCYYMMDD'
    OperatingPhysician:
      required:
      - lastName
      type: object
      properties:
        organizationName:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM103 where NM102=1 and NM101=72'
        identificationQualifierCode:
          type: string
          description: 'Loop: 2310B, Segment: REF, Element: REF01, Notes: Allowable values: ''0B'' State
            License Number, ''1G'' Provider UPIN Number, ''G2'' Provider Commercial Number, ''LU'' Location
            Number'
          enum:
          - 0B
          - 1G
          - G2
          - LU
        secondaryIdentifier:
          type: string
          description: 'Loop: 2310B, Segment: REF, Element: REF02'
        firstName:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM104'
        lastName:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM103 where NM102=1'
        middleName:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM105'
        suffix:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM107'
        npi:
          type: string
          description: 'Loop: 2310B, Segment: NM1, Element: NM109 when NM108=XX'
      description: 'Loop: 2420A, Segment: REF'
    OtherDiagnosisInformation:
      required:
      - otherDiagnosisCode
      - qualifierCode
      type: object
      properties:
        qualifierCode:
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01-01, Notes: Allowable values: ''ABF'' International
            Classification of Diseases Clinical Modification (ICD-10-CM) and ''BF'' International Classification
            of Diseases Clinical Modification (ICD-9-CM)'
          enum:
          - ABF
          - BF
        otherDiagnosisCode:
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01-02'
        presentOnAdmissionIndicator:
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01-09, Notes: Allowable Values are: ''N''
            NO, ''Y'' Yes, ''U'' Unknown, ''W'' Not Applicable'
          enum:
          - N
          - Y
          - U
          - W
    OtherPayerAttendingProvider:
      required:
      - otherPayerAttendingProviderIdentifier
      type: object
      properties:
        otherPayerAttendingProviderIdentifier:
          maxItems: 4
          minItems: 1
          type: array
          description: 'Loop: 2330C, Segment: REF'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
      description: 'Loop: 2330C, Notes: Information regarding other attending provider'
    OtherPayerBillingProvider:
      required:
      - otherPayerBillingProviderIdentifier
      type: object
      properties:
        otherPayerBillingProviderIdentifier:
          maxItems: 3
          minItems: 1
          type: array
          description: 'Loop: 2330I, Segment: REF'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
      description: 'Loop: 2330I, Notes: Information regarding other payer billing provider'
    OtherPayerName:
      required:
      - otherPayerIdentifier
      - otherPayerIdentifierTypeCode
      - otherPayerOrganizationName
      type: object
      properties:
        otherInsuredAdditionalIdentifier:
          type: string
        otherPayerOrganizationName:
          type: string
          description: 'Loop: 2330B, Segment: NM1, Element: NM103, Notes: Individual last name or organizational
            name.'
        otherPayerIdentifierTypeCode:
          type: string
          description: 'Loop: 2330B, Segment: NM1, Element: NM108, Notes: Allowable values: ''PI'' Payor
            Identification and ''XV'' Centers for Medicare and Medicaid Services PlanID'
          enum:
          - PI
          - XV
        otherPayerIdentifier:
          type: string
          description: 'Loop: 2330B, Segment: NM1, Element: NM109, Notes: Code identifying a party or
            other code.'
        otherPayerAddress:
          $ref: '#/components/schemas/Address'
        otherPayerAdjudicationOrPaymentDate:
          type: string
          description: 'Loop: 2330B, Segment: DTP, Element: DTP03, Notes: Expression of a date, a time,
            or range of dates, times or dates and times'
        otherPayerSecondaryIdentifier:
          maxItems: 2
          minItems: 0
          type: array
          description: 'Loop: 2330B, Segment: REF'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
        otherPayerPriorAuthorizationNumber:
          type: string
          description: 'Loop: 2330B, Segment: REF, Element: REF02, Notes: Reference information as defined
            for a particular Transaction Set or as specified by the Reference Identification Qualifier.'
        otherPayerPriorAuthorizationOrReferralNumber:
          type: string
          description: 'Loop: 2330B, Segment: REF, Element: REF02, Notes: Reference information as defined
            for a particular Transaction Set or as specified by the Reference Identification Qualifier.'
        otherPayerClaimAdjustmentIndicator:
          type: boolean
          description: 'Loop: 2330B, Segment: REF, Element: REF02, Notes: Allowable value: ''Y'''
          enum:
          - false
        otherPayerClaimControlNumber:
          type: string
          description: 'Loop: 2330B, Segment: REF, Element: REF02, Notes: Reference information as defined
            for a particular Transaction Set or as specified by the Reference Identification Qualifier.'
      description: 'Loop: 2330B, Notes: Information regarding other payer'
    OtherPayerOperatingPhysician:
      required:
      - otherPayerOperatingPhysicianIdentifier
      type: object
      properties:
        otherPayerOperatingPhysicianIdentifier:
          maxItems: 4
          minItems: 1
          type: array
          description: 'Loop: 2330D, Segment: REF, Notes: Code qualifying the Reference Identification.'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
      description: REF
    OtherPayerOtherOperatingPhysician:
      required:
      - otherPayerOtherOperatingPhysicianIdentifier
      type: object
      properties:
        otherPayerOtherOperatingPhysicianIdentifier:
          maxItems: 4
          minItems: 1
          type: array
          description: 'Loop: 2330E, Segment: REF, Notes: Code qualifying the Reference Identification.'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
      description: REF
    OtherPayerReferringProvider:
      required:
      - otherPayerReferringProviderIdentifier
      type: object
      properties:
        otherPayerReferringProviderIdentifier:
          maxItems: 3
          minItems: 1
          type: array
          description: 'Loop: 2330H, Segment: REF, Notes: Code qualifying the Reference Identification.'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
      description: REF
    OtherPayerRenderingProvider:
      required:
      - otherPayerRenderingProviderIdentifier
      type: object
      properties:
        otherPayerRenderingProviderIdentifier:
          maxItems: 4
          minItems: 1
          type: array
          description: 'Loop: 2330G, Segment: REF, Notes: Code qualifying the Reference Identification.'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
      description: REF
    OtherPayerServiceFacilityLocation:
      required:
      - otherPayerServiceFacilityLocationIdentifier
      type: object
      properties:
        otherPayerServiceFacilityLocationIdentifier:
          maxItems: 3
          minItems: 1
          type: array
          description: 'Loop: 2330F, Segment: REF, Notes: Code qualifying the Reference Identification.'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
      description: 'Loop: 2330F, Notes: Information regarding other payer service facility location'
    OtherProcedureInformation:
      required:
      - otherProcedureCode
      - qualifierCode
      type: object
      properties:
        qualifierCode:
          type: string
          description: 'Loop:2300, Segment: HI, Element: HI01-01, Notes: Code identifying specific industry
            code list, Allowed Values: ''BBQ'' International Classification of Diseases Clinical Modification
            Other Procedure Codes, ''BQ'' International Classification of Diseases Clinical Modification
            Other Procedure Codes'
          enum:
          - BBQ
          - BQ
        otherProcedureCode:
          type: string
          description: 'Loop:2300, Segment: HI, Element: HI01-02, Notes: Code from specified industry
            code list'
        otherProcedureDate:
          type: string
          description: 'Loop:2300, Segment: HI, Element: HI01-04, Notes: Date expressed in format CCYYMMDD'
    OtherSubscriberInformation:
      required:
      - benefitsAssignmentCertificationIndicator
      - claimFilingIndicatorCode
      - individualRelationshipCode
      - otherPayerName
      - otherSubscriberName
      - paymentResponsibilityLevelCode
      - releaseOfInformationCode
      type: object
      properties:
        paymentResponsibilityLevelCode:
          type: string
          description: 'Loop: 2320, Segment: SBR, Element: SBR01, Notes: Code identifying the insurance
            carrier''s level of responsibility for a payment of a claim, Allowed Values: ''A'' Payer Responsibility
            Four, ''B'' Payer Responsibility Five, ''C'' Payer Responsibility Six, ''D'' Payer Responsibility
            Seven, ''E'' Payer Responsibility Eight, ''F'' Payer Responsibility Nine, ''G'' Payer Responsibility
            Ten, ''H'' Payer Responsibility Eleven, ''P'' Primary, ''S'' Secondary, ''T'' Tertiary, ''U''
            Unknown'
          enum:
          - A
          - B
          - C
          - D
          - E
          - F
          - G
          - H
          - P
          - S
          - T
          - U
        individualRelationshipCode:
          type: string
          description: 'Loop: 2320, Segment: SBR, Element: SBR02, Notes: Code indicating the relationship
            between two individuals or entities, Allowed Values: ''01'' Spouse, ''18'' Self, ''19'' Child,
            ''20'' Employee, ''21'' Unknown, ''39'' Organ Donor, ''40'' Cadaver Donor, ''53'' Life Partner,
            ''G8'' Other Relationship'
          enum:
          - '01'
          - '18'
          - '19'
          - '20'
          - '21'
          - '39'
          - '40'
          - '53'
          - G8
        policyNumber:
          type: string
          description: 'Loop: 2320, Segment: SBR, Element: SBR03, Notes: Reference information as defined
            for a particular Transaction Set or as specified by the Reference Identification Qualifier'
        groupNumber:
          type: string
          description: 'Loop: 2320, Segment: SBR, Element: SBR03, Notes: Reference information as defined
            for a particular Transaction Set or as specified by the Reference Identification Qualifier'
        otherInsuredGroupName:
          type: string
          description: 'Loop: 2320, Segment: SBR, Element: SBR04, Notes: Free form name.'
        claimFilingIndicatorCode:
          type: string
          description: 'Loop: 2320, Segment: SBR, Element: SBR09, Notes: Reference information as defined
            for a particular Transaction Set or as specified by the Reference Identification Qualifier,
            Allowed Values: ''11'' Other Non-Federal Programs, ''12'' Preferred Provider Organization
            (PPO), ''13'' Point of Service (POS), ''14'' Exclusive Provider Organization (EPO), ''15''
            Indemnity Insurance,  ''16'' Health Maintenance Organization (HMO) Medicare Risk,''17'' Dental
            Maintenance Organization,''AM'' Automobile Medical, ''BL'' Blue Cross/Blue Shield, ''CH''
            Champus, ''CI'' Commercial Insurance Co., ''DS'' Disability, ''FI'' Federal Employees Program,
            ''HM'' Health Maintenance Organization, ''LM'' Liability Medical, ''MA'' Medicare Part A,
            ''MB'' Medicare Part B, ''MC'' Medicaid, ''OF'' Other Federal Program, ''TV'' Title V, ''VA''
            Veterans Affairs Plan, ''WC'' Worker''s Compensation Health Claim, ''ZZ'' Mutually Defined'
          enum:
          - '11'
          - '12'
          - '13'
          - '14'
          - '15'
          - '16'
          - '17'
          - AM
          - BL
          - CH
          - DS
          - FI
          - HM
          - LM
          - MA
          - MB
          - MC
          - OF
          - TV
          - VA
          - WC
          - ZZ
        payerPaidAmount:
          type: string
          description: 'Loop: 2320, Segment: AMT, Element: AMT02, Notes: Monetary amount'
        remainingPatientLiability:
          type: string
          description: 'Loop: 2320, Segment: AMT, Element: AMT02, Notes: Monetary amount'
        nonCoveredChargeAmount:
          type: string
          description: 'Loop: 2320, Segment: AMT, Element: AMT02, Notes: Monetary amount'
        benefitsAssignmentCertificationIndicator:
          type: string
          description: 'Loop: 2320, Segment: AMT, Element: AMT02, Notes: Monetary amount, Allowed Values:
            ''N'' No, ''Y'' Yes, ''W'' Not Applicable'
          enum:
          - N
          - Y
          - W
        releaseOfInformationCode:
          type: string
          description: 'Loop:2320, Segment: OI, Element: OI06, Notes: Code indicating whether the provider
            has on file a signed statement by the patient authorising the release of medical data to other
            organizations, Allowed Values are: ''I'' Informed Consent to Release Medical Information for
            Conditions or Diagnoses Regulated by Federal Statutes, ''Y'' Yes, Provider has a Signed Statement
            Permitting Release of Medical Billing Data Related to a Claim'
          enum:
          - I
          - Y
        medicareInpatientAdjudication:
          $ref: '#/components/schemas/MedicareInpatientAdjudication'
        medicareOutpatientAdjudication:
          $ref: '#/components/schemas/MedicareOutpatientAdjudication'
        otherSubscriberName:
          $ref: '#/components/schemas/OtherSubscriberName'
        claimLevelAdjustments:
          maxItems: 5
          minItems: 0
          type: array
          items:
            $ref: '#/components/schemas/ClaimAdjustment'
        otherPayerName:
          $ref: '#/components/schemas/OtherPayerName'
        otherPayerAttendingProvider:
          $ref: '#/components/schemas/OtherPayerAttendingProvider'
        otherPayerOperatingPhysician:
          $ref: '#/components/schemas/OtherPayerOperatingPhysician'
        otherPayerOtherOperatingPhysician:
          $ref: '#/components/schemas/OtherPayerOtherOperatingPhysician'
        otherPayerServiceFacilityLocation:
          $ref: '#/components/schemas/OtherPayerServiceFacilityLocation'
        otherPayerRenderingProvider:
          $ref: '#/components/schemas/OtherPayerRenderingProvider'
        otherPayerReferringProvider:
          $ref: '#/components/schemas/OtherPayerReferringProvider'
        otherPayerBillingProvider:
          $ref: '#/components/schemas/OtherPayerBillingProvider'
      description: 'Loop: 2320'
    OtherSubscriberName:
      required:
      - otherInsuredIdentifier
      - otherInsuredIdentifierTypeCode
      - otherInsuredLastName
      - otherInsuredQualifier
      type: object
      properties:
        otherInsuredQualifier:
          type: string
          description: 'Loop: 2330A, Segment: NM1, Element: NM102, Notes: Code qualifying the Reference
            Identification, Allowed Values: ''1'' Person ''2'' Non-Person Entity'
          enum:
          - '1'
          - '2'
        otherInsuredLastName:
          type: string
          description: 'Loop: 2330A, Segment: NM1, Element: NM103, Notes: Individual last name or organizational
            name.'
        otherInsuredFirstName:
          type: string
          writeOnly: true
        otherInsuredMiddleName:
          type: string
          description: 'Loop: 2330A, Segment: NM1, Element: NM105, Notes: Individual middle name.'
        otherInsuredSuffix:
          type: string
          description: 'Loop: 2330A, Segment: NM1, Element: NM107, Notes: Individual suffix.'
        otherInsuredIdentifierTypeCode:
          type: string
          description: 'Loop: 2330A, Segment: NM1, Element: NM108, Notes: Code identifying an organizational
            entity, a physical location, property or an individual, Allowed Values: ''II'' Standard Unique
            Health Identifier for each Individual in the United States, ''MI'' Member Identification Number'
          enum:
          - II
          - MI
        otherInsuredIdentifier:
          type: string
          description: 'Loop: 2330A, Segment: NM1, Element: NM109, Notes: Code identifying a party or
            other code.'
        otherInsuredAdditionalIdentifier:
          maxItems: 2
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop: 2330A, Segment: REF, Element: REF02, Notes: Reference information as defined
              for a particular Transaction Set or as specified by the Reference Identification Qualifier.'
        address:
          $ref: '#/components/schemas/Address'
        firstName:
          type: string
      description: 'Loop: 2330A, Notes: Information regarding other subscriber'
    PatientReasonForVisit:
      required:
      - patientReasonForVisitCode
      - qualifierCode
      type: object
      properties:
        qualifierCode:
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01-01, Notes: Code identifying a specific
            industry code list Allowed Values: ''APR'' International Classification of Diseases Clinical
            Modification Patient''s Reason for Visit,''PR'' International Classification of Diseases Clinical
            Modification Patient''s Reason for Visit'
          enum:
          - APR
          - PR
        patientReasonForVisitCode:
          type: string
          description: 'Loop: 2300, Segment:HI, Element: HI01-02, Notes: Code indicating a code from a
            specific industry code list'
    PayToAddressName:
      type: object
      properties:
        address:
          $ref: '#/components/schemas/Address'
        entityTypeQualifier:
          type: string
          description: 'Loop: 2010AB, Segment: NM1: Element: NM102, Notes: Used when NM101 is set to 87
            - qualifier of entity type, Allowed Values: ''2'' Non-Person Entity'
          example: '2'
          enum:
          - '2'
      description: 'Loop: 2010AB Billing Provider Pay To Address Name'
    PayToPlanName:
      required:
      - taxId
      type: object
      properties:
        address:
          $ref: '#/components/schemas/Address'
        organizationName:
          type: string
          description: 'Loop: 2010AC, Segment: NM1, Element: NM103 where NM102=2'
        identificationCodeQualifier:
          type: string
          description: 'Loop: 2010AC, Segment: NM1, Element: NM108, Notes: Allowed Values are: ''PI''
            Payor Identification, ''XV'' Centers for Medicare and Medicaid Services PlanID.'
          enum:
          - PI
          - XV
        identificationCode:
          type: string
          description: 'Loop: 2010AC, Segment: NM1, Element: NM109'
        payerIdentificationNumber:
          type: string
          description: 'Loop: 2010AC, Segment: NM1, Element: REF02 where REF01=2U'
        claimOfficeNumber:
          type: string
          description: 'Loop: 2010AC, Segment: NM1, Element: REF02 where REF01=FY'
        taxId:
          type: string
          description: 'Loop: 2010AC, Segment: NM1, Element: REF02 where REF01=EI  Employer''s Identification
            Number'
        naic:
          type: string
      description: 'Loop: 2010AC'
    PrincipalDiagnosis:
      required:
      - principalDiagnosisCode
      - qualifierCode
      type: object
      properties:
        qualifierCode:
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01-01, Notes: Allowed Values are: ''ABK''
            International Classification of Diseases Clinical Modification Principal Diagnosis,''BK''
            International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis'
          example: ABK
          enum:
          - ABK
          - BK
        principalDiagnosisCode:
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01-02'
          example: '99761'
        presentOnAdmissionIndicator:
          maxLength: 1
          minLength: 1
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01-09, Notes: Allowed Values are: ''N'' NO,
            ''Y'' Yes, ''U'' Unknown, ''W'' Not Applicable'
          example: N
          enum:
          - N
          - Y
          - U
          - W
      description: HI
    PrincipalProcedureInformation:
      required:
      - principalProcedureCode
      - qualifierCode
      type: object
      properties:
        qualifierCode:
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01-01, Notes: Allowed Values are: ''BBR''
            International Classification of Diseases Clinical Modification Principal Procedure Codes,
            ''BR'' International Classification of Diseases Clinical Modification Principal Procedure
            Codes ''CAH'' Advanced Billing Concepts (ABC) Codes'
          enum:
          - BBR
          - BR
          - CAH
        principalProcedureCode:
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01-02'
        principalProcedureDate:
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01-04 where HI01-03=D8, Notes: Date expressed
            in format CCYYMMDD'
      description: HI
    Provider:
      $ref: '#/components/schemas/attending'
    Receiver:
      required:
      - organizationName
      type: object
      properties:
        organizationName:
          type: string
          description: 'Segment: NM1, Element:NM103 where NM102=2'
          example: EXTRA HEALTHY INSURANCE
        taxId:
          type: string
          description: 'Segment: NM1, Element: NM109 where NM108=46'
          example: '67890'
      description: 'Loop: 1000B'
    ReferenceIdentification:
      required:
      - identifier
      - qualifier
      type: object
      properties:
        qualifier:
          type: string
          description: REF01 Code qualifying the type of entity
        identifier:
          type: string
          description: REF02 Code identifying an organizational entity, a physical location, property
            or an individual
    ReportInformation:
      required:
      - attachmentControlNumber
      - attachmentReportTypeCode
      - attachmentTransmissionCode
      type: object
      properties:
        attachmentReportTypeCode:
          type: string
          description: 'Loop 2300, 2400; Segment: PWK, Element: PWK01, Notes: Allowed Values are ''03''
            Report Justifying Treatment Beyond Utilization Guidelines, ''04'' Drugs Administered, ''05''
            Treatment Diagnosis, ''06'' Initial Assessment, ''07'' Functional Goals, ''08'' Plan of Treatment,
            ''09'' Progress Report, ''10'' Continued Treatment, ''11'' Chemical Analysis, ''13'' Certified
            Test Report, ''15'' Justification for Admission, ''21'' Recovery Plan, ''A3'' Allergies/Sensitivities
            Document, ''A4'' Autopsy Report, ''AM'' Ambulance Certification, ''AS'' Admission Summary,
            ''B2'' Prescription, ''B3'' Physician Order, ''B4'' Referral Form, ''BR'' Benchmark Testing
            Results, ''BS'' Baseline, ''BT'' Blanket Test Results, ''CB'' Chiropractic Justification,
            ''CK'' Consent Form(s), ''CT'' Certification, ''D2'' Drug Profile Document, ''DA'' Dental
            Models, ''DB'' Durable Medical Equipment Prescription, ''DG'' Diagnostic Report, ''DJ'' Discharge
            Monitoring Report, ''DS'' Discharge Summary, ''EB'' Explanation of Benefits (Coordination
            of Benefits or Medicare Secondary Payor), ''HC'' Health Certificate, ''HR'' Health Clinic
            Records, ''I5'' Immunization Record, ''IR'' State School Immunization Records, ''LA'' Laboratory
            Results, ''M1'' Medical Record Attachment, ''MT'' Models, ''NN'' Nursing Notes, ''OB'' Operative
            Note, ''OC'' Oxygen Content Averaging Report, ''OD'' Orders and Treatments Document, ''OE''
            Objective Physical Examination (including vital signs) Document, ''OX'' Oxygen Therapy Certification,
            ''OZ'' Support Data for Claim, ''P4'' Pathology Report, ''P5'' Patient Medical History Document,
            ''PE'' Parenteral or Enteral Certification, ''PN'' Physical Therapy Notes, ''PO'' Prosthetics
            or Orthotic Certification, ''PQ'' Paramedical Results, ''PY'' Physician''s Report, ''PZ''
            Physical Therapy Certification, ''RB'' Radiology Films, ''RR'' Radiology Reports, ''RT'' Report
            of Tests and Analysis Report, ''RX'' Renewable Oxygen Content Averaging Report, ''SG'' Symptoms
            Document, ''V5'' Death Notification, ''XP'' Photographs'
          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
        attachmentTransmissionCode:
          type: string
          description: 'Loop: 2300, 2400; Segment: PWK, Element: PWK02, Notes: Allowed Values are ''AA''
            Available on Request at Provider Site, ''BM'' By Mail, ''EL'' Electronically Only, ''EM''
            E-Mail, ''FT'' File Transfer, ''FX'' By Fax'
          enum:
          - AA
          - BM
          - EL
          - EM
          - FT
          - FX
        attachmentControlNumber:
          type: string
          description: 'Loop: 2300, 2400; Segment: PWK, Element: PWK06, Notes: Required when PWK02 = ''BM'',
            ''EL'', ''EM'', ''FX'', or ''FT''. If not required by this implementation guide, do not send'
      description: 'Loop: 2300, 2400; Segment: PWK'
    ServiceFacilityLocation:
      required:
      - address
      - organizationName
      type: object
      properties:
        organizationName:
          type: string
          description: 'Loop: 2310E, Segment: NM1, Element: NM103'
          example: ABC clinic
        address:
          $ref: '#/components/schemas/Address'
        secondaryIdentificationQualifierCode:
          type: string
          description: 'Loop: 2310E, Segment: REF, Element: REF01, Notes: Allowed Values are: ''0B'' State
            License Number, ''G2'' Provider Commercial Number, ''LU'' Location Number'
          enum:
          - 0B
          - G2
          - LU
        secondaryIdentifier:
          type: string
          description: 'Loop: 2310E, Segment: REF, Element: REF02'
        identificationCode:
          type: string
          description: 'Loop: 2310E, Segment: NM1, Element: NM109, Notes: Required when the service location
            to be identified has an NPI and is not a component or subpart of the Billing Provider entity.
            If not required by this implementation guide, do not send.'
      description: 'Loop: 2310E'
    ServiceLine:
      required:
      - assignedNumber
      - institutionalService
      type: object
      properties:
        assignedNumber:
          type: string
          description: 'Loop: 2400, Segment: LX, Element: LX01'
          example: '1'
        serviceDate:
          type: string
          description: 'Loop: 2400, Segment: DTP, DTP03, Notes: If no end date is passed, this will be
            DTP03, if end date is passed along with this then serviceDate will be used as the begin date
            for format ''CCYYMMDD-CCYYMMDD'' in DTP03, where DTP01=472'
        serviceDateEnd:
          type: string
          description: 'Loop: 2400, Segment: DTP, DTP03, Notes: Must send this with serviceDate (which
            will be used as the beginning service date) and they will be expressed as ''CCYYMMDD-CCYYMMDD''
            in DTP03'
        serviceTaxAmount:
          type: string
          description: 'Loop 2400, Segment: AMT, Element: AMT02, Notes: Where AMT01 = GT'
        facilityTaxAmount:
          type: string
          description: 'Loop 2400, Segment: AMT, Element: AMT02, Notes: Where AMT01 = N8'
        thirdPartyOrganizationNotes:
          type: string
          description: 'Loop 2400, Segment: NTE, Element: NTE02'
          deprecated: true
        lineItemControlNumber:
          type: string
          description: 'Loop 2400, Segment: REF, Element: REF02, Notes: Where REF01 = 6R'
        repricedLineItemReferenceNumber:
          type: string
          description: 'Loop 2400, Segment: REF, Element: REF02, Notes: Where REF01 = 9B'
        description:
          type: string
          description: 'Loop 2400, Segment: REF, Element: REF03'
        adjustedRepricedLineItemReferenceNumber:
          type: string
          description: 'Loop 2400, Segment: REF, Element: REF02, Notes: Where REF01 = 9D'
        lineNoteText:
          type: string
          description: 'Loop 2400, Segment: NTE, Element: NTE02, Notes: Where NTE01 = TPO'
        lineAdjudicationInformation:
          maxItems: 15
          minItems: 0
          type: array
          description: 'Loop 2430, Segment: SVD'
          items:
            $ref: '#/components/schemas/LineAdjudicationInformation'
        renderingProvider:
          $ref: '#/components/schemas/ServiceLineProvider'
        referringProvider:
          $ref: '#/components/schemas/ServiceLineProvider'
        lineSupplementInformation:
          $ref: '#/components/schemas/ClaimSupplementalInformation'
        institutionalService:
          $ref: '#/components/schemas/InstitutionalService'
        serviceLineSupplementalInformation:
          $ref: '#/components/schemas/ServiceLineSupplementalInformation'
        serviceLineDateInformation:
          $ref: '#/components/schemas/ServiceLineDateInformation'
        serviceLineReferenceInformation:
          $ref: '#/components/schemas/ServiceLineReferenceInformation'
        linePricingInformation:
          $ref: '#/components/schemas/LinePricingInformation'
        drugIdentification:
          $ref: '#/components/schemas/DrugIdentification'
        lineAdjustmentInformation:
          $ref: '#/components/schemas/LineAdjustmentInformation'
        operatingPhysician:
          $ref: '#/components/schemas/OperatingPhysician'
        otherOperatingPhysician:
          $ref: '#/components/schemas/OperatingPhysician'
        lineRepricingInformation:
          $ref: '#/components/schemas/ClaimPricingInformation'
      description: 'Loop: 2400, 2410, 2420A, 2420C, 2420D and 2430'
    ServiceLineDateInformation:
      type: object
      properties:
        serviceDate:
          type: string
          description: 'Loop: 2400, Segment: DTP, Element: DTP03, Notes: If no end date is passed, this
            will be DTP03, if end date is passed along with this then serviceDate will be used as the
            begin date for format ''CCYYMMDD-CCYYMMDD'' in DTP03, where DTP01=472'
        beginServiceDate:
          type: string
          description: 'Loop 2400, Segment: DTP, Element: DTP03'
          deprecated: true
        endServiceDate:
          type: string
          description: 'Loop 2400, Segment: DTP, Element: DTP03, Notes: Must send this with serviceDate
            (which will be used as the beginning service date) and they will be expressed as ''CCYYMMDD-CCYYMMDD
            in DTP03'
        validDateInformation:
          type: boolean
      description: 'Loop: 2400, Segment: DTP'
      deprecated: true
    ServiceLineProvider:
      required:
      - providerType
      type: object
      properties:
        providerType:
          type: string
          description: Type of Provider, sets properties to map to Loop 2000A for BillingProvider or 2310A
            for AttendingProvider or 2310D RenderingProvider or 2310F ReferringProvider
          example: BillingProvider
          enum:
          - BillingProvider
          - AttendingProvider
          - ReferringProvider
          - RenderingProvider
        npi:
          type: string
          description: 'Segment: NM1, Element:NM109 where NM108=XX'
          example: '1760854442'
        secondaryIdentificationQualifierCode:
          type: string
          description: 'Segment: REF, Element: REF01, Notes: Allowed Values are: ''0B'' State License
            Number, ''1G'' Provider UPIN Number, ''G2'' Provider Commercial Number,''LU'' Location Number'
          enum:
          - 0B
          - 1G
          - G2
          - LU
        secondaryIdentifier:
          type: string
          description: 'Segment: REF, Element: REF02'
        employerId:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=EI'
        commercialNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=G2, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        locationNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=LU, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        stateLicenseNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=0B, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        providerUpinNumber:
          type: string
          description: 'Segment: REF, Element: REF02 where REF01=1G, Notes: Deprecated see otherPayerAttendingProvider,
            otherPayerRenderingProvider and otherPayerReferringProvider.'
          deprecated: true
        taxonomyCode:
          type: string
          description: 'Segment: PRV03, Element: PRV03 where PRV02=PXC'
        firstName:
          type: string
          description: 'Segment: NM1, Element: NM104'
          example: johntwo
        lastName:
          type: string
          description: 'Segment: NM1, Element: NM103'
          example: doetwo
        middleName:
          type: string
          description: 'Segment: NM1, Element: NM105'
          example: middletwo
        suffix:
          type: string
          description: 'Segment: NM1, Element: NM107'
        organizationName:
          type: string
          description: 'Segment: NM1, Element:NM103'
          example: HAPPY DOCTORS GROUPPRACTICE
        address:
          $ref: '#/components/schemas/Address'
        contactInformation:
          $ref: '#/components/schemas/ContactInformation'
        referenceIdentification:
          maxItems: 20
          minItems: 0
          type: array
          description: 'Loop 2420D, Segment: NM1 and REF'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
      description: NM1 and REF
    ServiceLineReferenceInformation:
      type: object
      properties:
        providerControlNumber:
          type: string
          description: 'Loop 2400, Segment: REF, Element: REF02, Notes: Where REF01 = 6R'
        repricedLineItemRefNumber:
          type: string
          description: 'Loop 2400, Segment: REF, Element: REF02, Notes: Where REF01 = 9B'
        adjustedRepricedLineItemRefNumber:
          type: string
          description: 'Loop 2400, Segment: REF, Element: REF02, Notes: Where REF01 = 9D'
      description: 'Loop 2400, Segment: REF'
    ServiceLineSupplementalInformation:
      required:
      - attachmentReportTypeCode
      - attachmentTransmissionCode
      type: object
      properties:
        attachmentReportTypeCode:
          type: string
          description: 'Loop: 2400, Segment: PWK, Element: PWK01, Notes: Allowed Values are ''03'' Report
            Justifying Treatment Beyond Utilization Guidelines, ''04'' Drugs Administered, ''05'' Treatment
            Diagnosis, ''06'' Initial Assessment, ''07'' Functional Goals, ''08'' Plan of Treatment, ''09''
            Progress Report, ''10'' Continued Treatment, ''11'' Chemical Analysis, ''13'' Certified Test
            Report, ''15'' Justification for Admission, ''21'' Recovery Plan, ''A3'' Allergies/Sensitivities
            Document, ''A4'' Autopsy Report, ''AM'' Ambulance Certification, ''AS'' Admission Summary,
            ''B2'' Prescription, ''B3'' Physician Order, ''B4'' Referral Form, ''BR'' Benchmark Testing
            Results, ''BS'' Baseline, ''BT'' Blanket Test Results, ''CB'' Chiropractic Justification,
            ''CK'' Consent Form(s), ''CT'' Certification, ''D2'' Drug Profile Document, ''DA'' Dental
            Models, ''DB'' Durable Medical Equipment Prescription, ''DG'' Diagnostic Report, ''DJ'' Discharge
            Monitoring Report, ''DS'' Discharge Summary, ''EB'' Explanation of Benefits (Coordination
            of Benefits or Medicare Secondary Payor), ''HC'' Health Certificate, ''HR'' Health Clinic
            Records, ''I5'' Immunization Record, ''IR'' State School Immunization Records, ''LA'' Laboratory
            Results, ''M1'' Medical Record Attachment, ''MT'' Models, ''NN'' Nursing Notes, ''OB'' Operative
            Note, ''OC'' Oxygen Content Averaging Report, ''OD'' Orders and Treatments Document, ''OE''
            Objective Physical Examination (including vital signs) Document, ''OX'' Oxygen Therapy Certification,
            ''OZ'' Support Data for Claim, ''P4'' Pathology Report, ''P5'' Patient Medical History Document,
            ''PE'' Parenteral or Enteral Certification, ''PN'' Physical Therapy Notes, ''PO'' Prosthetics
            or Orthotic Certification, ''PQ'' Paramedical Results, ''PY'' Physician''s Report, ''PZ''
            Physical Therapy Certification, ''RB'' Radiology Films, ''RR'' Radiology Reports, ''RT'' Report
            of Tests and Analysis Report, ''RX'' Renewable Oxygen Content Averaging Report, ''SG'' Symptoms
            Document, ''V5'' Death Notification, ''XP'' Photographs'
          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
        attachmentTransmissionCode:
          type: string
          description: 'Loop: 2400, Segment: PWK, Element: PWK02, Notes: Allowed Values are ''AA'' Available
            on Request at Provider Site, ''BM'' By Mail, ''EL'' Electronically Only, ''EM'' E-Mail, ''FT''
            File Transfer, ''FX'' By Fax'
          enum:
          - AA
          - BM
          - EL
          - EM,
          - FT
          - FX
        attachmentControlNumber:
          type: string
          description: 'Loop: 2400, Segment: PWK, Element: PWK06, Notes: Required when PWK02 = ''BM'',
            ''EL'', ''EM'', ''FX'', or ''FT''. If not required by this implementation guide, do not send'
      description: 'Loop: 2400, Segment: PWK'
    Submitter:
      required:
      - contactInformation
      - organizationName
      type: object
      properties:
        organizationName:
          type: string
          description: 'Loop: 1000A, Segment: NM1, Element: NM103, Notes: NM103 where NM102=2'
          example: happy doctors group
        taxId:
          type: string
          description: 'Loop: 1000A, Segment: NM1, Element:NM109, Notes:NM109 where NM108=46'
          example: '12345'
        contactInformation:
          $ref: '#/components/schemas/ContactInformation'
      description: 'Loop: 1000A'
    Subscriber:
      required:
      - firstName
      - lastName
      - paymentResponsibilityLevelCode
      type: object
      properties:
        memberId:
          type: string
          description: 'Loop: 2010BA, Segment: NM1, Element: NM109, Notes:NM109 where NM108=MI'
          example: '0000000001'
        standardHealthId:
          type: string
          description: 'Loop: 2010BA, Segment: NM1, Element: NM109, Notes:NM109 where NM108=II'
        ssn:
          type: string
          description: 'Loop: 2010BA, Segment: REF, Element: REF02, Notes: REF02 where REF01=SY'
        paymentResponsibilityLevelCode:
          type: string
          description: 'Loop: 2000B, Segment: SBR, Element:SBR01, Notes: Allowed Values are ''A'' Payer
            Responsibility Four, ''B'' Payer Responsibility Five, ''C'' Payer Responsibility Six, ''D''
            Payer Responsibility Seven, ''E'' Payer Responsibility Eight, ''F'' Payer Responsibility Nine,
            ''G'' Payer Responsibility Ten, ''H'' Payer Responsibility Eleven, ''P'' Primary, ''S'' Secondary,
            ''T'' Tertiary, ''U'' Unknown'
          example: P
          enum:
          - A
          - B
          - C
          - D
          - E
          - F
          - G
          - H
          - P
          - S
          - T
          - U
        firstName:
          type: string
          description: 'Loop: 2010BA, Segment: NM1, Element:NM104'
          example: johnOne
        lastName:
          type: string
          description: 'Loop: 2010BA, Segment: NM1, Element:NM103, Notes: NM103 where NM102=1'
          example: doeOne
        middleName:
          type: string
          description: 'Loop: 2010BA, Segment: NM1, Element:NM105'
        suffix:
          type: string
          description: 'Loop: 2010BA, Segment: NM1, Element: NM107'
          example: Jr
        gender:
          type: string
          description: 'Loop: 2010BA, Segment: DMG, Element:DMG03'
          example: M
          enum:
          - F
          - M
          - U
        dateOfBirth:
          type: string
          description: 'Loop: 2010BA, Segment: DMG, Element:DMG02, Notes: DMG02 YYYYMMDD'
          example: '19800101'
        policyNumber:
          type: string
          description: 'Loop: 2000B, Segment: SBR, Element:SBR03, Notes: Deprecated see otherSubscriberInformation.policyNumber'
          deprecated: true
        groupNumber:
          type: string
          description: 'Loop: 2000B, Segment: SBR, Element:SBR03'
        address:
          $ref: '#/components/schemas/Address'
      description: 'Loop: 2000B, used in 2000C when dependent not present'
    ValueInformation:
      required:
      - valueCode
      - valueCodeAmount
      type: object
      properties:
        valueCode:
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01, Notes:HI01-02'
        valueCodeAmount:
          type: string
          description: 'Loop: 2300, Segment: HI, Element: HI01, Notes:HI01-05'
    ClaimReference:
      type: object
      properties:
        correlationId:
          type: string
          description: Claim correlation ID
          example: 200715R999898
        submitterId:
          type: string
          description: Submitter ID for transaction
          example: '999898'
        customerClaimNumber:
          type: string
          description: Claim number
          example: '000000001'
        patientControlNumber:
          type: string
          description: Control number for claim
          example: '12345'
        timeOfResponse:
          type: string
          description: Time of response for claim
          example: '2020-07-15T12:44:17.994-05:00'
        formatVersion:
          type: string
          description: Claim format version
          example: '5010'
        claimType:
          type: string
          description: Claim Type
          example: INST
        rhClaimNumber:
          type: string
          description: RH Claim Number
          example: 00001TEST
      description: ClaimReference
    EditResponse:
      type: object
      properties:
        qualifierCode:
          type: string
        errorDescription:
          type: string
        element:
          type: string
        segment:
          type: string
        fieldIndex:
          type: string
        editName:
          type: string
        editActivity:
          type: string
        referenceID:
          type: string
        claimCorePath:
          type: string
        allowOverride:
          type: string
        loop:
          type: string
        badData:
          type: string
        phaseID:
          type: string
    Error:
      type: object
      properties:
        field:
          type: string
          description: The field related to the error
          example: claimInformation.serviceLines[0].serviceDate
        value:
          type: string
          description: Value for bad data error
          example: '123'
        code:
          type: string
          description: Error code
          example: '123'
        description:
          type: string
          description: Description of error message.
          example: Must not be empty
        followupAction:
          type: string
          description: Follow up action to correct
          example: Add value
        location:
          type: string
          description: Location of error
          example: serviceDate
      description: Error
    Failure:
      type: object
      properties:
        description:
          type: string
        code:
          type: string
    Payer:
      type: object
      properties:
        payerName:
          type: string
        payerID:
          type: string
    Response:
      type: object
      properties:
        status:
          type: string
          description: Status of claim
          example: SUCCESS
        controlNumber:
          type: string
          description: Transaction Set Control Number
          example: '000000001'
        tradingPartnerServiceId:
          type: string
          description: Payer ID
          example: '9496'
        claimReference:
          $ref: '#/components/schemas/ClaimReference'
        errors:
          type: array
          description: List of errors
          items:
            $ref: '#/components/schemas/Error'
        httpStatusCode:
          type: string
          writeOnly: true
          enum:
          - 100 CONTINUE
          - 101 SWITCHING_PROTOCOLS
          - 102 PROCESSING
          - 103 CHECKPOINT
          - 200 OK
          - 201 CREATED
          - 202 ACCEPTED
          - 203 NON_AUTHORITATIVE_INFORMATION
          - 204 NO_CONTENT
          - 205 RESET_CONTENT
          - 206 PARTIAL_CONTENT
          - 207 MULTI_STATUS
          - 208 ALREADY_REPORTED
          - 226 IM_USED
          - 300 MULTIPLE_CHOICES
          - 301 MOVED_PERMANENTLY
          - 302 FOUND
          - 302 MOVED_TEMPORARILY
          - 303 SEE_OTHER
          - 304 NOT_MODIFIED
          - 305 USE_PROXY
          - 307 TEMPORARY_REDIRECT
          - 308 PERMANENT_REDIRECT
          - 400 BAD_REQUEST
          - 401 UNAUTHORIZED
          - 402 PAYMENT_REQUIRED
          - 403 FORBIDDEN
          - 404 NOT_FOUND
          - 405 METHOD_NOT_ALLOWED
          - 406 NOT_ACCEPTABLE
          - 407 PROXY_AUTHENTICATION_REQUIRED
          - 408 REQUEST_TIMEOUT
          - 409 CONFLICT
          - 410 GONE
          - 411 LENGTH_REQUIRED
          - 412 PRECONDITION_FAILED
          - 413 PAYLOAD_TOO_LARGE
          - 413 REQUEST_ENTITY_TOO_LARGE
          - 414 URI_TOO_LONG
          - 414 REQUEST_URI_TOO_LONG
          - 415 UNSUPPORTED_MEDIA_TYPE
          - 416 REQUESTED_RANGE_NOT_SATISFIABLE
          - 417 EXPECTATION_FAILED
          - 418 I_AM_A_TEAPOT
          - 419 INSUFFICIENT_SPACE_ON_RESOURCE
          - 420 METHOD_FAILURE
          - 421 DESTINATION_LOCKED
          - 422 UNPROCESSABLE_ENTITY
          - 423 LOCKED
          - 424 FAILED_DEPENDENCY
          - 425 TOO_EARLY
          - 426 UPGRADE_REQUIRED
          - 428 PRECONDITION_REQUIRED
          - 429 TOO_MANY_REQUESTS
          - 431 REQUEST_HEADER_FIELDS_TOO_LARGE
          - 451 UNAVAILABLE_FOR_LEGAL_REASONS
          - 500 INTERNAL_SERVER_ERROR
          - 501 NOT_IMPLEMENTED
          - 502 BAD_GATEWAY
          - 503 SERVICE_UNAVAILABLE
          - 504 GATEWAY_TIMEOUT
          - 505 HTTP_VERSION_NOT_SUPPORTED
          - 506 VARIANT_ALSO_NEGOTIATES
          - 507 INSUFFICIENT_STORAGE
          - 508 LOOP_DETECTED
          - 509 BANDWIDTH_LIMIT_EXCEEDED
          - 510 NOT_EXTENDED
          - 511 NETWORK_AUTHENTICATION_REQUIRED
        meta:
          $ref: '#/components/schemas/ResponseMeta'
        editStatus:
          type: string
        editResponses:
          type: array
          items:
            $ref: '#/components/schemas/EditResponse'
        payer:
          $ref: '#/components/schemas/Payer'
        failure:
          $ref: '#/components/schemas/Failure'
    ResponseMeta:
      type: object
      properties:
        submitterId:
          type: string
          description: submitterId assigned to this request
        senderId:
          type: string
          description: senderId assigned to this request
        billerId:
          type: string
          description: billerId assigned to this request
        traceId:
          type: string
          description: Unique Id assigned to each request by Optum
        applicationMode:
          type: string
          description: Used by Optum to identify where this request can be found for support
      description: meta data about the request
    RawX12Request:
      type: object
      properties:
        x12:
          type: string
  securitySchemes:
    bearer-key:
      type: http
      scheme: bearer
      bearerFormat: JWT