openapi: 3.0.1
info:
  title: Medical Network Professional Claims V3
  description: 835 Professional Claims
  version: V3
servers:
- url: https://sandbox-apigw.optum.com
  description: Optum
tags:
- name: Health Check
  description: Health Check
- name: Professional Claims
  description: Professional Claims
paths:
  /medicalnetwork/professionalclaims/v3/validation:
    post:
      tags:
      - Professional Claims
      summary: Claim Validation
      operationId: validateClaim
      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/ClaimSubmissionRequest'
        required: true
      responses:
        '200':
          description: OK
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Response'
  /medicalnetwork/professionalclaims/v3/submission:
    post:
      tags:
      - Professional 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/ClaimSubmissionRequest'
        required: true
      responses:
        '200':
          description: OK
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Response'
  /medicalnetwork/professionalclaims/v3/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/professionalclaims/v3/raw-x12-submission:
    post:
      tags:
      - Professional Claims
      summary: Claim Submission x12
      operationId: rawX12Submission
      parameters:
      - name: X-CHC-ClaimSubmission-BillerId
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-ClaimSubmission-Username
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-ClaimSubmission-Pwd
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-ClaimSubmission-SubmitterId
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-TraceId
        in: header
        required: false
        schema:
          type: string
      - 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/professionalclaims/v3/raw-x12-validation:
    post:
      tags:
      - Professional Claims
      summary: Claim Validation x12
      operationId: rawX12Validation
      parameters:
      - name: X-CHC-ClaimSubmission-BillerId
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-ClaimSubmission-Username
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-ClaimSubmission-Pwd
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-ClaimSubmission-SubmitterId
        in: header
        required: false
        schema:
          type: string
      - name: X-CHC-TraceId
        in: header
        required: false
        schema:
          type: string
      - 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
          example: BillingProvider
        npi:
          type: string
          description: 'NM109, Notes: National Provider Identifier'
          example: '1760854442'
        ssn:
          type: string
          description: 'REF02 when REF01=SY, Notes: The Social Security Number must be a string of nine
            numbers with no separators'
          example: '000000000'
        employerId:
          type: string
          description: 'REF02 when REF01=EI, Notes: The Employer Identification Number must be a string
            of exactly nine numbers with no separators'
          example: '123456789'
        commercialNumber:
          type: string
          description: REF02 when REF01=G2
        locationNumber:
          type: string
          description: REF02 when REF01=LU
        payerIdentificationNumber:
          type: string
          description: 'LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=2U'
        employerIdentificationNumber:
          type: string
          description: 'LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=EI'
        claimOfficeNumber:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=FY'
        naic:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=NF, Notes: National Association
            of Insurance Commissioners (NAIC) Code'
        stateLicenseNumber:
          type: string
          description: REF02 when REF01=0B
        providerUpinNumber:
          type: string
          description: 'REF02 when REF01=1G, Notes: UPINs must be formatted as either X99999 or XXX999'
        taxonomyCode:
          type: string
          description: PRV03
        firstName:
          type: string
          description: NM104
          example: johnone
        lastName:
          type: string
          description: NM103
          example: doeone
        middleName:
          type: string
          description: NM105
          example: middleone
        suffix:
          type: string
          description: NM107
          example: Jr
        organizationName:
          type: string
          description: 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
          example: BillingProvider
        npi:
          type: string
          description: 'NM109, Notes: National Provider Identifier'
          example: '1760854442'
        ssn:
          type: string
          description: 'REF02 when REF01=SY, Notes: The Social Security Number must be a string of nine
            numbers with no separators'
          example: '000000000'
        employerId:
          type: string
          description: 'REF02 when REF01=EI, Notes: The Employer Identification Number must be a string
            of exactly nine numbers with no separators'
          example: '123456789'
        commercialNumber:
          type: string
          description: REF02 when REF01=G2
        locationNumber:
          type: string
          description: REF02 when REF01=LU
        payerIdentificationNumber:
          type: string
          description: 'LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=2U'
        employerIdentificationNumber:
          type: string
          description: 'LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=EI'
        claimOfficeNumber:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=FY'
        naic:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=NF, Notes: National Association
            of Insurance Commissioners (NAIC) Code'
        stateLicenseNumber:
          type: string
          description: REF02 when REF01=0B
        providerUpinNumber:
          type: string
          description: 'REF02 when REF01=1G, Notes: UPINs must be formatted as either X99999 or XXX999'
        taxonomyCode:
          type: string
          description: PRV03
        firstName:
          type: string
          description: NM104
          example: johnone
        lastName:
          type: string
          description: NM103
          example: doeone
        middleName:
          type: string
          description: NM105
          example: middleone
        suffix:
          type: string
          description: NM107
          example: Jr
        organizationName:
          type: string
          description: NM103
          example: HAPPY DOCTORS GROUPPRACTICE
        address:
          $ref: '#/components/schemas/Address'
        contactInformation:
          $ref: '#/components/schemas/ContactInformation'
      description: 'Loop: 2420F'
    rendering:
      required:
      - providerType
      type: object
      properties:
        providerType:
          type: string
          example: BillingProvider
        npi:
          type: string
          description: 'NM109, Notes: National Provider Identifier'
          example: '1760854442'
        ssn:
          type: string
          description: 'REF02 when REF01=SY, Notes: The Social Security Number must be a string of nine
            numbers with no separators'
          example: '000000000'
        employerId:
          type: string
          description: 'REF02 when REF01=EI, Notes: The Employer Identification Number must be a string
            of exactly nine numbers with no separators'
          example: '123456789'
        commercialNumber:
          type: string
          description: REF02 when REF01=G2
        locationNumber:
          type: string
          description: REF02 when REF01=LU
        payerIdentificationNumber:
          type: string
          description: 'LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=2U'
        employerIdentificationNumber:
          type: string
          description: 'LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=EI'
        claimOfficeNumber:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=FY'
        naic:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=NF, Notes: National Association
            of Insurance Commissioners (NAIC) Code'
        stateLicenseNumber:
          type: string
          description: REF02 when REF01=0B
        providerUpinNumber:
          type: string
          description: 'REF02 when REF01=1G, Notes: UPINs must be formatted as either X99999 or XXX999'
        taxonomyCode:
          type: string
          description: PRV03
        firstName:
          type: string
          description: NM104
          example: johnone
        lastName:
          type: string
          description: NM103
          example: doeone
        middleName:
          type: string
          description: NM105
          example: middleone
        suffix:
          type: string
          description: NM107
          example: Jr
        organizationName:
          type: string
          description: NM103
          example: HAPPY DOCTORS GROUPPRACTICE
        address:
          $ref: '#/components/schemas/Address'
        contactInformation:
          $ref: '#/components/schemas/ContactInformation'
      description: 'Loop: 2420A'
    ordering:
      required:
      - providerType
      type: object
      properties:
        providerType:
          type: string
          example: BillingProvider
        npi:
          type: string
          description: 'NM109, Notes: National Provider Identifier'
          example: '1760854442'
        ssn:
          type: string
          description: 'REF02 when REF01=SY, Notes: The Social Security Number must be a string of nine
            numbers with no separators'
          example: '000000000'
        employerId:
          type: string
          description: 'REF02 when REF01=EI, Notes: The Employer Identification Number must be a string
            of exactly nine numbers with no separators'
          example: '123456789'
        commercialNumber:
          type: string
          description: REF02 when REF01=G2
        locationNumber:
          type: string
          description: REF02 when REF01=LU
        payerIdentificationNumber:
          type: string
          description: 'LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=2U'
        employerIdentificationNumber:
          type: string
          description: 'LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=EI'
        claimOfficeNumber:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=FY'
        naic:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=NF, Notes: National Association
            of Insurance Commissioners (NAIC) Code'
        stateLicenseNumber:
          type: string
          description: REF02 when REF01=0B
        providerUpinNumber:
          type: string
          description: 'REF02 when REF01=1G, Notes: UPINs must be formatted as either X99999 or XXX999'
        taxonomyCode:
          type: string
          description: PRV03
        firstName:
          type: string
          description: NM104
          example: johnone
        lastName:
          type: string
          description: NM103
          example: doeone
        middleName:
          type: string
          description: NM105
          example: middleone
        suffix:
          type: string
          description: NM107
          example: Jr
        organizationName:
          type: string
          description: NM103
          example: HAPPY DOCTORS GROUPPRACTICE
        address:
          $ref: '#/components/schemas/Address'
        contactInformation:
          $ref: '#/components/schemas/ContactInformation'
      description: 'Loop: 2420E, Setting ProviderType equal to OrderingProvider is deprecated, please
        use ClaimInformation.serviceLines.orderingProvider'
      deprecated: true
    supervising:
      required:
      - providerType
      type: object
      properties:
        providerType:
          type: string
          example: BillingProvider
        npi:
          type: string
          description: 'NM109, Notes: National Provider Identifier'
          example: '1760854442'
        ssn:
          type: string
          description: 'REF02 when REF01=SY, Notes: The Social Security Number must be a string of nine
            numbers with no separators'
          example: '000000000'
        employerId:
          type: string
          description: 'REF02 when REF01=EI, Notes: The Employer Identification Number must be a string
            of exactly nine numbers with no separators'
          example: '123456789'
        commercialNumber:
          type: string
          description: REF02 when REF01=G2
        locationNumber:
          type: string
          description: REF02 when REF01=LU
        payerIdentificationNumber:
          type: string
          description: 'LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=2U'
        employerIdentificationNumber:
          type: string
          description: 'LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=EI'
        claimOfficeNumber:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=FY'
        naic:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=NF, Notes: National Association
            of Insurance Commissioners (NAIC) Code'
        stateLicenseNumber:
          type: string
          description: REF02 when REF01=0B
        providerUpinNumber:
          type: string
          description: 'REF02 when REF01=1G, Notes: UPINs must be formatted as either X99999 or XXX999'
        taxonomyCode:
          type: string
          description: PRV03
        firstName:
          type: string
          description: NM104
          example: johnone
        lastName:
          type: string
          description: NM103
          example: doeone
        middleName:
          type: string
          description: NM105
          example: middleone
        suffix:
          type: string
          description: NM107
          example: Jr
        organizationName:
          type: string
          description: NM103
          example: HAPPY DOCTORS GROUPPRACTICE
        address:
          $ref: '#/components/schemas/Address'
        contactInformation:
          $ref: '#/components/schemas/ContactInformation'
      description: 'Loop: 2420D'
    Address:
      required:
      - address1
      - city
      type: object
      properties:
        address1:
          type: string
          description: 'Segment: N3, Element: N301'
          example: 123 address1
        address2:
          type: string
          description: 'Segment: N3, Element: N302'
          example: apt 000
        city:
          type: string
          description: 'Segment: N4, Element: N401'
          example: city1
        state:
          type: string
          description: 'Segment: N4, Element: N402'
          example: wa
        postalCode:
          type: string
          description: 'Segment: N4, Element: N403'
          example: '981010000'
        countryCode:
          type: string
          description: 'Segment: N4, Element: N404'
        countrySubDivisionCode:
          type: string
          description: 'Segment: N4, Element: N407'
      description: N3 and N4
    AmbulanceCertification:
      required:
      - certificationConditionIndicator
      - conditionCodes
      type: object
      properties:
        certificationConditionIndicator:
          type: string
          description: 'Loop: 2300, Segment: CRC, Element: CRC02 when CRC01 = 07, Note: Allowed Values
            are: ''N'' No, ''Y'' Yes'
          enum:
          - N
          - Y
        conditionCodes:
          maxItems: 5
          minItems: 1
          type: array
          description: 'Loop: 2300, Segment: CRC, Element: CRC03, CRC04, CRC05, CRC06, CRC07, Note: Allowed
            Values are: ''01'' Patient was admitted to a hospital, ''04'' Patient was moved by stretcher,
            ''05'' Patient was unconscious or in shock, ''06'' Patient was transported in an emergency
            situation, ''07'' Patient had to be physically restrained, ''08'' Patient had visible hemorrhaging,
            ''09'' Ambulance service was medically necessary, ''12'' Patient is confined to a bed or chair'
          items:
            type: string
            enum:
            - '01'
            - '04'
            - '05'
            - '06'
            - '07'
            - 08
            - 09
            - '12'
      description: CRC
    AmbulanceTransportInformation:
      required:
      - ambulanceTransportReasonCode
      - transportDistanceInMiles
      type: object
      properties:
        patientWeightInPounds:
          type: string
          description: 'Segment: CR1, Element: CR102'
        ambulanceTransportReasonCode:
          type: string
          description: 'CR104, Note: Allowed Values are: ''A'' Patient was transported to nearest facility
            for care of symptoms, complaints, or both, ''B'' Patient was transported for the benefit of
            a preferred physician, ''C'' Patient was transported for the nearness of family members, ''D''
            Patient was transported for the care of a specialist or for availability of specialized equipment,
            ''E'' Patient Transferred to Rehabilitation Facility'
          enum:
          - A
          - B
          - C
          - D
          - E
        transportDistanceInMiles:
          type: string
          description: 'Segment: CR1, Element: CR106'
        roundTripPurposeDescription:
          type: string
          description: 'Segment: CR1, Element: CR109'
        stretcherPurposeDescription:
          type: string
          description: 'Segment: CR1, Element: CR110'
      description: CR1
    ClaimAdjustment:
      required:
      - adjustmentDetails
      - adjustmentGroupCode
      type: object
      properties:
        adjustmentGroupCode:
          type: string
          description: 'Loop: 2430, Segment: CAS, Element: CAS01, Notes: Code identifying the general
            category of payment adjustment'
          enum:
          - CO
          - CR
          - OA
          - PI
          - PR
        adjustmentDetails:
          maxItems: 6
          minItems: 1
          type: array
          description: 'Loop: 2430, Segment: CAS'
          items:
            $ref: '#/components/schemas/ClaimAdjustmentDetails'
      description: CR1
    ClaimAdjustmentDetails:
      required:
      - adjustmentAmount
      - adjustmentReasonCode
      type: object
      properties:
        adjustmentReasonCode:
          type: string
          description: 'Loop: 2430, Segment: CAS, Element: CAS02, CAS05, CAS08, CAS11, CAS14, CAS17'
        adjustmentAmount:
          type: string
          description: 'Loop: 2430, Segment: CAS, Element: CAS03, CAS06, CAS09, CAS12, CAS15, CAS18'
        adjustmentQuantity:
          type: string
          description: 'Loop: 2430, Segment: CAS, Element: CAS04, CAS07, CAS10, CAS13, CAS16, CAS19'
      description: CAS
    ClaimContractInformation:
      required:
      - contractTypeCode
      type: object
      properties:
        contractTypeCode:
          type: string
          description: 'Loop: 2300,Segment: CN1, Element: CN101, Note: Allowed Values are: ''01'' Diagnosis
            Related Group (DRG), ''02'' Per Diem, ''03'' Variable Per Diem, ''04'' Flat, ''05'' Capitated,
            ''06'' Percent, ''09'' Other'
          enum:
          - '01'
          - '02'
          - '03'
          - '04'
          - '05'
          - '06'
          - 09
        contractAmount:
          type: string
          description: 'Loop: 2300, Segment: CN1, Element: CN102'
        contractPercentage:
          type: string
          description: 'Loop: 2300, Segment: CN1, Element: CN103'
        contractCode:
          type: string
          description: 'Loop: 2300, Segment: CN1, Element: CN104'
        termsDiscountPercentage:
          type: string
          description: 'Loop: 2300, Segment: CN1, Element: CN105'
        contractVersionIdentifier:
          type: string
          description: 'Loop: 2300, Segment: CN1, Element: CN106'
      description: 'Loop 2300, Segment: CN1'
    ClaimDateInformation:
      type: object
      properties:
        symptomDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        initialTreatmentDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        lastSeenDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        acuteManifestationDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        accidentDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        lastMenstrualPeriodDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        lastXRayDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        hearingAndVisionPrescriptionDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        disabilityBeginDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        disabilityEndDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        lastWorkedDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        authorizedReturnToWorkDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        admissionDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        dischargeDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        assumedAndRelinquishedCareBeginDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        assumedAndRelinquishedCareEndDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        repricerReceivedDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
        firstContactDate:
          type: string
          description: 'Loop: 2300, Segment: DTP, Element: DTP03'
      description: DTP
    ClaimInformation:
      required:
      - benefitsAssignmentCertificationIndicator
      - claimChargeAmount
      - claimFilingCode
      - claimFrequencyCode
      - healthCareCodeInformation
      - patientControlNumber
      - placeOfServiceCode
      - planParticipationCode
      - releaseInformationCode
      - serviceLines
      - signatureIndicator
      type: object
      properties:
        claimFilingCode:
          type: string
          description: 'Loop 2000B, Segment: SBR, Element: SBR09, Note: 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: CI
          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 2010BA, Segment: REF, Element: REF02'
        deathDate:
          type: string
          description: 'Loop 2000B and 2000C, Segment: PAT, Element: PAT06 and PAT05=D8'
        patientWeight:
          type: string
          description: 'Loop 2000B and 2000C, Segment: PAT, Element: PAT08 and PAT07=01'
        pregnancyIndicator:
          type: string
          description: 'Loop 2000B and 2000C, Segment: PAT, Element: PAT09'
          enum:
          - Y
        patientControlNumber:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM01'
          example: '12345'
        claimChargeAmount:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM02'
          example: '28.75'
        placeOfServiceCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM05-01'
          example: '11'
        claimFrequencyCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM05-03'
          example: '1'
        signatureIndicator:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM06, Note: Allowed Values are: ''N'' NO, ''Y''
            Yes'
          example: Y
          enum:
          - N
          - Y
        planParticipationCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM07, Note: 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, Note: Allowed Values are: ''N'' No, ''W''
            Not Applicable - Use code ''W'' when the patient refuses to assign benefits, ''Y'' Yes'
          example: Y
          enum:
          - N
          - W
          - Y
        releaseInformationCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM09, Note: Allowed Values are: ''I'' Informed
            Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes,
            ''Y'' Yes'
          example: Y
          enum:
          - I
          - Y
        patientSignatureSourceCode:
          type: boolean
          description: 'Loop 2300, Segment: CLM, Element: CLM10, Note: Allowed Values are: ''P'' Signature
            generated by provider because the patient was not physically present for services'
          enum:
          - false
        relatedCausesCode:
          maxItems: 2
          minItems: 0
          type: array
          description: 'Loop 2300, Segment: CLM, Element: CLM11-01, CLM11-02, Note: Allowed Values are:
            ''AA'' Auto Accident, ''EM'' Employment, ''OA'' Other Accident'
          items:
            type: string
            enum:
            - AA
            - EM
            - OA
        autoAccidentStateCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM11-04, Note: When CLM11-1 or CLM11-2 has
            a value of ''AA'' to identify the state, province or sub-country code in which the automobile
            accident occurred.'
          enum:
          - AA
          - EM
          - OA
        autoAccidentCountryCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM11-05, Note: When CLM11-1 or CLM11-2 = AA
            and the accident occurred in a country other than US or Canada.'
        specialProgramCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM12, Note: Allowed Values are: ''02'' Physically
            Handicapped Children''s Program, ''03'' Special Federal Funding, ''05'' Disabolity, ''09''
            Second Opinion or Surgery'
          enum:
          - '02'
          - '03'
          - '05'
          - 09
        delayReasonCode:
          type: string
          description: 'Loop 2300, Segment: CLM, Element: CLM20, Note: Allowed 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: 'Loop 2300, Segment: AMT, Element: AMT02'
        fileInformation:
          type: string
          description: 'Loop 2300, Segment: K3, Element: K301'
        fileInformationList:
          maxItems: 10
          minItems: 0
          type: array
          description: 'Loop 2300, Segment: K3, Element: K301'
          items:
            type: string
            description: 'Loop 2300, Segment: K3, Element: K301'
        claimDateInformation:
          $ref: '#/components/schemas/ClaimDateInformation'
        claimContractInformation:
          $ref: '#/components/schemas/ClaimContractInformation'
        claimSupplementalInformation:
          $ref: '#/components/schemas/ClaimSupplementalInformation'
        claimNote:
          $ref: '#/components/schemas/ClaimNote'
        ambulanceTransportInformation:
          $ref: '#/components/schemas/AmbulanceTransportInformation'
        spinalManipulationServiceInformation:
          $ref: '#/components/schemas/SpinalManipulationServiceInformation'
        ambulanceCertification:
          maxItems: 3
          minItems: 0
          type: array
          description: 'Loop 2300, Segment: CRC'
          items:
            $ref: '#/components/schemas/AmbulanceCertification'
        patientConditionInformationVision:
          maxItems: 3
          minItems: 0
          type: array
          description: 'Loop 2300, Segment: CRC'
          items:
            $ref: '#/components/schemas/PatientConditionInformationVision'
        homeboundIndicator:
          type: boolean
          description: 'Loop 2300, Segment: CRC'
        epsdtReferral:
          $ref: '#/components/schemas/EpsdtReferral'
        healthCareCodeInformation:
          maxItems: 12
          minItems: 1
          type: array
          description: 'Loop 2300, Segment: HI'
          items:
            $ref: '#/components/schemas/HealthCareInformation'
        anesthesiaRelatedSurgicalProcedure:
          maxItems: 2
          minItems: 1
          type: array
          description: 'Loop 2300, Segment: HI'
          items:
            type: string
            description: 'Loop 2300, Segment: HI'
        conditionInformation:
          maxItems: 2
          minItems: 0
          type: array
          description: 'Loop 2300, Segment: HI'
          items:
            $ref: '#/components/schemas/ConditionInformation'
        claimPricingRepricingInformation:
          $ref: '#/components/schemas/ClaimPricingRepricingInformation'
        serviceFacilityLocation:
          $ref: '#/components/schemas/ServiceFacilityLocation'
        ambulancePickUpLocation:
          $ref: '#/components/schemas/Address'
        ambulanceDropOffLocation:
          $ref: '#/components/schemas/Address'
        otherSubscriberInformation:
          maxItems: 10
          minItems: 0
          type: array
          description: Loop 2320
          items:
            $ref: '#/components/schemas/OtherSubscriberInformation'
        serviceLines:
          maxItems: 50
          minItems: 1
          type: array
          description: Loop 2400
          items:
            $ref: '#/components/schemas/ServiceLine'
      description: Loop2300
    ClaimNote:
      type: object
      properties:
        additionalInformation:
          type: string
          description: 'Loop 2300, Segment: NTE, Element: NTE02, Note: NTE01=ADD'
        certificationNarrative:
          type: string
          description: 'Loop 2300, Segment: NTE, Element: NTE02, Note: NTE01=CER'
        goalRehabOrDischargePlans:
          type: string
          description: 'Loop 2300, Segment: NTE, Element: NTE02, Note: NTE01=DCP'
        diagnosisDescription:
          type: string
          description: 'Loop 2300, Segment: NTE, Element: NTE02, Note: NTE01=DGN'
        thirdPartOrgNotes:
          type: string
          description: 'Loop 2300, Segment: NTE, Element: NTE02, Note: NTE01=TPO'
      description: NTE
    ClaimPricingRepricingInformation:
      required:
      - pricingMethodologyCode
      - repricedAllowedAmount
      type: object
      properties:
        pricingMethodologyCode:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP01, Note: Allowed Values are: ''00'' Zero
            Pricing (Not Covered Under Contract), ''01'' Priced as Billed at 100%, ''02'' Priced at the
            Standard Fee Schedule, ''03'' Priced at a Contractual Percentage, ''04'' Bundled Pricing,
            ''05'' Peer Review Pricing, ''06'' Bundled 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'
          example: '01'
          enum:
          - '00'
          - '01'
          - '02'
          - '03'
          - '04'
          - '05'
          - '06'
          - '07'
          - 08
          - 09
          - '10'
          - '11'
          - '12'
          - '13'
          - '14'
        repricedAllowedAmount:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP02'
          example: '1'
        repricedSavingAmount:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP03'
        repricingOrganizationIdentifier:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP04'
        repricingPerDiemOrFlatRateAmount:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP05'
        repricedApprovedAmbulatoryPatientGroupCode:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP06'
        repricedApprovedAmbulatoryPatientGroupAmount:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP07'
        rejectReasonCode:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP13, Note: 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, ''16'' Claim does not contain enough information for repricing'
          enum:
          - T1
          - T2
          - T3
          - T4
          - T5
          - T6
        policyComplianceCode:
          type: string
          description: 'Loop: 2300, Segment: HCP, Element: HCP14, Note: 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, Segment: HCP, Element: HCP15, Note: 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'
      description: HCP
    ClaimSubmissionRequest:
      required:
      - billing
      - claimInformation
      - controlNumber
      - receiver
      - submitter
      - subscriber
      type: object
      properties:
        controlNumber:
          type: string
          description: 'Header, Segment: ST02 (no loop), Notes: Transaction Set Control Number'
          example: '000000001'
        tradingPartnerServiceId:
          type: string
          description: 'Loop: 2010BB Segment: NM1, Element: NM109, Notes: we send this as MN108 as PI
            = Payer Identification'
          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: setting providers deprecated, please set all providers individually by it's type.
          deprecated: true
          items:
            $ref: '#/components/schemas/supervising'
        claimInformation:
          $ref: '#/components/schemas/ClaimInformation'
        payToAddress:
          $ref: '#/components/schemas/Address'
        payToPlan:
          $ref: '#/components/schemas/PayToPlan'
        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'
        ordering:
          $ref: '#/components/schemas/ordering'
        supervising:
          $ref: '#/components/schemas/supervising'
        tradingPartnerName:
          type: string
          description: Loop 2010BB NM103
    ClaimSupplementalInformation:
      type: object
      properties:
        reportInformation:
          $ref: '#/components/schemas/ReportInformation'
        priorAuthorizationNumber:
          type: string
          description: 'Loop: 2300, Segment: REF, Element: REF02 and REF01=G1'
        referralNumber:
          type: string
          description: 'Loop: 2300, Segment: REF, Element: REF02 and REF01=9F'
        claimControlNumber:
          type: string
          description: 'Loop: 2300, Segment: REF, Element: REF02 and REF01=F8'
        cliaNumber:
          type: string
          description: 'Loop: 2300, Segment: REF, Element: REF02 and REF01=X4'
        repricedClaimNumber:
          type: string
          description: 'Loop: 2300, Segment: REF, Element: REF02 and REF01=9A'
          example: '00001'
        adjustedRepricedClaimNumber:
          type: string
          description: 'Loop: 2300, Segment: REF, Element: REF02 and REF01=9C'
        investigationalDeviceExemptionNumber:
          type: string
          description: 'Loop: 2300, Segment: REF, Element: REF02 and REF01=LX'
        claimNumber:
          type: string
          description: 'Loop: 2300, Segment: REF, Element: REF02 and REF01=D9'
          example: '12345'
        mammographyCertificationNumber:
          type: string
          description: 'Loop: 2300, Segment: REF, Element: REF02 and REF01=EW'
        medicalRecordNumber:
          type: string
          description: 'Loop: 2300, Segment: REF, Element: REF02 and REF01=EA'
        demoProjectIdentifier:
          type: string
          description: 'Loop: 2300, Segment: REF, Element: REF02 and REF01=P4'
        carePlanOversightNumber:
          type: string
          description: 'Loop: 2300, Segment: REF, Element: REF02 and REF01=1J'
        medicareCrossoverReferenceId:
          type: string
          description: 'Loop: 2300, Segment: REF, Element: REF02 and REF01=F5'
        serviceAuthorizationExceptionCode:
          type: string
          description: 'Loop: 2300, Segment: REF, Element: REF02 and REF01=4N, Note: ''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, Null'
          enum:
          - '1'
          - '2'
          - '3'
          - '4'
          - '5'
          - '6'
          - '7'
      description: PWK and REF
    CompositeDiagnosisCodePointers:
      required:
      - diagnosisCodePointers
      type: object
      properties:
        diagnosisCodePointers:
          maxItems: 2147483647
          minItems: 1
          type: array
          description: 'Loop: 2400, Segment: SV1, Element: SV107-01, SV107-02, SV107-03, SV107-04'
          example: 1
          items:
            type: string
      description: SVC107
    ConditionIndicatorDurableMedicalEquipment:
      required:
      - certificationConditionIndicator
      - conditionIndicator
      type: object
      properties:
        certificationConditionIndicator:
          type: string
          description: 'Loop 2400, Segment: CRC, Element: CRC02 and CRC01=09, Note: Allowed Values are:
            ''N'' No, ''Y'' Yes'
          example: Y
          enum:
          - Y
          - N
        conditionIndicator:
          type: string
          description: 'Loop 2400, Segment: CRC, Element: CRC03, Note: Allowed Values are: ''38'' Certification
            signed by the physician is on file at the supplier''s office, ''ZV'' Replacement Item'
          example: '38'
          enum:
          - '38'
          - ZV
        conditionIndicatorCode:
          type: string
          description: 'Loop 2400, Segment: CRC, Element: CRC04, Note: Allowed Values are: ''38'' Certification
            signed by the physician is on file at the supplier''s office, ''ZV'' Replacement Item'
          example: '38'
          enum:
          - '38'
          - ZV
      description: CRC
    ConditionInformation:
      required:
      - conditionCodes
      type: object
      properties:
        conditionCodes:
          maxItems: 12
          minItems: 1
          type: array
          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, HI11-02, HI12-02'
      description: HI
    ContactInformation:
      required:
      - name
      type: object
      properties:
        name:
          type: string
          description: 'Segment: PER, Element: PER02 and PER01=IC'
          example: SUBMITTER CONTACT INFO
        phoneNumber:
          type: string
          description: 'Segment: PER, Element: PER04 (Provider, Submitter, Subscriber, Dependent) or PER06
            (Provider, Submitter) or PER08 (Provider, Submitter), Note: Used when PER03=TE (Provider,
            Submitter, Subscriber, Dependent) or PER05=TE (Provider, Submitter) or PER07=TE (Provider,
            Submitter)'
          example: '5554567890'
        faxNumber:
          type: string
          description: 'Segment: PER, Element: PER04 or PER06 or PER08, Note: This is used in (Provider,
            Submitter) when PER03=FX or PER05=FX or PER07=FX'
          example: '5551234567'
        email:
          type: string
          description: 'Segment: PER, Element: PER04 or PER06 or PER08, Note: This used in (Provider,
            Submitter) when PER03=EM or PER05=EM or PER07=EM'
          example: email@email.com
        phoneExtension:
          type: string
          description: 'Segment: PER, Element: PER06 (Provider, Submitter, Subscriber, Dependent) or PER08
            (Provider, Submitter),Note: Used when PER05=EX (Provider, Submitter, Subscriber, Dependent)
            or PER07=EX (Provider, Submitter)'
          example: '1234'
      description: PER
    ContactInformationOrderingProvider:
      required:
      - name
      type: object
      properties:
        name:
          type: string
          description: 'Segment: PER, Element: PER02 and PER01=IC'
          example: SUBMITTER CONTACT INFO
        phoneNumber:
          type: string
          description: 'Segment: PER, Element: PER04 (Provider, Submitter, Subscriber, Dependent) or PER06
            (Provider, Submitter) or PER08 (Provider, Submitter), Note: Used when PER03=TE (Provider,
            Submitter, Subscriber, Dependent) or PER05=TE (Provider, Submitter) or PER07=TE (Provider,
            Submitter)'
          example: '5554567890'
        faxNumber:
          type: string
          description: 'Segment: PER, Element: PER04 or PER06 or PER08, Note: This is used in (Provider,
            Submitter) when PER03=FX or PER05=FX or PER07=FX'
          example: '5551234567'
        email:
          type: string
          description: 'Segment: PER, Element: PER04 or PER06 or PER08, Note: This used in (Provider,
            Submitter) when PER03=EM or PER05=EM or PER07=EM'
          example: email@email.com
        phoneExtension:
          type: string
          description: 'Segment: PER, Element: PER06 or PER08, Note: PER05=EX or PER07=EX'
          example: '1234'
      description: PER
    ContractInformation:
      required:
      - contractTypeCode
      type: object
      properties:
        contractTypeCode:
          type: string
          description: 'Segment: CN1, Element: CN101, Allowed Values are: ''01'' Diagnosis Related Group
            (DRG), ''02'' Per Diem, ''03'' Variable Per Diem, ''04'' Flat, ''05'' Capitated, ''06'' Percent,
            ''09'' Other'
          example: '01'
          enum:
          - '01'
          - '02'
          - '03'
          - '04'
          - '05'
          - '06'
          - 09
        contractAmount:
          type: string
          description: 'Segment: CN1, Element: CN102'
        contractPercentage:
          type: string
          description: 'Segment: CN1, Element: CN103'
        contractCode:
          type: string
          description: 'Segment: CN1, Element: CN104'
        termsDiscountPercentage:
          type: string
          description: 'Segment: CN1, Element: CN105'
        contractVersionIdentifier:
          type: string
          description: 'Segment: CN1, Element: CN106'
      description: CN1
    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'
          example: doeOne
        middleName:
          type: string
          description: 'Loop: 2010CA, Segment: NM1, Element: NM105'
        suffix:
          type: string
          description: 'Loop: 2010CA,  Segment: NM, Element: NM107'
          example: Jr
        gender:
          type: string
          description: 'Loop: 2010CA, Segment: DMG, Element: DMG03, Note: 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 when DMG01=D8'
          example: '19800102'
        ssn:
          type: string
          description: 'Loop: 2010CA, Segment: REF, Element: REF02 when REF01=SY'
          example: '19800102'
        memberId:
          type: string
          description: 'Loop: 2010CA, Segment: REF, Element: REF02 when REF01=1W'
          example: '19800102'
        relationshipToSubscriberCode:
          type: string
          description: 'Loop: 2000C, Segment: PAT, Element: PAT01, Note: 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
        contactInformation:
          $ref: '#/components/schemas/ContactInformation'
        address:
          $ref: '#/components/schemas/Address'
      description: LOOP 2000C
    DrugIdentification:
      required:
      - measurementUnitCode
      - nationalDrugCode
      - nationalDrugUnitCount
      - serviceIdQualifier
      type: object
      properties:
        serviceIdQualifier:
          type: string
          description: 'Loop: 2410, Segment: LIN, Element: LIN02, Note: Allowed Values are: ''EN'' EAN/UCC
            - 13, ''EO'' EAN/UCC - 8, ''HI'' HIBC (Health Care Industry Bar Code) Supplier Labeling Standard
            Primary Data Message, ''N4'' National Drug Code in 5-4-2 Format, ''ON'' Customer Order Number,
            ''UK'' GTIN 14-digit Data Structure, ''UP'' UCC - 12'
          enum:
          - EN
          - EO
          - HI
          - N4
          - 'ON'
          - UK
          - UP
        nationalDrugCode:
          type: string
          description: 'Loop: 2410, Segment: LIN, Element: LIN03'
        nationalDrugUnitCount:
          type: string
          description: 'Loop: 2410, Segment: CTP, Element: CTP04'
        measurementUnitCode:
          type: string
          description: 'Loop: 2410, Segment: CTP05, Element: CTP05-01, 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'
        pharmacyPrescriptionNumber:
          type: string
          description: 'Loop: 2410, Segment: REF, Element: REF02 when REF01=XZ'
      description: LOOP 2410
    DurableMedicalEquipmentCertificateOfMedicalNecessity:
      required:
      - attachmentTransmissionCode
      type: object
      properties:
        attachmentTransmissionCode:
          type: string
          description: 'Loop: 2400, Segment: PWK, Element: PWK02 when PWK01=CT, Note: Allowed Values are:
            ''AB'' Previously Submitted to Payer, ''AD'' Certification Included in this Claim, ''AF''
            Narrative Segment Included in this Claim, ''AG'' No Documentation is Required, ''NS'' Not
            Specified'
          enum:
          - AB
          - AD
          - AF
          - AG
          - NS
      description: PWK
    DurableMedicalEquipmentCertification:
      required:
      - certificationTypeCode
      - durableMedicalEquipmentDurationInMonths
      type: object
      properties:
        certificationTypeCode:
          type: string
          description: 'Loop: 2400, Segment: CR3, Element: CR301, Note: Allowed Values are: ''I'' Initial,
            ''R'' Renewal, ''S'' Revised'
          enum:
          - I
          - R
          - S
        durableMedicalEquipmentDurationInMonths:
          type: string
          description: 'Loop: 2400, Segment: CR3, Element: CR303 when CR302=MO'
      description: CR3
    DurableMedicalEquipmentService:
      required:
      - days
      - frequencyCode
      - purchasePrice
      - rentalPrice
      type: object
      properties:
        days:
          type: string
          description: 'Loop: 2410, Segment: SV5, Element: SV503'
        rentalPrice:
          type: string
          description: 'Loop: 2410, Segment: SV5, Element: SV504'
        purchasePrice:
          type: string
          description: 'Loop: 2410, Segment: SV5, Element: SV505'
        frequencyCode:
          type: string
          description: 'Loop: 2410, Segment: SV5, Element: SV506, Note: Allowed Values are: ''1'' weekly,
            ''4'' monthly, ''6'' daily'
          enum:
          - '1'
          - '4'
          - '6'
      description: SV5
    EpsdtReferral:
      required:
      - certificationConditionCodeAppliesIndicator
      - conditionCodes
      type: object
      properties:
        certificationConditionCodeAppliesIndicator:
          type: string
          description: 'Loop: 2300, Segment: CRC, Element: CRC02 When CRC01=ZZ, Note: ''N'' No, ''Y''
            Yes'
          enum:
          - N
          - Y
        conditionCodes:
          maxItems: 3
          minItems: 1
          type: array
          description: 'Loop: 2300, Segment: CRC, Elements: CRC03, CRC04, CRC05 Note: 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
      description: CRC
    FormIdentification:
      required:
      - formIdentifier
      - formTypeCode
      type: object
      properties:
        formTypeCode:
          type: string
          description: 'Loop: 2440, Segment: LQ, Element: LQ01, Note: Allowed Values are:''AS'' Form Type
            Code, ''UT'' Centers for Medicare and Medicaid Services (CMS) Durable Medical Equipment Regional
            Carrier (DMERC) Certificate of Medical Necessity (CMN) Forms'
          enum:
          - AS
          - UT
        formIdentifier:
          type: string
          description: 'Loop: 2440, Segment: LQ, Element: LQ02'
        supportingDocumentation:
          maxItems: 99
          minItems: 0
          type: array
          description: 'Loop: 2440, Segment: FRM'
          items:
            $ref: '#/components/schemas/SupportingDocumentation'
      description: LQ and FRM
    HealthCareInformation:
      required:
      - diagnosisCode
      - diagnosisTypeCode
      type: object
      properties:
        diagnosisTypeCode:
          type: string
          description: 'Loop: 2440, Segment: HI, Element: HI01-01 or HI02-01 or HI03-01 or HI04-01 or
            HI05-01 or HI06-01 or HI07-01 or HI08-01 or HI09-01 or HI10-01 or HI11-01 or HI12-01, Note:
            Allowed Values are: ''BK'' International Classification of Diseases Clinical Modification
            (ICD-9-CM) Principal Diagnosis, ''ABK'' International Classification of Diseases Clinical
            Modification (ICD-10-CM) Principal Diagnosis, ''BF'' International Classification of Diseases
            Clinical Modification (ICD-9-CM) Diagnosis, ''ABF'' International Classification of Diseases
            Clinical Modification (ICD-10-CM) Diagnosis'
          enum:
          - BK
          - ABK
          - BF
          - ABF
        diagnosisCode:
          type: string
          description: 'Loop: 2440, Segment: HI, Element: HI01-02 or HI02-02 or HI03-02 or HI04-02 or
            HI05-02 or HI06-02 or HI07-02 or HI08-02 or HI09-02 or HI10-02 or HI11-02 or HI12-02'
      description: HI
    LineAdjudicationInformation:
      required:
      - adjudicationOrPaymentDate
      - otherPayerPrimaryIdentifier
      - paidServiceUnitCount
      - procedureCode
      - serviceIdQualifier
      - serviceLinePaidAmount
      type: object
      properties:
        otherPayerPrimaryIdentifier:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD01'
        serviceLinePaidAmount:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD02'
        serviceIdQualifier:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD03-01, 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: 2430, Segment: SVD, Element: SVD03-02'
        procedureModifier:
          maxItems: 4
          minItems: 0
          type: array
          items:
            type: string
            description: 'Loop: 2430, Segment: SVD, Element: SVD03-03, SVD03-04, SVD03-05, SVD03-06'
        procedureCodeDescription:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD03-07'
        paidServiceUnitCount:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD05'
        bundledOrUnbundledLineNumber:
          type: string
          description: 'Loop: 2430, Segment: SVD, Element: SVD06'
        claimAdjustmentInformation:
          maxItems: 5
          minItems: 0
          type: array
          description: 'Loop: 2430, Segment: CAS'
          items:
            $ref: '#/components/schemas/ClaimAdjustment'
        adjudicationOrPaymentDate:
          type: string
          description: 'Loop: 2430, Segment: DTP, Element=DTP03 when DTP02=D8 and DTP01=573'
        remainingPatientLiability:
          type: string
          description: 'Loop: 2430, Segment: AMT, Element=AMT02 when AMT01=EAF'
      description: SVD, CAS, DTP and AMT
    Measurements:
      required:
      - measurementQualifier
      - measurementReferenceIdentificationCode
      - testResults
      type: object
      properties:
        measurementReferenceIdentificationCode:
          type: string
          description: 'Loop 2400, Segment: MEA; Element: MEA01, Notes: Allowable values are ''OG'' Original
            and ''TR'' Test Results'
          enum:
          - OG
          - TR
        measurementQualifier:
          type: string
          description: 'Loop 2400, Segment: MEA; Element: MEA02, Notes: Allowable values are ''HT'' Height,
            ''R1'' Hemoglobin, ''R2'' Hematocrit, ''R3'' Epoetin Starting Dosage, ''R4'' Creatinine'
          enum:
          - HT
          - R1
          - R2
          - R3
          - R4
        testResults:
          type: string
          description: 'Loop 2400, Segment: MEA; Element: MEA03'
    MedicareOutpatientAdjudication:
      type: object
      properties:
        reimbursementRate:
          type: string
          description: 'Loop 2320, Segment: MOA; Element: MOA01'
        hcpcsPayableAmount:
          type: string
          description: 'Loop 2320, Segment: MOA; Element: MOA02'
        claimPaymentRemarkCode:
          maxItems: 5
          minItems: 0
          type: array
          description: 'Loop: 2320: Segment: MOA, Element: MOA03 to MOA07'
          items:
            type: string
        endStageRenalDiseasePaymentAmount:
          type: string
          description: 'Loop 2320, Segment: MOA; Element: MOA08'
        nonPayableProfessionalComponentBilledAmount:
          type: string
          description: 'Loop 2320, Segment: MOA; Element: MOA09'
      description: 'Loop: 2320, Segment: MOA'
    OtherPayerBillingProvider:
      required:
      - entityTypeQualifier
      - otherPayerBillingProviderIdentifier
      type: object
      properties:
        entityTypeQualifier:
          type: string
          description: 'Loop 2330G, Segment: NM1; Element: NM101, Notes: Code identifying an organizational
            entity, a physical location, property or an individual. Allowablevalues: ''1'' Person, ''2''
            Non-Person Entity '
          enum:
          - '1'
          - '2'
        otherPayerBillingProviderIdentifier:
          maxItems: 2
          minItems: 1
          type: array
          description: 'Loop 2330G, Segment: NM1 and REF'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
      description: Loop 2330G
    OtherPayerName:
      required:
      - otherPayerIdentifier
      - otherPayerIdentifierTypeCode
      - otherPayerOrganizationName
      type: object
      properties:
        otherInsuredAdditionalIdentifier:
          type: string
          description: 'Loop: 2330B; Segment: NM1, Element: NM111'
        otherPayerOrganizationName:
          type: string
          description: 'Loop: 2330B; Segment: NM1, Element: NM103'
        otherPayerIdentifierTypeCode:
          type: string
          description: 'Loop: 2330B; Segment: NM1, Element: NM108, Notes: Allowable values: ''PI'' Payor
            Identification and ''XV'' Centers for Medicare/Medicaid Services PlanID'
          enum:
          - PI
          - XV
        otherPayerIdentifier:
          type: string
          description: 'Loop: 2330B; Segment: NM1, Element: NM109'
        otherPayerAddress:
          $ref: '#/components/schemas/Address'
        otherPayerAdjudicationOrPaymentDate:
          type: string
          description: 'Loop: 2330B, Segment: DTP, Element: DTP03'
        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 when REF01=G1'
        otherPayerPriorAuthorizationOrReferralNumber:
          type: string
          description: 'Loop: 2330B; Segment: REF, Element: REF02 when REF01=9F'
        otherPayerClaimAdjustmentIndicator:
          type: boolean
          description: 'Loop: 2330B, Segment: REF, Element: REF02 when REF01=T4'
        otherPayerClaimControlNumber:
          type: string
          description: 'Loop: 2330B, Segment: REF, Element: REF02 when REF01=F8'
      description: 'Loop: 2330B'
    OtherPayerReferringProvider:
      required:
      - otherPayerReferringProviderIdentifier
      type: object
      properties:
        otherPayerReferringProviderIdentifier:
          maxItems: 3
          minItems: 1
          type: array
          description: 'Loop 2330E, Segment: NM1 and REF'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
      description: Loop 2330C
    OtherPayerRenderingProvider:
      required:
      - entityTypeQualifier
      type: object
      properties:
        entityTypeQualifier:
          type: string
          description: 'Loop: 2330D, Segment NM1, Element: NM102, Notes: Allowable values are ''1'' Person
            and ''2'' Non-Person Entity'
          enum:
          - '1'
          - '2'
        otherPayerRenderingProviderSecondaryIdentifier:
          maxItems: 3
          minItems: 1
          type: array
          description: 'Loop 2330D, Segment: NM1 and REF'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
      description: Loop 2330D
    OtherPayerServiceFacilityLocation:
      required:
      - otherPayerServiceFacilityLocationSecondaryIdentifier
      type: object
      properties:
        otherPayerServiceFacilityLocationSecondaryIdentifier:
          maxItems: 3
          minItems: 1
          type: array
          description: 'Loop 2330E, Segments: NM1 and REF'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
      description: Loop 2330E
    OtherPayerSupervisingProvider:
      required:
      - otherPayerSupervisingProviderIdentifier
      type: object
      properties:
        otherPayerSupervisingProviderIdentifier:
          maxItems: 3
          minItems: 1
          type: array
          description: 'Loop 2330F, Segments: NM1 and REF'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
      description: Loop 2330F
    OtherSubscriberInformation:
      required:
      - benefitsAssignmentCertificationIndicator
      - claimFilingIndicatorCode
      - individualRelationshipCode
      - otherPayerName
      - otherSubscriberName
      - paymentResponsibilityLevelCode
      - releaseOfInformationCode
      type: object
      properties:
        paymentResponsibilityLevelCode:
          type: string
          description: 'Loop: 2320, Segment: SBR, Element: SBR01, Notes: Allowable 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, and ''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: Required when patient is the
            subscriber, Notes: Allowed Values are: ''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
        insuranceGroupOrPolicyNumber:
          type: string
          description: 'Loop: 2320, Segment: SBR, Element: SBR03'
        otherInsuredGroupName:
          type: string
          description: 'Loop: 2000B, Segment: SBR, Element: SBR04'
        insuranceTypeCode:
          type: string
          description: 'Loop: 2320, Segment: SBR, Element: SBR05, Notes: Allowable Values are:  ''12''
            Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan, ''13''
            Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period,
            ''14'' Medicare Secondary, No-fault Insurance including Auto is Primary, ''15'' Medicare Secondary
            Worker''s Compensation, ''16'' Medicare Secondary Public Health Service (PHS)or Other Federal
            Agency, ''41'' Medicare Secondary Black Lung,  ''42'' Medicare Secondary Veteran''s Administration,
            ''43'' Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP),
            ''47'' Medicare Secondary, Other Liability Insurance is Primary'
          enum:
          - '12'
          - '13'
          - '14'
          - '15'
          - '16'
          - '41'
          - '42'
          - '43'
          - '47'
        claimFilingIndicatorCode:
          type: string
          description: 'Loop: 2320, Segment: SBR, Element: SBR09, Notes: 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'' Medicare Part
            C, ''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
          - CI
          - DS
          - FI
          - HM
          - LM
          - MA
          - MB
          - MC
          - OF
          - TV
          - VA
          - WC
          - ZZ
        claimLevelAdjustments:
          maxItems: 5
          minItems: 0
          type: array
          description: 'Loop: 2320, Segment: CAS'
          items:
            $ref: '#/components/schemas/ClaimAdjustment'
        payerPaidAmount:
          type: string
          description: 'Loop: 2320, Segment: AMT, Element: AMT02 when AMT01=D, Notes: It is acceptable
            to show ''0'' (Zero)'
        nonCoveredChargeAmount:
          type: string
          description: 'Loop: 2320, Segment: AMT, Element: AMT02 when AMT01=A8'
        remainingPatientLiability:
          type: string
          description: 'Loop: 2320, Segment: AMT, Element: AMT02 when AMT01=EAF'
        benefitsAssignmentCertificationIndicator:
          type: string
          description: 'Loop: 2320, Segment: OI, Element: OI03, Notes: Allowable values are: ''N'' No,
            ''W'' Not Applicable, ''Y'' Yes'
          enum:
          - N
          - W
          - Y
        patientSignatureGeneratedForPatient:
          type: boolean
          description: 'Loop: 2320, Segment: OI, Element: OI04, Notes: Allowable value is ''P'' Signature
            generated by provider because the patient was not physically present for services'
        releaseOfInformationCode:
          type: string
          description: 'Loop: 2320, Segment: OI, Element: OI04, Notes: Allowable values are ''I'' Informed
            Consent to Release Medical Information, ''Y'' Yes'
          enum:
          - I
          - Y
        medicareOutpatientAdjudication:
          $ref: '#/components/schemas/MedicareOutpatientAdjudication'
        otherSubscriberName:
          $ref: '#/components/schemas/OtherSubscriberName'
        otherPayerName:
          $ref: '#/components/schemas/OtherPayerName'
        otherPayerReferringProvider:
          type: array
          items:
            $ref: '#/components/schemas/OtherPayerReferringProvider'
        otherPayerRenderingProvider:
          type: array
          items:
            $ref: '#/components/schemas/OtherPayerRenderingProvider'
        otherPayerServiceFacilityLocation:
          type: array
          items:
            $ref: '#/components/schemas/OtherPayerServiceFacilityLocation'
        otherPayerSupervisingProvider:
          type: array
          items:
            $ref: '#/components/schemas/OtherPayerSupervisingProvider'
        otherPayerBillingProvider:
          type: array
          items:
            $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: Allowed Values are: ''1'' Person,
            ''2'' Non-Person Entity'
          enum:
          - '1'
          - '2'
        otherInsuredLastName:
          type: string
          description: 'Loop: 2330A, Segment: NM1, Element: NM103'
        otherInsuredFirstName:
          type: string
          description: 'Loop: 2330A, Segment: NM1, Element: NM102, Notes: Required when NM102 = 1 (Person)'
        otherInsuredMiddleName:
          type: string
          description: 'Loop: 2330A, Segment: NM1, Element: NM105, Notes: Required when NM102 = 1 (Person)'
        otherInsuredNameSuffix:
          type: string
          description: 'Loop: 2330A, Segment: NM1, Element: NM107, Notes: Required when NM102 = 1 (Person)'
        otherInsuredIdentifierTypeCode:
          type: string
          description: 'Loop: 2330A, Segment: NM1, Element: NM108, Notes: Allowable values are: ''II''
            Standard Unique HealthIdentifier for each individual in the United States and ''MI'' member
            identification number'
          enum:
          - II
          - MI
        otherInsuredIdentifier:
          type: string
          description: 'Loop: 2330A, Segment: NM1, Element: NM109'
        otherInsuredAddress:
          $ref: '#/components/schemas/Address'
        otherInsuredAdditionalIdentifier:
          type: string
          description: 'Loop: 2330A, Segment: REF, Element: REF02 when REF01=SY'
      description: 'Loop: 2330A'
    PatientConditionInformationVision:
      required:
      - certificationConditionIndicator
      - codeCategory
      - conditionCodes
      type: object
      properties:
        codeCategory:
          type: string
          description: 'Loop: 2300, Segment: CRC, Element: CRC01, Notes: Allowed Values are: ''E1'' Spectacle
            Lenses, ''E2'' Contact Lenses, ''E3'' Spectacle Frames'
          enum:
          - E1
          - E2
          - E3
        certificationConditionIndicator:
          type: string
          description: 'Loop: 2300, Segment: CRC, Element: CRC02, Notes: Allowed Values are: ''N'' No,
            ''Y'' Yes'
          enum:
          - N
          - Y
        conditionCodes:
          maxItems: 5
          minItems: 1
          type: array
          description: 'Loop: 2300, Segment: CRC, Element: CRC03 to CRC07, Notes: CRC03 is required, others
            are situational. Allowed Values are: ''L1'' General Standard of 20 Degree or .5 Diopter Sphere
            or Cylinder Change Met, ''L2'' Replacement Due to Loss or Theft, ''L3'' Replacement Due to
            Breakage or Damage, L4'' Replacement Due to Patient Preference, ''L5'' Replacement Due to
            Medical Reason'
          items:
            type: string
            enum:
            - L1
            - L2
            - L3
            - L4
            - L5
      description: 'Loop 2300, Segment: CRC'
    PayToPlan:
      required:
      - address
      - organizationName
      - primaryIdentifier
      - primaryIdentifierTypeCode
      - taxIdentificationNumber
      type: object
      properties:
        organizationName:
          type: string
          description: 'Loop: 2010AC, Segment: NM1, Element: NM103'
          example: Example Org
        primaryIdentifierTypeCode:
          type: string
          description: 'Loop: 2010AC, Segment: NM1, Element: NM108, Notes: ''PI'' Payor Identification
            and ''XV'' Centers for Medicare/Medicaid Services PlanID'
          example: PI
          enum:
          - PI
          - XV
        primaryIdentifier:
          type: string
          description: 'Loop: 2010AC, Segment: NM1, Element: NM109'
        address:
          $ref: '#/components/schemas/Address'
        secondaryIdentifierTypeCode:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF01, Notes: ''2U Payer Identification Number,
            ''FY'' Claim Office Number, ''NF National Association of Insurance Commissioners'''
          example: 2U
          enum:
          - 2U
          - FY
          - NF
        secondaryIdentifier:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02'
          example: '11'
        taxIdentificationNumber:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=EI'
      description: 2010AC
    PriorAuthorization:
      required:
      - priorAuthorizationOrReferralNumber
      type: object
      properties:
        priorAuthorizationOrReferralNumber:
          type: string
          description: 'Loop: 2400, Segment: REF, Element: REF02 when REF01=G1'
        otherPayerPrimaryIdentifier:
          type: string
          description: 'Loop: 2400, Segment: REF, Element: REF04-2 when REF04-1=2U'
      description: Loop 2400 REF
    ProfessionalService:
      required:
      - compositeDiagnosisCodePointers
      - lineItemChargeAmount
      - measurementUnit
      - procedureCode
      - procedureIdentifier
      - serviceUnitCount
      type: object
      properties:
        procedureIdentifier:
          type: string
          description: 'Loop: 2400, Segment: SV1, Element: SV101-01, Notes: Allowed Values are: ''ER''
            Jurisdiction Specific Procedure and Supply Codes, ''HC'' Health Care Financing Administration
            Common Procedural Coding System (HCPCS) Codes, ''IV'' Home Infusion EDI Coalition (HIEC) Product/Service
            Code,''WK'' Advanced Billing Concepts (ABC) Codes'
          example: HC
          enum:
          - ER
          - HC
          - IV
          - WK
        procedureCode:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV101-02'
          example: E0570
        procedureModifiers:
          maxItems: 4
          minItems: 0
          type: array
          description: 'Loop 2400, Segment: SV1, Elements: SV101-03 to SV101-06, Notes: Required when
            modifier clarifies or improves the reporting accuracy of the associated procedure code. If
            not required then do not send'
          items:
            type: string
        description:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV101-07, Notes: A free form description to
            clarify teh related data elements and their content'
        lineItemChargeAmount:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV102, Notes: Required value for total charge
            amount, ''0'' (Zero) is acceptable for this value'
          example: '25'
        measurementUnit:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV103, Notes: Allowed values are ''MJ'' Minutes,
            ''UN'' Unit'
          example: UN
          enum:
          - MJ
          - UN
        serviceUnitCount:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV104, Notes: When a decimal is needed to report
            units, include it in this element'
          example: '1'
        placeOfServiceCode:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV105'
        compositeDiagnosisCodePointers:
          $ref: '#/components/schemas/CompositeDiagnosisCodePointers'
        emergencyIndicator:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV109'
          enum:
          - Y
        epsdtIndicator:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV111'
          enum:
          - Y
        familyPlanningIndicator:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV112'
          enum:
          - Y
        copayStatusCode:
          type: string
          description: 'Loop 2400, Segment: SV1, Element: SV115'
          enum:
          - '0'
    Provider:
      $ref: '#/components/schemas/supervising'
    PurchasedServiceInformation:
      required:
      - purchasedServiceChargeAmount
      - purchasedServiceProviderIdentifier
      type: object
      properties:
        purchasedServiceProviderIdentifier:
          type: string
          description: 'Loop: 2400, Segment: PS1, Element: PS101'
          example: '01'
        purchasedServiceChargeAmount:
          type: string
          description: 'Loop: 2400, Segment: PS1, Element: PS102'
          example: '10'
    Receiver:
      required:
      - organizationName
      type: object
      properties:
        organizationName:
          type: string
          description: 'Loop: 1000B, Segment: NM1, Element: NM103'
          example: EXTRA HEALTHY INSURANCE
      description: 'Loop: 1000B'
    ReferenceIdentification:
      required:
      - identifier
      - qualifier
      type: object
      properties:
        qualifier:
          type: string
          description: 'Segment: REF, Element: REF01'
        identifier:
          type: string
          description: 'Segment: REF, Element: REF02'
        otherIdentifier:
          type: string
          description: 'Segment: REF, Element: REF03'
    ReportInformation:
      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, ''NM 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'
          example: '93'
          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
          - NM
          - 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 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'
          example: AA
          enum:
          - AA
          - BM
          - EL
          - EM
          - FT
          - FX
        attachmentControlNumber:
          type: string
          description: 'Loop 2400, Segment: PWK, Element: PWK05'
    ServiceFacilityLocation:
      required:
      - address
      - organizationName
      type: object
      properties:
        organizationName:
          type: string
          description: 'Loop: 2420C, Segment: NM1, Element: NM103'
          example: HAPPY DOCTORS GROUP
        address:
          $ref: '#/components/schemas/Address'
        npi:
          type: string
          description: 'Loop: 2420C, Segment: NM1, Element: NM109, Note: National Provider Identifier'
        secondaryIdentifier:
          maxItems: 3
          minItems: 0
          type: array
          description: 'Loop: 2420C: Segment: REF, Notes: A list containing qualifier (REF01), identifier
            (REF02), and otherIdentifier(REF04)'
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
        phoneName:
          type: string
          description: 'Loop: 2310C, Segment: PER, Element: PER02'
        phoneNumber:
          type: string
          description: 'Loop: 2310C, Segment: PER, Element: PER04'
        phoneExtension:
          type: string
          description: 'Loop: 2310C, Segment: PER, Element: PER06'
    ServiceLine:
      required:
      - professionalService
      - serviceDate
      type: object
      properties:
        assignedNumber:
          type: string
          description: 'Loop: 2400, Segment: LX, Element: LX01'
        serviceDate:
          type: string
          description: 'Loop: 2400, Segment: DTP, Element: DTP03, Notes: When sent with serviceDateEnd
            it will be used as the start date for Date Time period, if sent without serviceDateEnd will
            use DTP02 = D8. Expressed in Format CCYYMMDD'
          example: '20050514'
        serviceDateEnd:
          type: string
          description: 'Loop: 2400, Segment: DTP, Element: DTP03, Notes: Range of Dates Expressed in Format
            CCYYMMDD'
        providerControlNumber:
          type: string
          description: 'Loop: 2400, Segment: REF, Element: REF04-02 when REF01=6R'
        professionalService:
          $ref: '#/components/schemas/ProfessionalService'
        durableMedicalEquipmentService:
          $ref: '#/components/schemas/DurableMedicalEquipmentService'
        serviceLineSupplementalInformation:
          maxItems: 10
          minItems: 0
          type: array
          items:
            $ref: '#/components/schemas/ReportInformation'
        durableMedicalEquipmentCertificateOfMedicalNecessity:
          $ref: '#/components/schemas/DurableMedicalEquipmentCertificateOfMedicalNecessity'
        ambulanceTransportInformation:
          $ref: '#/components/schemas/AmbulanceTransportInformation'
        durableMedicalEquipmentCertification:
          $ref: '#/components/schemas/DurableMedicalEquipmentCertification'
        ambulanceCertification:
          maxItems: 3
          minItems: 0
          type: array
          items:
            $ref: '#/components/schemas/AmbulanceCertification'
        hospiceEmployeeIndicator:
          type: boolean
          description: 'Loop: 2400, Segment: CRC, Element: CRC02 Notes: True or False'
        conditionIndicatorDurableMedicalEquipment:
          $ref: '#/components/schemas/ConditionIndicatorDurableMedicalEquipment'
        serviceLineDateInformation:
          $ref: '#/components/schemas/ServiceLineDateInformation'
        ambulancePatientCount:
          type: integer
          description: 'Loop: 2400, Segment: QTY, Element: QTY02 when QTY01=PT'
          format: int32
        obstetricAnesthesiaAdditionalUnits:
          type: integer
          description: 'Loop: 2400, Segment: QTY, Element: QTY02 when QTY01=FL'
          format: int32
        testResults:
          maxItems: 5
          minItems: 0
          type: array
          items:
            $ref: '#/components/schemas/Measurements'
        contractInformation:
          $ref: '#/components/schemas/ContractInformation'
        serviceLineReferenceInformation:
          $ref: '#/components/schemas/ServiceLineReferenceInformation'
        salesTaxAmount:
          type: string
          description: 'Loop: 2400, Segment: AMT, Element: AMT02 when AMT01=T'
        postageTaxAmount:
          type: string
          description: 'Loop: 2400, Segment: AMT, Element: AMT02 when AMT01=F4'
        fileInformation:
          maxItems: 10
          minItems: 0
          type: array
          description: 'Loop: 2400, Segment: K3, Element: K301'
          items:
            type: string
            description: 'Loop: 2400, Segment: K3, Element: K301'
        additionalNotes:
          type: string
          description: 'Loop: 2400, Segment: NTE, Element: NTE02 when NTE01=ADD'
        goalRehabOrDischargePlans:
          type: string
          description: 'Loop: 2400, Segment: NTE, Element: NTE02 when NTE01=DCP'
        thirdPartyOrganizationNotes:
          type: string
          description: 'Loop: 2400, Segment: NTE, Element: NTE02 when NTE01=TPO'
        purchasedServiceInformation:
          $ref: '#/components/schemas/PurchasedServiceInformation'
        linePricingRepricingInformation:
          $ref: '#/components/schemas/ClaimPricingRepricingInformation'
        drugIdentification:
          $ref: '#/components/schemas/DrugIdentification'
        renderingProvider:
          $ref: '#/components/schemas/ServiceLineProvider'
        purchasedServiceProvider:
          $ref: '#/components/schemas/ServiceLineProvider'
        serviceFacilityLocation:
          $ref: '#/components/schemas/ServiceFacilityLocation'
        supervisingProvider:
          $ref: '#/components/schemas/ServiceLineProvider'
        orderingProvider:
          $ref: '#/components/schemas/ServiceLineOrderingProvider'
        referringProvider:
          $ref: '#/components/schemas/ServiceLineProvider'
        ambulancePickUpLocation:
          $ref: '#/components/schemas/Address'
        ambulanceDropOffLocation:
          $ref: '#/components/schemas/Address'
        lineAdjudicationInformation:
          maxItems: 15
          minItems: 0
          type: array
          items:
            $ref: '#/components/schemas/LineAdjudicationInformation'
        formIdentification:
          type: array
          items:
            $ref: '#/components/schemas/FormIdentification'
      description: Loop 2400
    ServiceLineDateInformation:
      type: object
      properties:
        prescriptionDate:
          type: string
          description: 'Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=471, Notes: Date Expressed
            in Format CCYYMMDD'
        certificationRevisionOrRecertificationDate:
          type: string
          description: 'Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=607, Notes: Date Expressed
            in Format CCYYMMDD'
        beginTherapyDate:
          type: string
          description: 'Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=463, Notes: Date Expressed
            in Format CCYYMMDD'
        lastCertificationDate:
          type: string
          description: 'Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=461, Notes: Date Expressed
            in Format CCYYMMDD'
        treatmentOrTherapyDate:
          type: string
          description: 'Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=304, Notes: Date Expressed
            in Format CCYYMMDD'
        hemoglobinTestDate:
          type: string
          description: 'Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=738, Notes: Date Expressed
            in Format CCYYMMDD'
        serumCreatineTestDate:
          type: string
          description: 'Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=739, Notes: Date Expressed
            in Format CCYYMMDD'
        shippedDate:
          type: string
          description: 'Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=011, Notes: Date Expressed
            in Format CCYYMMDD'
        lastXRayDate:
          type: string
          description: 'Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=455, Notes: Date Expressed
            in Format CCYYMMDD'
        initialTreatmentDate:
          type: string
          description: 'Loop: 2400, Segment: DPT, Element: DTP03 when DPT01=454, Notes: Date Expressed
            in Format CCYYMMDD'
    ServiceLineOrderingProvider:
      required:
      - providerType
      type: object
      properties:
        providerType:
          type: string
          example: BillingProvider
        npi:
          type: string
          description: 'NM109, Notes: National Provider Identifier'
          example: '1760854442'
        ssn:
          type: string
          description: 'REF02 when REF01=SY, Notes: The Social Security Number must be a string of nine
            numbers with no separators'
          example: '000000000'
        employerId:
          type: string
          description: 'REF02 when REF01=EI, Notes: The Employer Identification Number must be a string
            of exactly nine numbers with no separators'
          example: '123456789'
        commercialNumber:
          type: string
          description: REF02 when REF01=G2
        locationNumber:
          type: string
          description: REF02 when REF01=LU
        payerIdentificationNumber:
          type: string
          description: 'LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=2U'
        employerIdentificationNumber:
          type: string
          description: 'LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=EI'
        claimOfficeNumber:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=FY'
        naic:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=NF, Notes: National Association
            of Insurance Commissioners (NAIC) Code'
        stateLicenseNumber:
          type: string
          description: REF02 when REF01=0B
        providerUpinNumber:
          type: string
          description: 'REF02 when REF01=1G, Notes: UPINs must be formatted as either X99999 or XXX999'
        taxonomyCode:
          type: string
          description: PRV03
        firstName:
          type: string
          description: NM104
          example: johnone
        lastName:
          type: string
          description: NM103
          example: doeone
        middleName:
          type: string
          description: NM105
          example: middleone
        suffix:
          type: string
          description: NM107
          example: Jr
        organizationName:
          type: string
          description: NM103
          example: HAPPY DOCTORS GROUPPRACTICE
        address:
          $ref: '#/components/schemas/Address'
        contactInformation:
          $ref: '#/components/schemas/ContactInformationOrderingProvider'
        otherIdentifier:
          type: string
        secondaryIdentifier:
          maxItems: 20
          minItems: 0
          type: array
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
    ServiceLineProvider:
      required:
      - providerType
      type: object
      properties:
        providerType:
          type: string
          example: BillingProvider
        npi:
          type: string
          description: 'NM109, Notes: National Provider Identifier'
          example: '1760854442'
        ssn:
          type: string
          description: 'REF02 when REF01=SY, Notes: The Social Security Number must be a string of nine
            numbers with no separators'
          example: '000000000'
        employerId:
          type: string
          description: 'REF02 when REF01=EI, Notes: The Employer Identification Number must be a string
            of exactly nine numbers with no separators'
          example: '123456789'
        commercialNumber:
          type: string
          description: REF02 when REF01=G2
        locationNumber:
          type: string
          description: REF02 when REF01=LU
        payerIdentificationNumber:
          type: string
          description: 'LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=2U'
        employerIdentificationNumber:
          type: string
          description: 'LOOP: 2010AC, Segment: REF, Element: REF02 when REF01=EI'
        claimOfficeNumber:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=FY'
        naic:
          type: string
          description: 'Loop: 2010AC, Segment: REF, Element: REF02 when REF01=NF, Notes: National Association
            of Insurance Commissioners (NAIC) Code'
        stateLicenseNumber:
          type: string
          description: REF02 when REF01=0B
        providerUpinNumber:
          type: string
          description: 'REF02 when REF01=1G, Notes: UPINs must be formatted as either X99999 or XXX999'
        taxonomyCode:
          type: string
          description: PRV03
        firstName:
          type: string
          description: NM104
          example: johnone
        lastName:
          type: string
          description: NM103
          example: doeone
        middleName:
          type: string
          description: NM105
          example: middleone
        suffix:
          type: string
          description: NM107
          example: Jr
        organizationName:
          type: string
          description: NM103
          example: HAPPY DOCTORS GROUPPRACTICE
        address:
          $ref: '#/components/schemas/Address'
        contactInformation:
          $ref: '#/components/schemas/ContactInformation'
        otherIdentifier:
          type: string
        secondaryIdentifier:
          maxItems: 20
          minItems: 0
          type: array
          items:
            $ref: '#/components/schemas/ReferenceIdentification'
    ServiceLineReferenceInformation:
      type: object
      properties:
        repricedLineItemReferenceNumber:
          type: string
          description: 'Loop: 2400, Segment: REF, Element: REF02 Notes: When REF01=9B'
        adjustedRepricedLineItemReferenceNumber:
          type: string
          description: 'Loop: 2400, Segment: REF, Element: REF02 Note: When REF01=9D'
        priorAuthorization:
          maxItems: 5
          minItems: 0
          type: array
          description: Loop 2400 REF
          items:
            $ref: '#/components/schemas/PriorAuthorization'
        mammographyCertificationNumber:
          type: string
          description: 'Loop: 2400, Segment: REF, Element: REF02 Note: When REF01=EW'
        clinicalLaboratoryImprovementAmendmentNumber:
          type: string
          description: 'Loop: 2400, Segment: REF, Element: REF02 Note: When REF01=X4'
        referringCliaNumber:
          type: string
          description: 'Loop: 2400, Segment: REF, Element: REF02 Note: When REF01=F4'
        immunizationBatchNumber:
          type: string
          description: 'Loop: 2400, Segment: REF, Element: REF02 Note: When REF01=BT'
        referralNumber:
          maxItems: 5
          minItems: 0
          type: array
          description: 'Loop: 2400, Segment: REF, Element: REF Note: When REF01=9F'
          items:
            type: string
            description: 'Loop: 2400, Segment: REF, Element: REF Note: When REF01=9F'
    SpinalManipulationServiceInformation:
      required:
      - patientConditionCode
      type: object
      properties:
        patientConditionCode:
          type: string
          description: 'Loop: 2300, Segment: CR, Element: CR208'
        patientConditionDescription1:
          type: string
          description: 'Loop: 2300, Segment: CR, Element: CR210 Note: Allowed Values are: ''A'' Acute
            Condition, ''C'' Chronic Condition, ''D'' Chronic Condition, ''E'' Non-Life Threatening, ''F''
            Routine, ''G'' Symptomatic, ''M'' Acute Manifestation of a Chronic Condition'
          enum:
          - A
          - C
          - D
          - E
          - F
          - G
          - M
        patientConditionDescription2:
          type: string
          description: 'Loop: 2300, Segment: CR, Element: CR211'
      description: 'Loop 2300, Segment: CR2'
    Submitter:
      required:
      - contactInformation
      type: object
      properties:
        organizationName:
          type: string
          description: 'Loop: 1000A,  Segment: NM1, Element: NM103'
          example: REGIONAL PPO NETWORK
        lastName:
          type: string
          description: 'Loop: 1000A,  Segment: NM1, Element: NM103'
          example: doeOne
        firstName:
          type: string
          description: 'Loop: 1000A,  Segment: NM1, Element: NM104'
          example: janeone
        middleName:
          type: string
          description: 'Loop: 1000A,  Segment: NM1, Element: NM105'
          example: middleone
        contactInformation:
          $ref: '#/components/schemas/ContactInformation'
      description: 'Loop: 1000A'
    Subscriber:
      required:
      - paymentResponsibilityLevelCode
      type: object
      properties:
        memberId:
          type: string
          description: 'Loop: 2010BA,  Segment: NM1, Element: NM109'
          example: '0000000001'
        ssn:
          type: string
          description: 'Loop: 2010BA,  Segment: REF, Element: REF02 when REF01=SY'
        paymentResponsibilityLevelCode:
          type: string
          description: 'Loop: 2000B, Segment: SBR, Element: SBR01, 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'
          example: P
          enum:
          - A
          - B
          - C
          - D
          - E
          - F
          - G
          - H
          - P
          - S
          - T
          - U
        organizationName:
          type: string
          description: 'Loop: 2010BA, Segment: NM1, Element: NM103 when NM102=2, Notes: when subscriber
            is organization pass patient as dependent'
        insuranceTypeCode:
          type: string
          description: 'Loop: 2000B,  Segment: SBR, Element:SBR05 Notes: Allowed values: ''12'' Medicare
            Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan, ''13'' Medicare
            Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an
            Employer''s Group Health Plan, ''14'' Medicare Secondary, No-fault Insurance including Auto
            is Primary, ''15'' Medicare Secondary Worker''s Compensation, ''16'' Medicare Secondary Public
            Health Service (PHS)or Other Federal Agency, ''41'' Medicare Secondary Black Lung, ''42''
            Medicare Secondary Veteran''s Administration, ''43'' Medicare Secondary Disabled Beneficiary
            Under Age 65 with Large Group Health Plan (LGHP), ''47'' Medicare Secondary, Other Liability
            Insurance is Primary'
          enum:
          - '12'
          - '13'
          - '14'
          - '15'
          - '16'
          - '41'
          - '42'
          - '43'
          - '47'
        subscriberGroupName:
          type: string
          description: 'Loop: 2000B,  Segment: SBR, Element: SBR04 Notes: Freeform text'
          example: Subscriber Group Name
        firstName:
          type: string
          description: 'Loop: 2010BA,  Segment: NM1, Element: NM104'
          example: johnone
        lastName:
          type: string
          description: 'Loop: 2010BA,  Segment: NM1, Element: NM103'
          example: doeOne
        middleName:
          type: string
          description: 'Loop: 2010BA,  Segment: NM, Element: NM105'
        suffix:
          type: string
          description: 'Loop: 2010BA,  Segment: NM, Element: NM107'
          example: Jr
        gender:
          type: string
          description: 'Loop: 2010BA,  Segment: DMG, Element: DMG03 Subscriber Gender, Notes: ''M'' Male,
            ''F'' Female''U'' Unknown'
          example: M
          enum:
          - M
          - F
          - U
        dateOfBirth:
          type: string
          description: 'Loop: 2010BA,  Segment: DMG, Element: DMG02'
          example: '19800102'
        policyNumber:
          type: string
          description: 'Loop: 2000B,  Segment: SBR, Element: SBR03'
          example: '00001'
        groupNumber:
          type: string
          description: 'Loop: 2010BA,  Segment: SBR, Element: SBR04'
        contactInformation:
          $ref: '#/components/schemas/ContactInformation'
        address:
          $ref: '#/components/schemas/Address'
      description: 'Loop: 2000B'
    SupportingDocumentation:
      required:
      - questionNumber
      type: object
      properties:
        questionNumber:
          type: string
          description: 'Loop: 2440,  Segment: FRM, Element: FRM01'
        questionResponseCode:
          type: string
          description: 'Loop: 2440,  Segment: FRM, Element: FRM02, Notes: Allowed Values are: ''N'' No,
            ''W'' Not Applicable, ''Y'' Yes'
          enum:
          - N
          - W
          - Y
        questionResponse:
          type: string
          description: 'Loop: 2440,  Segment: FRM, Element: FRM03'
        questionResponseAsDate:
          type: string
          description: 'Loop: 2440,  Segment: FRM, Element: FRM04'
        questionResponseAsPercent:
          type: string
          description: 'Loop: 2440,  Segment: FRM, Element: FRM05'
      description: 'Loop: 2440, Segment: FRM'
    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'
        claimType:
          type: string
          description: Claim Type
          example: PRO
        payerID:
          type: string
          description: Payer ID
          example: '9496'
        formatVersion:
          type: string
          description: Format version
          example: '5010'
        rhclaimNumber:
          type: string
      description: Collection of info specific to a given claim
    EditResponse:
      type: object
      properties:
        errorDescription:
          type: string
        badData:
          type: string
        fieldIndex:
          type: string
        editName:
          type: string
        editActivity:
          type: string
        phaseID:
          type: string
        referenceID:
          type: string
        claimCorePath:
          type: string
        allowOverride:
          type: string
        qualifierCode:
          type: string
        element:
          type: string
        loop:
          type: string
        segment:
          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
    Failure:
      type: object
      properties:
        code:
          type: string
        description:
          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 EARLY_HINTS
          - 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
        payer:
          $ref: '#/components/schemas/Payer'
        editResponses:
          type: array
          items:
            $ref: '#/components/schemas/EditResponse'
        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
          description: For the x12 endpoint, the value should be a full 837 edi request.
    ClaiRequest:
      required:
      - billing
      - claimInformation
      - controlNumber
      - receiver
      - submitter
      - subscriber
      type: object
      properties:
        controlNumber:
          type: string
          description: 'Header, Segment: ST02 (no loop), Notes: Transaction Set Control Number'
          example: '000000001'
        tradingPartnerServiceId:
          type: string
          description: 'Loop: 2010BB Segment: NM1, Element: NM109, Notes: we send this as MN108 as PI
            = Payer Identification'
          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: setting providers deprecated, please set all providers individually by it's type.
          deprecated: true
          items:
            $ref: '#/components/schemas/supervising'
        claimInformation:
          $ref: '#/components/schemas/ClaimInformation'
        payToAddress:
          $ref: '#/components/schemas/Address'
        payToPlan:
          $ref: '#/components/schemas/PayToPlan'
        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'
        ordering:
          $ref: '#/components/schemas/ordering'
        supervising:
          $ref: '#/components/schemas/supervising'
        tradingPartnerName:
          type: string
          description: Loop 2010BB NM103
        precisionThreshold:
          type: number
          format: double
  securitySchemes:
    bearer-key:
      type: http
      scheme: bearer
      bearerFormat: JWT