openapi: 3.0.3 info: title: Prior Authorization v1 description: '' version: 1.1.0 contact: email: '' servers: - url: https://sandbox-apigw.optum.com/rcm/prior-authorization/v1/ - url: /processor paths: /determination/x12: post: summary: 278x215 Prior Authorization Determination description: Prior authorization determination using 278x215 requests tags: - Determination parameters: - $ref: '#/components/parameters/x-optum-tenant-id' - $ref: '#/components/parameters/x-optum-correlation-id' requestBody: description: Authorization request content: application/json: schema: $ref: '#/components/schemas/DeterminationX12Request' responses: '200': description: Success headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' transaction-id: $ref: '#/components/headers/transaction-id' content: application/json: schema: $ref: '#/components/schemas/DeterminationResponse' '400': $ref: '#/components/responses/400' '401': $ref: '#/components/responses/401' '403': $ref: '#/components/responses/403' '500': $ref: '#/components/responses/500' /determination: post: summary: JSON Prior Authorization Determination description: Prior authorization determination using JSON requests tags: - Determination parameters: - $ref: '#/components/parameters/x-optum-tenant-id' - $ref: '#/components/parameters/x-optum-correlation-id' requestBody: description: Determination request content: application/json: schema: $ref: '#/components/schemas/InquiryJSONRequestWithDetermination' examples: subscriber: $ref: '#/components/examples/UserInquiryRequestSubscriberWithDetermination' dependent: $ref: '#/components/examples/UserInquiryRequestDependentWithDetermination' responses: '200': description: Success headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' transaction-id: $ref: '#/components/headers/transaction-id' content: application/json: schema: $ref: '#/components/schemas/DeterminationResponse' '400': $ref: '#/components/responses/400' '401': $ref: '#/components/responses/401' '403': $ref: '#/components/responses/403' '500': $ref: '#/components/responses/500' /inquiry/x12: post: summary: 278x215 Prior Authorization Inquiry description: 'Given a valid X12 278x215 request, the request will be submitted to the payer or clearing house and a 278 response returned. ' tags: - Inquiry parameters: - $ref: '#/components/parameters/x-optum-tenant-id' - $ref: '#/components/parameters/x-optum-correlation-id' requestBody: description: Authorization request content: application/json: schema: $ref: '#/components/schemas/InquiryX12Request' responses: '200': description: Success headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' transaction-id: $ref: '#/components/headers/transaction-id' content: application/json: schema: $ref: '#/components/schemas/InquiryResponse' examples: subscriber: $ref: '#/components/examples/UserInquiryResponseSubscriber' dependent: $ref: '#/components/examples/UserInquiryResponseDependent' '400': $ref: '#/components/responses/400' '401': $ref: '#/components/responses/401' '403': $ref: '#/components/responses/403' '500': $ref: '#/components/responses/500' /inquiry: post: summary: JSON Prior Authorization Inquiry description: 'Given a valid JSON request, the request will be submitted to the payer or clearing house and a JSON response returned. ' tags: - Inquiry parameters: - $ref: '#/components/parameters/x-optum-tenant-id' - $ref: '#/components/parameters/x-optum-correlation-id' requestBody: description: Authorization request content: application/json: schema: $ref: '#/components/schemas/InquiryJSONRequest' examples: subscriber: $ref: '#/components/examples/UserInquiryRequestSubscriber' dependent: $ref: '#/components/examples/UserInquiryRequestDependent' responses: '200': description: Success headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' transaction-id: $ref: '#/components/headers/transaction-id' content: application/json: schema: $ref: '#/components/schemas/InquiryResponse' examples: subscriber: $ref: '#/components/examples/UserInquiryResponseSubscriber' dependent: $ref: '#/components/examples/UserInquiryResponseDependent' '400': $ref: '#/components/responses/400' '401': $ref: '#/components/responses/401' '403': $ref: '#/components/responses/403' '500': $ref: '#/components/responses/500' /submission/x12: post: summary: 278x217 Prior Authorization Submission description: Prior authorization submission using EDI X12 278x217 requests tags: - Submission parameters: - $ref: '#/components/parameters/x-optum-tenant-id' - $ref: '#/components/parameters/x-optum-correlation-id' requestBody: description: Authorization Submission request content: application/json: schema: $ref: '#/components/schemas/SubmissionX12Request' responses: '200': description: Success headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' transaction-id: $ref: '#/components/headers/transaction-id' content: application/json: schema: $ref: '#/components/schemas/SubmissionResponse' examples: subscriber: $ref: '#/components/examples/UserSubmissionResponseSubscriber' dependent: $ref: '#/components/examples/UserSubmissionResponseDependent' '400': $ref: '#/components/responses/400' '401': $ref: '#/components/responses/401' '403': $ref: '#/components/responses/403' '500': $ref: '#/components/responses/500' /submission: post: summary: JSON Prior Authorization Submission description: Prior authorization submission using JSON requests tags: - Submission parameters: - $ref: '#/components/parameters/x-optum-tenant-id' - $ref: '#/components/parameters/x-optum-correlation-id' requestBody: description: Authorization submission request content: application/json: schema: $ref: '#/components/schemas/AuthorizationSubmissionJSON' examples: subscriber: $ref: '#/components/examples/UserSubmissionRequestSubscriber' dependent: $ref: '#/components/examples/UserSubmissionRequestDependent' responses: '200': description: Success headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' transaction-id: $ref: '#/components/headers/transaction-id' content: application/json: schema: $ref: '#/components/schemas/SubmissionResponse' examples: subscriber: $ref: '#/components/examples/UserSubmissionResponseSubscriber' dependent: $ref: '#/components/examples/UserSubmissionResponseDependent' '400': $ref: '#/components/responses/400' '401': $ref: '#/components/responses/401' '403': $ref: '#/components/responses/403' '500': $ref: '#/components/responses/500' /noa/x12: post: summary: 278x216 Prior Authorization Notice Of Admission description: Prior authorization noa using EDI X12 278x216 requests tags: - Noa parameters: - $ref: '#/components/parameters/x-optum-tenant-id' - $ref: '#/components/parameters/x-optum-correlation-id' requestBody: description: Authorization Noa request content: application/json: schema: $ref: '#/components/schemas/NoaX12Request' responses: '200': description: Success headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' transaction-id: $ref: '#/components/headers/transaction-id' content: application/json: schema: $ref: '#/components/schemas/NoaResponse' examples: subscriber: $ref: '#/components/examples/UserNoaResponse' '400': $ref: '#/components/responses/400' '401': $ref: '#/components/responses/401' '403': $ref: '#/components/responses/403' '500': $ref: '#/components/responses/500' /noa: post: summary: JSON Notice of Admission description: Prior authorization notice of admission using JSON requests tags: - Noa parameters: - $ref: '#/components/parameters/x-optum-tenant-id' - $ref: '#/components/parameters/x-optum-correlation-id' requestBody: description: Authorization notice of admission request content: application/json: schema: $ref: '#/components/schemas/AuthorizationNoaJSON' examples: subscriber: $ref: '#/components/examples/UserNoaRequest' responses: '200': description: Success headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' transaction-id: $ref: '#/components/headers/transaction-id' content: application/json: schema: $ref: '#/components/schemas/NoaResponse' examples: subscriber: $ref: '#/components/examples/UserNoaResponse' '400': $ref: '#/components/responses/400' '401': $ref: '#/components/responses/401' '403': $ref: '#/components/responses/403' '500': $ref: '#/components/responses/500' /authorization/x12: post: summary: 278x215 Prior Authorization Orchestration description: Prior authorization orchestration using EDI X12 278x215 requests tags: - Authorization (Orchestration) parameters: - $ref: '#/components/parameters/x-optum-tenant-id' - $ref: '#/components/parameters/x-optum-correlation-id' requestBody: description: Authorization request content: application/json: schema: $ref: '#/components/schemas/AuthorizationX12Request' examples: required-and-not-required: $ref: '#/components/examples/X12OrchRequestTwoCodesOneRequired' required-with-split: $ref: '#/components/examples/X12OrchRequestTwoRequiredCodesWithSplit' no-procedure-codes: $ref: '#/components/examples/X12OrchRequestNoProcedureCodes' responses: '200': description: Success headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' transaction-id: $ref: '#/components/headers/transaction-id' content: application/json: schema: $ref: '#/components/schemas/AuthorizationResponse' '400': $ref: '#/components/responses/400' '401': $ref: '#/components/responses/401' '403': $ref: '#/components/responses/403' '500': $ref: '#/components/responses/500' /authorization: post: summary: JSON Prior Authorization Orchestration description: Prior authorization orchestration using JSON requests tags: - Authorization (Orchestration) parameters: - $ref: '#/components/parameters/x-optum-tenant-id' - $ref: '#/components/parameters/x-optum-correlation-id' requestBody: description: Authorization request content: application/json: schema: $ref: '#/components/schemas/InquiryJSONRequestWithDetermination' examples: inquiry-split: $ref: '#/components/examples/OrchestrationJSONRequestWithSplit' single-requires-pa: $ref: '#/components/examples/OrchestrationJSONRequestOneRequired' none-require-pa: $ref: '#/components/examples/OrchestrationJSONRequestAuthNotRequired' responses: '200': description: Success headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' transaction-id: $ref: '#/components/headers/transaction-id' content: application/json: schema: $ref: '#/components/schemas/AuthorizationResponse' '400': $ref: '#/components/responses/400' '401': $ref: '#/components/responses/401' '403': $ref: '#/components/responses/403' '500': $ref: '#/components/responses/500' /healthcheck: get: description: Returns the health of the API tags: - Health Check summary: Service heartbeat responses: '200': description: Success '500': description: Internal Server Error components: headers: x-amzn-trace-id: description: Generated traceId of the request required: true example: Root=1-61d7441a-56e4c77350687b5230e5707 schema: type: string transaction-id: description: Transaction Id of the request required: true schema: type: string format: uuid example: c9476bc2-b563-4555-9527-4afe9dccaf9a schemas: InquiryX12Request: type: object properties: x12: type: string description: EDI X12 278x215 Request example: ISA*00* *00* *ZZ*943207296 *ZZ*000000000000001*230810*1021*^*00501*916040697*0*P*:~GS*HI*943207296*INQHEALTHHELP*20230810*102137*3294199*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1402448037*20230810*102137~HL*1**20*1~NM1*PR*2*Humana*****PI*HUMANA~HL*2*1*21*1~NM1*1P*2*North Memorial Health*****XX*1851344907~REF*EI*410729979~N4*Robbinsdale*MN*55422~PER*IC**TE*7635814480*FX*7635814480~HL*3*2*22*1~NM1*IL*1*DOE*JOE****MI*H1111111~REF*6P*00000000~DMG*D8*19010101~HL*4*3*EV*0~UM*HS*I*1*11:B~DTP*AAH*D8*20230802~HI*ABK:C34.32~NM1*SJ*2*North Memorial Medical Center*****XX*1851344907~NM1*DN*2*North Memorial Medical Center*****XX*1851344907~REF*ZH*410729979~SE*21*0001~GE*1*3294199~IEA*1*916040697~ AuthorizationX12Request: type: object properties: rhPayerId: type: string description: Global payer identifier used for determination example: UHCDEMODV1 planId: type: string description: Payer plan identifier used for determination example: 41 x12: type: string description: EDI X12 278x215 Request example: ISA*00* *00* *ZZ*201985AAS *ZZ*UHCDIRECT *260220*2231*^*00501*310114548*0*P*:~GS*HI*201985AAS*UHCDIRECT*20260220*223147*549621530*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1234567890*20260220*223147~HL*1**20*1~NM1*PR*2*UHCDIRECT*****PI*UHCDIRECT~HL*2*1*21*1~NM1*1P*2*Regional Medical Center*****XX*1234567890~REF*EI*123456789~N4*Orangeburg*SC*12345~PER*IC**TE*803-555-2200~HL*3*2*22*1~NM1*IL*1*TEST*BRITTANY****MI*multi-01-approved~REF*6P*123456789~REF*SY*111223333~DMG*D8*19701231~HL*4*3*EV*1~UM*HS*I*1*11:B~DTP*AAH*RD8*20231017-20231017~NM1*SJ*1*TEST*STEVEN****XX*1234567890~NM1*DN*1*TEST*STEVEN****XX*1234567890~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:T1000~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:0214T~SE*28*0001~GE*1*549621530~IEA*1*310114548~ SubmissionX12Request: type: object properties: x12: type: string description: EDI X12 278x217 Request example: ISA*00*4444 *00*5555 *ZZ*6546564 *ZZ*278_217_01 *0623 *1301*^*00501*000000001*0*T*:~GS*HI*FL0738*PERSEPVS*20090601*040612*1*X*005010X217~ST*278*0001*005010X217~BHT*0007*13*165932*20050502*1525~HL*1**20*1~NM1*X3*2*ABC PAYER*****PI*1234560010~HL*2*1*21*1~NM1*1P*1*XYZ AMBULANCE SVC*****24*7759621873~HL*3*2*22*1~NM1*IL*1*SMITH*JOE****MI*12345689001~REF*EJ*1234567890~DMG*D8*19700101*M~HL*4*3*EV*1~UM*HS*I*56*41:B~DTP*AAH*D8*20250101~CRC*07*Y*09~CR1***X*D*DH*27***TRIP FROM HOME TO OFFICE VISIT TO DIALYSIS TREATMENT AND BACK HOME~NM1*PW*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*ND*2*DOCTOR OFFICE~N3*SOME AVENUE~N4*SACRAMENTO*CA*95624~NM1*R3*2*SOME DIALYSIS CENTER~N3*7622 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*FS*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~HL*5*4*SS*0~SV1*HC:A0428:RX**UN*5~HL*6*5*SS*0~SV1*HC:A0428:PD**UN*8~HL*7*6*SS*0~SV1*HC:A0428:DR**UN*14~SE*34*0001~GE*1*1~IEA*1*000000001~ NoaX12Request: type: object properties: x12: type: string description: EDI X12 278x216 Request example: ISA*00* *00* *ZZ*83825418A *ZZ*IMNDIRECT *260203*0815*^*00501*375720525*0*P*:~GS*HI*LRX1210001*MTEXE*20260203*0815*1234*X*005010X216~ST*278*0001*005010X216~BHT*0007*CN*222438911WEB*20260203*0815*NO~HL*1**20*1~NM1*FA*2*Benefis Health System*****XX*1881650737~PER*IC**TE*4064552959~HL*2*1*21*1~NM1*X3*2*AETNA*****PI*60054~HL*3*2*22*1~NM1*IL*1*LNAME*FNAME****MI*NOA-01-SUCCESS~REF*6P*0123456789012~DMG*D8*19700101~HL*4*3*EV*1~UM*AR*I*1*11:A~DTP*435*D8*20260101~HI*ABJ:N1330~MSG*AT=061500;ICD=N1330~NM1*71*1*SLATER*RICHARD****XX*1285928754~NM1*FA*2*Benefis Health System*****XX*1881650737~NM1*AAJ*1*SLATER*RICHARD****XX*1285928754~SE*20*0001~GE*1*1234~IEA*1*375720525~ DeterminationX12Request: type: object properties: rhPayerId: type: string description: Global payer identifier used for determination example: UHCDEMODV1 planId: type: string description: Payer plan identifier used for determination example: 41 x12: type: string example: ISA*00* *00* *ZZ*943207296 *ZZ*INQDEMO *230810*1021*^*00501*916040697*0*P*:~GS*HI*943207296*INQDEMO*20230810*102137*3294199*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1402448037*20230810*102137~HL*1**20*1~NM1*PR*2*INQDEMO*****PI*INQDEMO~HL*2*1*21*1~NM1*1P*2*Demo Hospital*****XX*1234567890~REF*EI*123456789~N4*Nashville*TN*12345~PER*IC**TE*1112223333*FX*2223334444~HL*3*2*22*1~NM1*IL*1*DOE*JOE****MI*TST1~REF*6P*00000000~DMG*D8*19010101~HL*4*3*EV*1~UM*HS*I*1*11:B~DTP*AAH*D8*20230802~HI*ABK:C34.32~NM1*SJ*2*Demo Hospital*****XX*1234567890~NM1*DN*2*Demo Hospital*****XX*1234567890~REF*ZH*123456789~HL*5*4*SS*0~DTP*472*D8*20160615~SV1*HC:70488~SE*24*0001~GE*1*3294199~IEA*1*916040697~ SimplifiedDeterminationRequest: type: object properties: rhPayerId: type: string example: COMM112601 planId: type: string example: '6223' procedureCodes: type: string example: - 0042T - Q5127 SimplifiedDeterminationResponse: type: array items: $ref: '#/components/schemas/SimplifiedResponse' SimplifiedResponse: type: object properties: authorizationRequired: type: boolean UMVendor: type: string payerCPID: type: string planName: type: string rhPayerId: type: string planId: type: string code: type: string exceptions: type: string externalRoute: type: string payerXrefStatus: type: string UMVendorXrefStatus: type: string AuthorizationSubmissionJSON: type: object properties: senderId: type: string submitterTransactionIdentifier: type: string payerId: type: string payerName: type: string umClearingHouseId: type: string requester: type: object properties: requesterType: type: string organizationName: type: string lastName: type: string firstName: type: string requesterIdentification: type: object properties: providerUpinNumber: type: string facilityIdNumber: type: string employerIdentificationNumber: type: string providerSiteNumber: type: string providerPlanNetworkIdNumber: type: string facilityNetworkIdNumber: type: string socialSecurityNumber: type: string carrierAssignedReferenceNumber: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string npi: type: string ssn: type: string servicesPlanID: type: string employersId: type: string etin: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string contactTelephoneExtension: type: string providerCode: type: string referenceIdentification: type: string subscriber: type: object properties: lastName: type: string firstName: type: string middleName: type: string suffix: type: string memberId: type: string dateOfBirth: type: string genderCode: type: string supplementalIdentification: type: object properties: policyNumber: type: string branchIdentifier: type: string groupNumber: type: string departmentNumber: type: string patientAccountNumber: type: string healthInsuranceClaimNumber: type: string idCard: type: string insurancePolicyNumber: type: string planNetworkIdentificationNumber: type: string medicaidRecipientIdentificationNumber: type: string ssn: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string insuredIndicator: type: string militaryRelationship: type: string dependent: type: object properties: lastName: type: string firstName: type: string middleName: type: string suffix: type: string dateOfBirth: type: string genderCode: type: string supplementalIdentification: type: object properties: patientAccountNumber: type: string ssn: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string insuredIndicator: type: string relationshipToInsuredCode: type: string birthSequenceNumber: type: string patientEventDetail: type: object properties: requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string relatedCausesCode1: type: string relatedCausesCode2: type: string relatedCausesCode3: type: string stateCode: type: string countryCode: type: string levelOfServiceCode: type: string currentHealthConditionCode: type: string prognosisCode: type: string releaseOfInformationCode: type: string delayReasonCode: type: string previousReviewAuthorizationNumber: type: string previousAdministrativeReferenceNumber: type: string accidentDate: type: string lastMenstrualPeriodDate: type: string estimatedDateOfBirth: type: string onsetDate: type: string eventDateBegin: type: string eventDateEnd: type: string admissionDateBegin: type: string admissionDateEnd: type: string dischargeDate: type: string diagnosisTypeCode1: type: string diagnosisCode1: type: string diagnosisDate1: type: string diagnosisTypeCode2: type: string diagnosisCode2: type: string diagnosisDate2: type: string diagnosisTypeCode3: type: string diagnosisCode3: type: string diagnosisDate3: type: string diagnosisTypeCode4: type: string diagnosisCode4: type: string diagnosisDate4: type: string diagnosisTypeCode5: type: string diagnosisCode5: type: string diagnosisDate5: type: string diagnosisTypeCode6: type: string diagnosisCode6: type: string diagnosisDate6: type: string diagnosisTypeCode7: type: string diagnosisCode7: type: string diagnosisDate7: type: string diagnosisTypeCode8: type: string diagnosisCode8: type: string diagnosisDate8: type: string diagnosisTypeCode9: type: string diagnosisCode9: type: string diagnosisDate9: type: string diagnosisTypeCode10: type: string diagnosisCode10: type: string diagnosisDate10: type: string diagnosisTypeCode11: type: string diagnosisCode11: type: string diagnosisDate11: type: string diagnosisTypeCode12: type: string diagnosisCode12: type: string diagnosisDate12: type: string quantityQualifier: type: string serviceUnitCount: type: string unitOrBasisForMeasurementCode: type: string sampleSelectionModulus: type: string timePeriodQualifier: type: string periodCount: type: string deliveryFrequencyCode: type: string deliveryPatternTimeCode: type: string ambulanceCertificationConditionIndicator: type: string ambulanceCertificationConditionCode1: type: string ambulanceCertificationConditionCode2: type: string ambulanceCertificationConditionCode3: type: string ambulanceCertificationConditionCode4: type: string ambulanceCertificationConditionCode5: type: string chiropracticCertificationConditionIndicator: type: string chiropracticCertificationConditionCode1: type: string chiropracticCertificationConditionCode2: type: string chiropracticCertificationConditionCode3: type: string chiropracticCertificationConditionCode4: type: string chiropracticCertificationConditionCode5: type: string durableMedicalEquipmentCertificationConditionIndicator: type: string durableMedicalEquipmentCertificationConditionCode1: type: string durableMedicalEquipmentCertificationConditionCode2: type: string durableMedicalEquipmentCertificationConditionCode3: type: string durableMedicalEquipmentCertificationConditionCode4: type: string durableMedicalEquipmentCertificationConditionCode5: type: string oxygenTherapyCertificationConditionIndicator: type: string oxygenTherapyCertificationConditionCode1: type: string oxygenTherapyCertificationConditionCode2: type: string oxygenTherapyCertificationConditionCode3: type: string oxygenTherapyCertificationConditionCode4: type: string oxygenTherapyCertificationConditionCode5: type: string functionalLimitationsCertificationConditionIndicator: type: string functionalLimitationsCertificationConditionCode1: type: string functionalLimitationsCertificationConditionCode2: type: string functionalLimitationsCertificationConditionCode3: type: string functionalLimitationsCertificationConditionCode4: type: string functionalLimitationsCertificationConditionCode5: type: string activitiesPermittedCertificationConditionIndicator: type: string activitiesPermittedCertificationConditionCode1: type: string activitiesPermittedCertificationConditionCode2: type: string activitiesPermittedCertificationConditionCode3: type: string activitiesPermittedCertificationConditionCode4: type: string activitiesPermittedCertificationConditionCode5: type: string mentalStatusCertificationConditionIndicator: type: string mentalStatusCertificationConditionCode1: type: string mentalStatusCertificationConditionCode2: type: string mentalStatusCertificationConditionCode3: type: string mentalStatusCertificationConditionCode4: type: string mentalStatusCertificationConditionCode5: type: string admissionToFacility: type: object properties: admissionTypeCode: type: string admissionSourceCode: type: string patientStatusCode: type: string nursingHomeResidentialStatusCode: type: string ambulanceTransport: type: object properties: patientWeight: type: string transportCode: type: string transportReasonCode: type: string transportDistance: type: string roundTripPurposeDescription: type: string stretcherPurposeDescription: type: string spinalManipulation: type: object properties: treatmentSeriesNumber: type: string treatmentCount: type: string subluxationBeginningLevelCode: type: string subluxationEndLevelCode: type: string patientConditionCode: type: string complicationIndicator: type: string patientConditionDescription1: type: string patientConditionDescription2: type: string xrayAvailabilityIndicator: type: string homeOxygenTherapyInformation: type: object properties: equipmentTypeCode1: type: string equipmentTypeCode2: type: string equipmentTypeCode3: type: string equipmentReasonDescription: type: string flowRate: type: string dailyUseCount: type: string usePeriodHourCount: type: string respiratoryTherapistOrderText: type: string arterialBloodGasQuantity: type: string saturationQuantity: type: string testConditionCode: type: string testFindingsCode1: type: string testFindingsCode2: type: string testFindingsCode3: type: string portableSystemFlowRate: type: string deliverySystemCode: type: string homeHealth: type: object properties: prognosisCode: type: string startDate: type: string certificationPeriodStartDate: type: string certificationPeriodEndDate: type: string medicareCoverageIndicator: type: string certificationTypeCode: type: string surgeryDate: type: string productOrServiceQualifier: type: string surgicalProcedureCode: type: string physicalOrderDate: type: string lastVisitDate: type: string physicianContactDate: type: string lastAdmissionPeriodStartDate: type: string lastAdmissionPeriodEndDate: type: string patientLocationCode: type: string attachments: type: array items: type: object properties: reportTypeCode: type: string transmissionCode: type: string controlNumber: type: string description: type: string freeFormMessageText: type: string patientEventProviderName: type: array items: type: object properties: entityIdentifierCode: type: string organizationName: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: type: object properties: stateLicenseNumber: type: string licenseNumberStateCode: type: string providerUpinNumber: type: string facilityIdNumber: type: string employersIdentificationNumber: type: string providerPlanNetworkIdentificationNumber: type: string facilityNetworkIdentificationNumber: type: string ssn: type: string carrierAssignedReferenceNumber: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string contactTelephoneExtension: type: string providerCode: type: string providerTaxonomyCode: type: string patientEventTransportInformation: type: array items: type: object properties: entityIdentifierCode: type: string transportLocationName: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string patientEventOtherUmoName: type: array items: type: object properties: entityIdentifierCode: type: string otherUmoName: type: string otherUmoDenialReason1: type: string otherUmoDenialReason2: type: string otherUmoDenialReason3: type: string otherUmoDenialReason4: type: string otherUmoDenialDate: type: string serviceLevel: type: array items: type: object properties: requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string previousReviewAuthorizationNumber: type: string previousAdministrativeReferenceNumber: type: string serviceDateBegin: type: string serviceDateEnd: type: string professionalService: type: object properties: productOrServiceIDQualifier: type: string procedureCode: type: string procedureModifier1: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string unitOrBasisForMeasurementCode: type: string serviceUnitCount: type: string diagnosisCodePointer1: type: string diagnosisCodePointer2: type: string diagnosisCodePointer3: type: string diagnosisCodePointer4: type: string epsdtIndicator: type: string nursingHomeLevelOfCare: type: string institutionalService: type: object properties: serviceLineRevenueCode: type: string productOrServiceIDQualifier: type: string procedureCode: type: string procedureModifier1: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string unitOrBasisForMeasurementCode: type: string serviceUnitCount: type: string serviceLineRate: type: string nursingHomeResidentialStatusCode: type: string nursingHomeLevelOfCare: type: string dentalService: type: object properties: procedureCode: type: string procedureModifier1: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string oralCavityDesignationCode: type: string oralCavityDesignationCode2: type: string oralCavityDesignationCode3: type: string oralCavityDesignationCode4: type: string oralCavityDesignationCode5: type: string prosthesisCrownOrInlayCode: type: string serviceUnitCount: type: string description: type: string toothInformation: type: array items: type: object properties: toothCode: type: string toothSurfaceCode1: type: string toothSurfaceCode2: type: string toothSurfaceCode3: type: string toothSurfaceCode4: type: string toothSurfaceCode5: type: string healthCareServiceDelivery: type: object properties: quantityQualifier: type: string serviceQuantity: type: string unitOrBasisForMeasurementCode: type: string sampleSelectionModulus: type: string timePeriodQualifier: type: string periodCount: type: string deliveryFrequencyCode: type: string deliveryPatternTimeCode: type: string attachments: type: array items: type: object properties: reportTypeCode: type: string transmissionCode: type: string controlNumber: type: string description: type: string freeFormMessageText: type: string serviceProviderName: type: array items: type: object properties: entityIdentifierCode: type: string organizationName: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: type: object properties: stateLicenseNumber: type: string licenseNumberStateCode: type: string providerUpinNumber: type: string facilityIdNumber: type: string employersIdentificationNumber: type: string providerPlanNetworkIdentificationNumber: type: string facilityNetworkIdentificationNumber: type: string ssn: type: string carrierAssignedReferenceNumber: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string providerCode: type: string providerTaxonomyCode: type: string AuthorizationNoaJSON: type: object properties: senderId: type: string submitterTransactionIdentifier: type: string payerId: type: string payerName: type: string umClearingHouseId: type: string requester: type: object properties: requesterType: type: string organizationName: type: string lastName: type: string firstName: type: string requesterIdentification: type: object properties: providerUpinNumber: type: string facilityIdNumber: type: string employerIdentificationNumber: type: string providerSiteNumber: type: string providerPlanNetworkIdNumber: type: string facilityNetworkIdNumber: type: string socialSecurityNumber: type: string carrierAssignedReferenceNumber: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string npi: type: string ssn: type: string servicesPlanID: type: string employersId: type: string etin: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string contactTelephoneExtension: type: string providerCode: type: string referenceIdentification: type: string subscriber: type: object properties: lastName: type: string firstName: type: string middleName: type: string suffix: type: string memberId: type: string dateOfBirth: type: string genderCode: type: string supplementalIdentification: type: object properties: policyNumber: type: string branchIdentifier: type: string groupNumber: type: string departmentNumber: type: string patientAccountNumber: type: string healthInsuranceClaimNumber: type: string idCard: type: string insurancePolicyNumber: type: string planNetworkIdentificationNumber: type: string medicaidRecipientIdentificationNumber: type: string ssn: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string insuredIndicator: type: string militaryRelationship: type: string dependent: type: object properties: lastName: type: string firstName: type: string middleName: type: string suffix: type: string dateOfBirth: type: string genderCode: type: string supplementalIdentification: type: object properties: patientAccountNumber: type: string ssn: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string insuredIndicator: type: string relationshipToInsuredCode: type: string birthSequenceNumber: type: string patientEventDetail: type: object properties: requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string relatedCausesCode1: type: string relatedCausesCode2: type: string relatedCausesCode3: type: string stateCode: type: string countryCode: type: string levelOfServiceCode: type: string currentHealthConditionCode: type: string prognosisCode: type: string releaseOfInformationCode: type: string delayReasonCode: type: string previousReviewAuthorizationNumber: type: string previousAdministrativeReferenceNumber: type: string accidentDate: type: string lastMenstrualPeriodDate: type: string estimatedDateOfBirth: type: string onsetDate: type: string eventDateBegin: type: string eventDateEnd: type: string admissionDateBegin: type: string admissionDateEnd: type: string dischargeDate: type: string diagnosisTypeCode1: type: string diagnosisCode1: type: string diagnosisDate1: type: string diagnosisTypeCode2: type: string diagnosisCode2: type: string diagnosisDate2: type: string diagnosisTypeCode3: type: string diagnosisCode3: type: string diagnosisDate3: type: string diagnosisTypeCode4: type: string diagnosisCode4: type: string diagnosisDate4: type: string diagnosisTypeCode5: type: string diagnosisCode5: type: string diagnosisDate5: type: string diagnosisTypeCode6: type: string diagnosisCode6: type: string diagnosisDate6: type: string diagnosisTypeCode7: type: string diagnosisCode7: type: string diagnosisDate7: type: string diagnosisTypeCode8: type: string diagnosisCode8: type: string diagnosisDate8: type: string diagnosisTypeCode9: type: string diagnosisCode9: type: string diagnosisDate9: type: string diagnosisTypeCode10: type: string diagnosisCode10: type: string diagnosisDate10: type: string diagnosisTypeCode11: type: string diagnosisCode11: type: string diagnosisDate11: type: string diagnosisTypeCode12: type: string diagnosisCode12: type: string diagnosisDate12: type: string quantityQualifier: type: string serviceUnitCount: type: string unitOrBasisForMeasurementCode: type: string sampleSelectionModulus: type: string timePeriodQualifier: type: string periodCount: type: string deliveryFrequencyCode: type: string deliveryPatternTimeCode: type: string ambulanceCertificationConditionIndicator: type: string ambulanceCertificationConditionCode1: type: string ambulanceCertificationConditionCode2: type: string ambulanceCertificationConditionCode3: type: string ambulanceCertificationConditionCode4: type: string ambulanceCertificationConditionCode5: type: string chiropracticCertificationConditionIndicator: type: string chiropracticCertificationConditionCode1: type: string chiropracticCertificationConditionCode2: type: string chiropracticCertificationConditionCode3: type: string chiropracticCertificationConditionCode4: type: string chiropracticCertificationConditionCode5: type: string durableMedicalEquipmentCertificationConditionIndicator: type: string durableMedicalEquipmentCertificationConditionCode1: type: string durableMedicalEquipmentCertificationConditionCode2: type: string durableMedicalEquipmentCertificationConditionCode3: type: string durableMedicalEquipmentCertificationConditionCode4: type: string durableMedicalEquipmentCertificationConditionCode5: type: string oxygenTherapyCertificationConditionIndicator: type: string oxygenTherapyCertificationConditionCode1: type: string oxygenTherapyCertificationConditionCode2: type: string oxygenTherapyCertificationConditionCode3: type: string oxygenTherapyCertificationConditionCode4: type: string oxygenTherapyCertificationConditionCode5: type: string functionalLimitationsCertificationConditionIndicator: type: string functionalLimitationsCertificationConditionCode1: type: string functionalLimitationsCertificationConditionCode2: type: string functionalLimitationsCertificationConditionCode3: type: string functionalLimitationsCertificationConditionCode4: type: string functionalLimitationsCertificationConditionCode5: type: string activitiesPermittedCertificationConditionIndicator: type: string activitiesPermittedCertificationConditionCode1: type: string activitiesPermittedCertificationConditionCode2: type: string activitiesPermittedCertificationConditionCode3: type: string activitiesPermittedCertificationConditionCode4: type: string activitiesPermittedCertificationConditionCode5: type: string mentalStatusCertificationConditionIndicator: type: string mentalStatusCertificationConditionCode1: type: string mentalStatusCertificationConditionCode2: type: string mentalStatusCertificationConditionCode3: type: string mentalStatusCertificationConditionCode4: type: string mentalStatusCertificationConditionCode5: type: string admissionToFacility: type: object properties: admissionTypeCode: type: string admissionSourceCode: type: string patientStatusCode: type: string nursingHomeResidentialStatusCode: type: string ambulanceTransport: type: object properties: patientWeight: type: string transportCode: type: string transportReasonCode: type: string transportDistance: type: string roundTripPurposeDescription: type: string stretcherPurposeDescription: type: string spinalManipulation: type: object properties: treatmentSeriesNumber: type: string treatmentCount: type: string subluxationBeginningLevelCode: type: string subluxationEndLevelCode: type: string patientConditionCode: type: string complicationIndicator: type: string patientConditionDescription1: type: string patientConditionDescription2: type: string xrayAvailabilityIndicator: type: string homeOxygenTherapyInformation: type: object properties: equipmentTypeCode1: type: string equipmentTypeCode2: type: string equipmentTypeCode3: type: string equipmentReasonDescription: type: string flowRate: type: string dailyUseCount: type: string usePeriodHourCount: type: string respiratoryTherapistOrderText: type: string arterialBloodGasQuantity: type: string saturationQuantity: type: string testConditionCode: type: string testFindingsCode1: type: string testFindingsCode2: type: string testFindingsCode3: type: string portableSystemFlowRate: type: string deliverySystemCode: type: string homeHealth: type: object properties: prognosisCode: type: string startDate: type: string certificationPeriodStartDate: type: string certificationPeriodEndDate: type: string medicareCoverageIndicator: type: string certificationTypeCode: type: string surgeryDate: type: string productOrServiceQualifier: type: string surgicalProcedureCode: type: string physicalOrderDate: type: string lastVisitDate: type: string physicianContactDate: type: string lastAdmissionPeriodStartDate: type: string lastAdmissionPeriodEndDate: type: string patientLocationCode: type: string attachments: type: array items: type: object properties: reportTypeCode: type: string transmissionCode: type: string controlNumber: type: string description: type: string freeFormMessageText: type: string patientEventProviderName: type: array items: type: object properties: entityIdentifierCode: type: string organizationName: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: type: object properties: stateLicenseNumber: type: string licenseNumberStateCode: type: string providerUpinNumber: type: string facilityIdNumber: type: string employersIdentificationNumber: type: string providerPlanNetworkIdentificationNumber: type: string facilityNetworkIdentificationNumber: type: string ssn: type: string carrierAssignedReferenceNumber: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string contactTelephoneExtension: type: string providerCode: type: string providerTaxonomyCode: type: string patientEventTransportInformation: type: array items: type: object properties: entityIdentifierCode: type: string transportLocationName: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string patientEventOtherUmoName: type: array items: type: object properties: entityIdentifierCode: type: string otherUmoName: type: string otherUmoDenialReason1: type: string otherUmoDenialReason2: type: string otherUmoDenialReason3: type: string otherUmoDenialReason4: type: string otherUmoDenialDate: type: string serviceLevel: type: array items: type: object properties: requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string previousReviewAuthorizationNumber: type: string previousAdministrativeReferenceNumber: type: string serviceDateBegin: type: string serviceDateEnd: type: string professionalService: type: object properties: productOrServiceIDQualifier: type: string procedureCode: type: string procedureModifier1: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string unitOrBasisForMeasurementCode: type: string serviceUnitCount: type: string diagnosisCodePointer1: type: string diagnosisCodePointer2: type: string diagnosisCodePointer3: type: string diagnosisCodePointer4: type: string epsdtIndicator: type: string nursingHomeLevelOfCare: type: string institutionalService: type: object properties: serviceLineRevenueCode: type: string productOrServiceIDQualifier: type: string procedureCode: type: string procedureModifier1: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string unitOrBasisForMeasurementCode: type: string serviceUnitCount: type: string serviceLineRate: type: string nursingHomeResidentialStatusCode: type: string nursingHomeLevelOfCare: type: string dentalService: type: object properties: procedureCode: type: string procedureModifier1: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string oralCavityDesignationCode: type: string oralCavityDesignationCode2: type: string oralCavityDesignationCode3: type: string oralCavityDesignationCode4: type: string oralCavityDesignationCode5: type: string prosthesisCrownOrInlayCode: type: string serviceUnitCount: type: string description: type: string toothInformation: type: array items: type: object properties: toothCode: type: string toothSurfaceCode1: type: string toothSurfaceCode2: type: string toothSurfaceCode3: type: string toothSurfaceCode4: type: string toothSurfaceCode5: type: string healthCareServiceDelivery: type: object properties: quantityQualifier: type: string serviceQuantity: type: string unitOrBasisForMeasurementCode: type: string sampleSelectionModulus: type: string timePeriodQualifier: type: string periodCount: type: string deliveryFrequencyCode: type: string deliveryPatternTimeCode: type: string attachments: type: array items: type: object properties: reportTypeCode: type: string transmissionCode: type: string controlNumber: type: string description: type: string freeFormMessageText: type: string serviceProviderName: type: array items: type: object properties: entityIdentifierCode: type: string organizationName: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: type: object properties: stateLicenseNumber: type: string licenseNumberStateCode: type: string providerUpinNumber: type: string facilityIdNumber: type: string employersIdentificationNumber: type: string providerPlanNetworkIdentificationNumber: type: string facilityNetworkIdentificationNumber: type: string ssn: type: string carrierAssignedReferenceNumber: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string providerCode: type: string providerTaxonomyCode: type: string RecheckRequest: type: object properties: recheckFrequency: description: (Optional) How often re-checkable records are considered type: integer example: 12 default: 12 recheckPeriodBackoff: description: (Optional) Given a recheck_batch_date, how long has it been since this has last been rechecked type: integer example: 2 default: 2 dosProximity: description: (Optional) When we are within this proximity to date of service, the frequency changes to dos-proximity-recheck-freq type: integer example: 3 dosProximityRecheckFrequency: description: (Optional) This is the frequency at which we recheck when we are within dos-proximity of the date of service type: integer example: 3 default: 3 InquiryJSONRequest: type: object properties: senderId: type: string submitterTransactionIdentifier: type: string payerId: type: string payerName: type: string umClearingHouseId: type: string requester: type: object properties: requesterType: type: string organizationName: type: string lastName: type: string firstName: type: string requesterIdentification: type: object properties: providerUpinNumber: type: string facilityIdNumber: type: string employerIdentificationNumber: type: string providerSiteNumber: type: string providerPlanNetworkIdNumber: type: string facilityNetworkIdNumber: type: string socialSecurityNumber: type: string federalTaxpayerIdentificationNumber: type: string carrierAssignedReferenceNumber: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string npi: type: string payorId: type: string ssn: type: string servicesPlanID: type: string employersId: type: string etin: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string contactTelephoneExtension: type: string providerCode: type: string referenceIdentification: type: string subscriber: type: object properties: lastName: type: string firstName: type: string middleName: type: string suffix: type: string memberId: type: string dateOfBirth: type: string supplementalIdentification: type: object properties: policyNumber: type: string branchIdentifier: type: string groupNumber: type: string departmentNumber: type: string patientAccountNumber: type: string healthInsuranceClaimNumber: type: string idCard: type: string insurancePolicyNumber: type: string planNetworkIdentificationNumber: type: string medicaidRecipientIdentificationNumber: type: string ssn: type: string dependent: type: object properties: lastName: type: string firstName: type: string middleName: type: string suffix: type: string dateOfBirth: type: string supplementalIdentification: type: object properties: employeeIdentificationNumber: type: string patientAccountNumber: type: string ssn: type: string patientEventDetail: type: object properties: requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string certificationActionCode: type: string previousReviewAuthorizationNumber: type: string previousAdministrativeReferenceNumber: type: string accidentDate: type: string eventDateBegin: type: string eventDateEnd: type: string admissionDateBegin: type: string admissionDateEnd: type: string dischargeDate: type: string certificationIssueDateBegin: type: string certificationIssueDateEnd: type: string certificationExpirationDateBegin: type: string certificationExpirationDateEnd: type: string certificationEffectiveDateBegin: type: string certificationEffectiveDateEnd: type: string healthCareServicesReviewRequestDate: type: string diagnosisTypeCode: type: string diagnosisCode: type: string patientEventProviderName: type: array items: type: object properties: entityIdentifierCode: type: string organizationName: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: type: object properties: stateLicenseNumber: type: string licenseNumberStateCode: type: string providerUpinNumber: type: string facilityIdNumber: type: string employersIdentificationNumber: type: string providerPlanNetworkIdentificationNumber: type: string facilityNetworkIdentificationNumber: type: string ssn: type: string carrierAssignedReferenceNumber: type: string providerCode: type: string providerTaxonomyCode: type: string serviceLevel: type: array items: type: object properties: requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string certificationActionCode: type: string previousReviewAuthorizationNumber: type: string previousAdministrativeReferenceNumber: type: string serviceDateBegin: type: string serviceDateEnd: type: string certificationIssueDateBegin: type: string certificationIssueDateEnd: type: string certificationExpirationDateBegin: type: string certificationExpirationDateEnd: type: string certificationEffectiveDateBegin: type: string certificationEffectiveDateEnd: type: string professionalService: type: object properties: productOrServiceIDQualifier: type: string procedureCode: type: string procedureCode2: type: string unitOrBasisForMeasurementCode: type: string serviceUnitCount: type: string institutionalService: type: object properties: serviceLineRevenueCode: type: string productOrServiceIDQualifier: type: string procedureCode: type: string procedureCode2: type: string unitOrBasisForMeasurementCode: type: string serviceUnitCount: type: string dentalService: type: object properties: procedureCode: type: string procedureCode2: type: string americanDentalAssociationCodes: type: string prosthesisCrownOrInlayCode: type: string serviceUnitCount: type: string toothInformation: type: object properties: toothCode: type: string toothSurfaceCode: type: string serviceProviderName: type: array items: type: object properties: entityIdentifierCode: type: string organizationName: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: type: object properties: stateLicenseNumber: type: string licenseNumberStateCode: type: string providerUpinNumber: type: string facilityIdNumber: type: string employersIdentificationNumber: type: string providerSiteNumber: type: string providerPlanNetworkIdentificationNumber: type: string facilityNetworkIdentificationNumber: type: string ssn: type: string carrierAssignedReferenceNumber: type: string providerCode: type: string providerTaxonomyCode: type: string ExecuteDeterminationRulesRequest: type: object properties: globalPayerId: type: string example: UHCDEMODV1 filePath: type: string example: Authorization/Global payerId: type: string example: UHC planId: type: string example: '41' billingFacility: type: string example: MED1 dateOfService: type: string example: '2006-01-02' dataSource: type: string example: EMR groupNumber: type: string example: '0000000000' patientType: type: string example: InPatient serviceCode: type: string example: '86' policyNumber: type: string example: '0000001' dateOfBirth: type: string example: '2001-01-30' procedureCodes: type: string example: - 0200T - Q5127 diagnosisCodes: type: string example: - M80.88XA InquiryJSONRequestWithDetermination: allOf: - $ref: '#/components/schemas/InquiryJSONRequest' - type: object properties: rhPayerId: type: string description: Global payer identifier used for determination example: UHCDEMODV1 planId: type: string description: Payer plan identifier used for determination example: '41' AuthorizationResponse: type: object properties: authorizationId: type: string determination: type: object properties: x12: type: string json: $ref: '#/components/schemas/AuthorizationJSONResponse' inquiry: type: array maxItems: 100 items: type: object properties: x12: type: string json: $ref: '#/components/schemas/AuthorizationJSONResponse' DeterminationResponse: type: object properties: determination: type: object properties: x12: type: string json: $ref: '#/components/schemas/AuthorizationJSONResponse' InquiryResponse: type: object properties: authorizationId: type: string inquiry: type: object properties: x12: type: string json: $ref: '#/components/schemas/AuthorizationJSONResponse' SubmissionResponse: type: object properties: authorizationId: type: string submission: type: object properties: x12: type: string json: $ref: '#/components/schemas/SubmissionJSONResponse' SubmissionJSONResponse: type: object properties: requestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string submitterTransactionIdentifier: type: string payerId: type: string payerName: type: string umClearingHouseId: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string umRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string requester: type: object properties: requesterRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string requesterType: type: string organizationName: type: string firstName: type: string requesterIdentification: type: object properties: facilityIdNumber: type: string socialSecurityNumber: type: string npi: type: string providerCode: type: string referenceIdentification: type: string subscriber: type: object properties: subscriberRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string lastName: type: string firstName: type: string middleName: type: string prefix: type: string suffix: type: string memberId: type: string dateOfBirth: type: string genderCode: type: string supplementalIdentification: type: object properties: medicaidRecipientIdentificationNumber: type: string ssn: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string insuredIndicator: type: string militaryRelationship: type: string dependent: type: object properties: dependentRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string lastName: type: string firstName: type: string middleName: type: string suffix: type: string dateOfBirth: type: string genderCode: type: string supplementalIdentification: type: object properties: patientAccountNumber: type: string ssn: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string insuredIndicator: type: string relationshipToInsuredCode: type: string birthSequenceNumber: type: string patientEventDetail: type: object properties: patientEventRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string levelOfServiceCode: type: string certificationActionCode: type: string reviewIdentificationNumber: type: string reviewDecisionReasonCode: type: string secondSurgicalOpinionIndicator: type: string administrativeReferenceNumber: type: string previousReviewAuthorizationNumber: type: string accidentDate: type: string lastMenstrualPeriodDate: type: string estimatedDateOfBirth: type: string onsetOfCurrentSymptomsOrIllnessDate: type: string eventDateBegin: type: string eventDateEnd: type: string admissionDateBegin: type: string admissionDateEnd: type: string dischargeDate: type: string certificationIssueDate: type: string certificationExpirationDate: type: string certificationEffectiveDateBegin: type: string certificationEffectiveDateEnd: type: string diagnosisTypeCode1: type: string diagnosisCode1: type: string diagnosisDate1: type: string diagnosisTypeCode2: type: string diagnosisCode2: type: string diagnosisDate2: type: string diagnosisTypeCode3: type: string diagnosisCode3: type: string diagnosisDate3: type: string diagnosisTypeCode4: type: string diagnosisCode4: type: string diagnosisDate4: type: string diagnosisTypeCode5: type: string diagnosisCode5: type: string diagnosisDate5: type: string diagnosisTypeCode6: type: string diagnosisCode6: type: string diagnosisDate6: type: string diagnosisTypeCode7: type: string diagnosisCode7: type: string diagnosisDate7: type: string diagnosisTypeCode8: type: string diagnosisCode8: type: string diagnosisDate8: type: string diagnosisTypeCode9: type: string diagnosisCode9: type: string diagnosisDate9: type: string diagnosisTypeCode10: type: string diagnosisCode10: type: string diagnosisDate10: type: string diagnosisTypeCode11: type: string diagnosisCode11: type: string diagnosisDate11: type: string diagnosisTypeCode12: type: string diagnosisCode12: type: string diagnosisDate12: type: string quantityQualifier: type: string serviceUnitCount: type: string unitOrBasisForMeasurementCode: type: string sampleSelectionModulus: type: string timePeriodQualifier: type: string periodCount: type: string deliveryFrequencyCode: type: string deliveryPatternTimeCode: type: string institutionalAdmissionTypeCode: type: string institutionalAdmissionSourceCode: type: string institutionalPatientStatusCode: type: string ambulanceTransportCode: type: string ambulanceUnitOrBasisForMeasurementCode: type: string ambulanceTransportDistance: type: string spinalManipulationTreatmentSeriesNumber: type: string spinalManipulationTreatmentCount: type: string spinalManipulationSubluxationLevelCode: type: string spinalManipulationSubluxationLevelCode2: type: string oxygenEquipmentTypeCode: type: string oxygenEquipmentTypeCode2: type: string oxygenFlowRate: type: string dailyOxygenUseCount: type: string oxygenUsePeriodHourCount: type: string respiratoryTherapistOrderText: type: string portableOxygenSystemFlowRate: type: string oxygenDeliverySystemCode: type: string oxygenSystemTypeCode: type: string homeHealthPrognosisCode: type: string homeHealthStartDate: type: string homeHealthCertificationPeriodStartDate: type: string homeHealthMedicareCoverageIndicator: type: string homeHealthCertificationTypeCode: type: string attachments: type: array items: type: object properties: reportTypeCode: type: string transmissionCode: type: string controlNumber: type: string description: type: string freeFormMessageText: type: string patientEventProviderName: type: array items: type: object properties: patientEventProviderRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string entityIdentifierCode: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: type: object properties: ssn: type: string carrierAssignedReferenceNumber: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string providerCode: type: string providerTaxonomyCode: type: string patientEventAdditionalPatientInformationContactName: type: array items: type: object properties: organizationName: type: string middleName: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string patientEventTransportInformation: type: array items: type: object properties: patientEventTransportInformationValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string entityIdentifierCode: type: string transportLocationName: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string serviceLevel: type: array items: type: object properties: serviceRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string certificationActionCode: type: string reviewIdentificationNumber: type: string reviewDecisionReasonCode: type: string secondSurgicalOpinionIndicator: type: string administrativeReferenceNumber: type: string previousReviewAuthorizationNumber: type: string serviceDateBegin: type: string serviceDateEnd: type: string certificationIssueDate: type: string certificationExpirationDate: type: string certificationEffectiveDateBegin: type: string certificationEffectiveDateEnd: type: string professionalService: type: object properties: productOrServiceIDQualifier: type: string procedureCode: type: string procedureModifier: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string unitOrBasisForMeasurementCode: type: string serviceUnitCount: type: string epsdtIndicator: type: string nursingHomeLevelOfCareCode: type: string institutionalService: type: object properties: serviceLineRevenueCode: type: string productOrServiceIDQualifier: type: string procedureCode: type: string procedureModifier: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string unitOrBasisForMeasurementCode: type: string serviceUnitCount: type: string serviceLineRate: type: string nursingHomeLevelOfCare: type: string dentalService: type: object properties: procedureCode: type: string procedureModifier: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string americanDentalAssociationCodes: type: string americanDentalAssociationCodes2: type: string americanDentalAssociationCodes3: type: string americanDentalAssociationCodes4: type: string americanDentalAssociationCodes5: type: string prosthesisCrownOrInlayCode: type: string serviceUnitCount: type: string toothInformation: type: array items: type: object properties: toothCode: type: string toothSurfaceCode: type: string toothSurfaceCode2: type: string toothSurfaceCode3: type: string toothSurfaceCode4: type: string toothSurfaceCode5: type: string quantityQualifier: type: string serviceUnitCount: type: string unitOrBasisForMeasurementCode: type: string sampleSelectionModulus: type: string timePeriodQualifier: type: string periodCount: type: string deliveryFrequencyCode: type: string deliveryPatternTimeCode: type: string attachments: type: array items: type: object properties: reportTypeCode: type: string transmissionCode: type: string controlNumber: type: string description: type: string freeFormMessageText: type: string serviceProviderName: type: array items: type: object properties: serviceProviderRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string entityIdentifierCode: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: type: object properties: ssn: type: string carrierAssignedReferenceNumber: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string providerCode: type: string providerTaxonomyCode: type: string serviceDetailAdditionalServiceInformationContactName: type: array items: type: object properties: organizationName: type: string middleName: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string NoaResponse: type: object properties: authorizationId: type: string submission: type: object properties: x12: type: string json: $ref: '#/components/schemas/NoaJSONResponse' NoaJSONResponse: type: object properties: requestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string submitterTransactionIdentifier: type: string payerId: type: string payerName: type: string umClearingHouseId: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string umRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string requester: type: object properties: requesterRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string requesterType: type: string organizationName: type: string firstName: type: string requesterIdentification: type: object properties: facilityIdNumber: type: string socialSecurityNumber: type: string npi: type: string providerCode: type: string referenceIdentification: type: string subscriber: type: object properties: subscriberRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string lastName: type: string firstName: type: string middleName: type: string prefix: type: string suffix: type: string memberId: type: string dateOfBirth: type: string genderCode: type: string supplementalIdentification: type: object properties: medicaidRecipientIdentificationNumber: type: string ssn: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string insuredIndicator: type: string militaryRelationship: type: string dependent: type: object properties: dependentRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string lastName: type: string firstName: type: string middleName: type: string suffix: type: string dateOfBirth: type: string genderCode: type: string supplementalIdentification: type: object properties: patientAccountNumber: type: string ssn: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string insuredIndicator: type: string relationshipToInsuredCode: type: string birthSequenceNumber: type: string patientEventDetail: type: object properties: patientEventRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string levelOfServiceCode: type: string certificationActionCode: type: string reviewIdentificationNumber: type: string reviewDecisionReasonCode: type: string secondSurgicalOpinionIndicator: type: string administrativeReferenceNumber: type: string previousReviewAuthorizationNumber: type: string accidentDate: type: string lastMenstrualPeriodDate: type: string estimatedDateOfBirth: type: string onsetOfCurrentSymptomsOrIllnessDate: type: string eventDateBegin: type: string eventDateEnd: type: string admissionDateBegin: type: string admissionDateEnd: type: string dischargeDate: type: string certificationIssueDate: type: string certificationExpirationDate: type: string certificationEffectiveDateBegin: type: string certificationEffectiveDateEnd: type: string diagnosisTypeCode1: type: string diagnosisCode1: type: string diagnosisDate1: type: string diagnosisTypeCode2: type: string diagnosisCode2: type: string diagnosisDate2: type: string diagnosisTypeCode3: type: string diagnosisCode3: type: string diagnosisDate3: type: string diagnosisTypeCode4: type: string diagnosisCode4: type: string diagnosisDate4: type: string diagnosisTypeCode5: type: string diagnosisCode5: type: string diagnosisDate5: type: string diagnosisTypeCode6: type: string diagnosisCode6: type: string diagnosisDate6: type: string diagnosisTypeCode7: type: string diagnosisCode7: type: string diagnosisDate7: type: string diagnosisTypeCode8: type: string diagnosisCode8: type: string diagnosisDate8: type: string diagnosisTypeCode9: type: string diagnosisCode9: type: string diagnosisDate9: type: string diagnosisTypeCode10: type: string diagnosisCode10: type: string diagnosisDate10: type: string diagnosisTypeCode11: type: string diagnosisCode11: type: string diagnosisDate11: type: string diagnosisTypeCode12: type: string diagnosisCode12: type: string diagnosisDate12: type: string quantityQualifier: type: string serviceUnitCount: type: string unitOrBasisForMeasurementCode: type: string sampleSelectionModulus: type: string timePeriodQualifier: type: string periodCount: type: string deliveryFrequencyCode: type: string deliveryPatternTimeCode: type: string institutionalAdmissionTypeCode: type: string institutionalAdmissionSourceCode: type: string institutionalPatientStatusCode: type: string ambulanceTransportCode: type: string ambulanceUnitOrBasisForMeasurementCode: type: string ambulanceTransportDistance: type: string spinalManipulationTreatmentSeriesNumber: type: string spinalManipulationTreatmentCount: type: string spinalManipulationSubluxationLevelCode: type: string spinalManipulationSubluxationLevelCode2: type: string oxygenEquipmentTypeCode: type: string oxygenEquipmentTypeCode2: type: string oxygenFlowRate: type: string dailyOxygenUseCount: type: string oxygenUsePeriodHourCount: type: string respiratoryTherapistOrderText: type: string portableOxygenSystemFlowRate: type: string oxygenDeliverySystemCode: type: string oxygenSystemTypeCode: type: string homeHealthPrognosisCode: type: string homeHealthStartDate: type: string homeHealthCertificationPeriodStartDate: type: string homeHealthMedicareCoverageIndicator: type: string homeHealthCertificationTypeCode: type: string attachments: type: array items: type: object properties: reportTypeCode: type: string transmissionCode: type: string controlNumber: type: string description: type: string freeFormMessageText: type: string patientEventProviderName: type: array items: type: object properties: patientEventProviderRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string entityIdentifierCode: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: type: object properties: ssn: type: string carrierAssignedReferenceNumber: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string providerCode: type: string providerTaxonomyCode: type: string patientEventAdditionalPatientInformationContactName: type: array items: type: object properties: organizationName: type: string middleName: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string patientEventTransportInformation: type: array items: type: object properties: patientEventTransportInformationValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string entityIdentifierCode: type: string transportLocationName: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string serviceLevel: type: array items: type: object properties: serviceRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string certificationActionCode: type: string reviewIdentificationNumber: type: string reviewDecisionReasonCode: type: string secondSurgicalOpinionIndicator: type: string administrativeReferenceNumber: type: string previousReviewAuthorizationNumber: type: string serviceDateBegin: type: string serviceDateEnd: type: string certificationIssueDate: type: string certificationExpirationDate: type: string certificationEffectiveDateBegin: type: string certificationEffectiveDateEnd: type: string professionalService: type: object properties: productOrServiceIDQualifier: type: string procedureCode: type: string procedureModifier: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string unitOrBasisForMeasurementCode: type: string serviceUnitCount: type: string epsdtIndicator: type: string nursingHomeLevelOfCareCode: type: string institutionalService: type: object properties: serviceLineRevenueCode: type: string productOrServiceIDQualifier: type: string procedureCode: type: string procedureModifier: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string unitOrBasisForMeasurementCode: type: string serviceUnitCount: type: string serviceLineRate: type: string nursingHomeLevelOfCare: type: string dentalService: type: object properties: procedureCode: type: string procedureModifier: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string americanDentalAssociationCodes: type: string americanDentalAssociationCodes2: type: string americanDentalAssociationCodes3: type: string americanDentalAssociationCodes4: type: string americanDentalAssociationCodes5: type: string prosthesisCrownOrInlayCode: type: string serviceUnitCount: type: string toothInformation: type: array items: type: object properties: toothCode: type: string toothSurfaceCode: type: string toothSurfaceCode2: type: string toothSurfaceCode3: type: string toothSurfaceCode4: type: string toothSurfaceCode5: type: string quantityQualifier: type: string serviceUnitCount: type: string unitOrBasisForMeasurementCode: type: string sampleSelectionModulus: type: string timePeriodQualifier: type: string periodCount: type: string deliveryFrequencyCode: type: string deliveryPatternTimeCode: type: string attachments: type: array items: type: object properties: reportTypeCode: type: string transmissionCode: type: string controlNumber: type: string description: type: string freeFormMessageText: type: string serviceProviderName: type: array items: type: object properties: serviceProviderRequestValidation: type: array items: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string entityIdentifierCode: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: type: object properties: ssn: type: string carrierAssignedReferenceNumber: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string providerCode: type: string providerTaxonomyCode: type: string serviceDetailAdditionalServiceInformationContactName: type: array items: type: object properties: organizationName: type: string middleName: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string DeterminationExecuteRuleResponse: type: array items: $ref: '#/components/schemas/ExecuteRulesResponse' ExecuteRulesResponse: type: object properties: authorizationRequired: type: boolean umVendor: type: string payerCpid: type: string planName: type: string rhPayerId: type: string planId: type: string code: type: string exceptions: type: string externalRoute: type: string payerXrefStatus: type: string umVendorXrefStatus: type: string rule: type: string canSubmit: type: boolean vendor: type: string lob: type: string isGlobal: type: boolean AuthorizationJSONResponse: type: object properties: requestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' submitterTransactionIdentifier: type: string payerId: type: string payerName: type: string umClearingHouseId: type: string contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string contactTelephoneExtension: type: string contactUrl: type: string umRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' requester: $ref: '#/components/schemas/AuthorizationJSONResponseRequester' subscriber: $ref: '#/components/schemas/AuthorizationJSONResponseSubscriber' dependent: $ref: '#/components/schemas/AuthorizationJSONResponseDependent' patientEventDetail: $ref: '#/components/schemas/AuthorizationJSONResponsePatientEventDetail' AuthorizationJSONResponseDependent: type: object properties: dependentRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' lastName: type: string firstName: type: string middleName: type: string suffix: type: string dateOfBirth: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string supplementalIdentification: $ref: '#/components/schemas/AuthorizationJSONResponseDependentSupplementalIdentification' AuthorizationJSONResponseRequestValidation: type: object properties: responseCode: type: string rejectReasonCode: type: string followupActionCode: type: string AuthorizationJSONResponseDependentSupplementalIdentification: type: object additionalProperties: false properties: employeeIdentificationNumber: type: string patientAccountNumber: type: string ssn: type: string AuthorizationJSONResponsePatientEventDetail: type: object properties: dependentRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string certificationActionCode: type: string reviewIdentificationNumber: type: string reviewDecisionReasonCode: type: string secondSurgicalOpinionIndicator: type: string previousReviewAuthorizationNumber: type: string previousAdministrativeReferenceNumber: type: string eventDateBegin: type: string eventDateEnd: type: string admissionDateBegin: type: string admissionDateEnd: type: string dischargeDate: type: string certificationIssueDate: type: string certificationExpirationDate: type: string certificationEffectiveDateBegin: type: string certificationEffectiveDateEnd: type: string healthCareServicesReviewRequestDateBegin: type: string healthCareServicesReviewRequestDateEnd: type: string diagnosisTypeCode: type: string diagnosisCode: type: string quantityQualifier: type: string serviceUnitCount: type: string unitOrBasisForMeasurementCode: type: string sampleSelectionModulus: type: string timePeriodQualifier: type: string periodCount: type: string deliveryFrequencyCode: type: string deliveryPatternTimeCode: type: string institutionalAdmissionTypeCode: type: string institutionalAdmissionSourceCode: type: string institutionalPatientStatusCode: type: string ambulanceTransportCode: type: string ambulanceUnitOrBasisForMeasurementCode: type: string ambulanceTransportDistance: type: string spinalManipulationTreatmentSeriesNumber: type: string spinalManipulationTreatmentCount: type: string spinalManipulationSubluxationLevelCode: type: string spinalManipulationSubluxationLevelCode2: type: string oxygenEquipmentTypeCode: type: string oxygenEquipmentTypeCode2: type: string oxygenFlowRate: type: string dailyOxygenUseCount: type: string oxygenUsePeriodHourCount: type: string respiratoryTherapistOrderText: type: string portableOxygenSystemFlowRate: type: string oxygenDeliverySystemCode: type: string oxygenSystemTypeCode: type: string homeHealthPrognosisCode: type: string homeHealthStartDate: type: string homeHealthCertificationPeriod: type: string homeHealthMedicareCoverageIndicator: type: string homeHealthCertificationTypeCode: type: string freeFormMessageText: type: string patientEventProviderName: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponsePatientEventProviderName' patientEventTransportInformation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponsePatientEventTransportInformation' serviceLevel: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseServiceLevel' AuthorizationJSONResponsePatientEventProviderName: type: object properties: patientEventProviderRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' entityIdentifierCode: type: string organizationName: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: $ref: '#/components/schemas/AuthorizationJSONResponseProviderSupplementalInformation' contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string contactTelephoneExtension: type: string contactUrl: type: string providerCode: type: string providerTaxonomyCode: type: string AuthorizationJSONResponseProviderSupplementalInformation: type: object properties: stateLicenseNumber: type: string licenseNumberStateCode: type: string providerUpinNumber: type: string facilityIdNumber: type: string employersIdentificationNumber: type: string providerPlanNetworkIdentificationNumber: type: string facilityNetworkIdentificationNumber: type: string ssn: type: string carrierAssignedReferenceNumber: type: string providerSiteNumber: type: string AuthorizationJSONResponsePatientEventTransportInformation: type: object properties: entityIdentifierCode: type: string organizationName: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string AuthorizationJSONResponseServiceLevel: type: object properties: serviceRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' requestCategoryCode: type: string certificationTypeCode: type: string serviceTypeCode: type: string facilityTypeCode: type: string facilityCodeQualifier: type: string certificationActionCode: type: string reviewIdentificationNumber: type: string reviewDecisionReasonCode: type: string secondSurgicalOpinionIndicator: type: string previousReviewAuthorizationNumber: type: string previousAdministrativeReferenceNumber: type: string serviceDateBegin: type: string serviceDateEnd: type: string certificationIssueDate: type: string certificationExpirationDate: type: string certificationEffectiveDateBegin: type: string certificationEffectiveDateEnd: type: string professionalService: $ref: '#/components/schemas/AuthorizationJSONResponseIonalService' institutionalService: $ref: '#/components/schemas/AuthorizationJSONResponseIonalService' dentalService: $ref: '#/components/schemas/AuthorizationJSONResponseDentalService' toothInformation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseToothInformation' quantityQualifier: type: string serviceUnitCount: type: string unitOrBasisForMeasurementCode: type: string sampleSelectionModulus: type: string timePeriodQualifier: type: string periodCount: type: string deliveryFrequencyCode: type: string deliveryPatternTimeCode: type: string freeFormMessageText: type: string serviceProviderName: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseServiceProviderName' AuthorizationJSONResponseDentalService: type: object properties: procedureCode: type: string procedureModifier: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string americanDentalAssociationCodes: type: string americanDentalAssociationCodes2: type: string americanDentalAssociationCodes3: type: string americanDentalAssociationCodes4: type: string americanDentalAssociationCodes5: type: string prosthesisCrownOrInlayCode: type: string serviceUnitCount: type: string AuthorizationJSONResponseIonalService: type: object properties: serviceLineRevenueCode: type: string productOrServiceIDQualifier: type: string procedureCode: type: string procedureModifier: type: string procedureModifier2: type: string procedureModifier3: type: string procedureModifier4: type: string procedureCodeDescription: type: string procedureCode2: type: string serviceLineAmount: type: string unitOrBasisForMeasurementCode: type: string serviceUnitCount: type: string serviceLineRate: type: string epsdtIndicator: type: string AuthorizationJSONResponseServiceProviderName: type: object properties: serviceProviderRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' entityIdentifierCode: type: string organizationName: type: string lastName: type: string firstName: type: string middleName: type: string namePrefix: type: string nameSuffix: type: string identificationCodeQualifier: type: string identifier: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string providerSupplementalInformation: $ref: '#/components/schemas/AuthorizationJSONResponseProviderSupplementalInformation' contactName: type: string contactElectronicMail: type: string contactFacsimile: type: string contactTelephone: type: string contactTelephoneExtension: type: string contactUrl: type: string providerCode: type: string providerTaxonomyCode: type: string AuthorizationJSONResponseToothInformation: type: object properties: toothCode: type: string toothSurfaceCode: type: string toothSurfaceCode2: type: string toothSurfaceCode3: type: string toothSurfaceCode4: type: string toothSurfaceCode5: type: string AuthorizationJSONResponseRequester: type: object properties: requesterRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' requesterType: type: string organizationName: type: string lastName: type: string firstName: type: string requesterIdentification: $ref: '#/components/schemas/AuthorizationJSONResponseRequesterIdentification' npi: type: string payorId: type: string ssn: type: string servicesPlanID: type: string employersId: type: string etin: type: string providerCode: type: string referenceIdentification: type: string AuthorizationJSONResponseRequesterIdentification: type: object properties: providerUpinNumber: type: string facilityIdNumber: type: string employerIdentificationNumber: type: string providerSiteNumber: type: string providerPlanNetworkIdNumber: type: string facilityNetworkIdNumber: type: string socialSecurityNumber: type: string carrierAssignedReferenceNumber: type: string AuthorizationJSONResponseSubscriber: type: object properties: subscriberRequestValidation: type: array items: $ref: '#/components/schemas/AuthorizationJSONResponseRequestValidation' lastName: type: string firstName: type: string middleName: type: string suffix: type: string memberId: type: string dateOfBirth: type: string address1: type: string address2: type: string city: type: string state: type: string postalCode: type: string countryCode: type: string countrySubDivisionCode: type: string supplementalIdentification: $ref: '#/components/schemas/AuthorizationJSONResponseSubscriberSupplementalIdentification' AuthorizationJSONResponseSubscriberSupplementalIdentification: type: object properties: policyNumber: type: string branchIdentifier: type: string groupNumber: type: string departmentNumber: type: string patientAccountNumber: type: string healthInsuranceClaimNumber: type: string idCard: type: string insurancePolicyNumber: type: string planNetworkIdentificationNumber: type: string medicaidRecipientIdentificationNumber: type: string ssn: type: string TradingPartnerResponseAll: type: array items: $ref: '#/components/schemas/TradingPartnerResponse' TradingPartnerResponse: type: object properties: payerId: type: string example: HUMAN2 cicPayerId: type: string example: HUMANA cicInterchangeReceiverId: type: string example: INQHEALTHHELP cicPayerName: type: string example: HUMANA SmokeTestResult: type: object properties: failureReason: type: string status: type: string Errors: type: array items: type: string example: This is an example error string parameters: x-optum-integrator: description: The integrator that the invoking user belongs to. in: header name: x-optum-integrator schema: type: string example: Clearance x-optum-user-id: description: The unique ID of the user that invoked the request. in: header name: x-optum-user-id schema: type: string format: uuid example: c9476bc2-b563-4555-9527-4afe9dccaf9a required: true x-optum-user-email: description: The email of the user that invoked the request. in: header name: x-optum-user-email schema: type: string example: firstName.lastName@company.com required: true x-optum-tenant-id: description: The unique ID of the tenant that the invoking user belongs to. in: header name: x-optum-tenant-id schema: type: string format: uuid example: 9fb77454-8c58-4345-aa50-43f133e06d20 required: true x-optum-tenant-id2: description: The unique ID of the tenant that the invoking user belongs to. in: header name: x-optum-tenant-id schema: type: string format: uuid example: bc5dfbfb-376d-49fb-b42c-40e39b6f4b39 required: true x-optum-correlation-id: description: A unique identifier assigned to each request. in: header name: x-optum-correlation-id schema: type: string format: uuid example: c9476bc2-b563-4555-9527-4afe9dccaf9a x-optum-customer-indicator: description: The customer identifier clearance uses to identify a database. in: header name: x-optum-customer-indicator schema: type: string example: CorrelationId:StagingInputRegEligibilityId:VisitId:BatchId x-optum-tundro-mock-external-response: description: (Optional) A comma-delimited list of controlled scenarios that influence the evaluation of a submitted transaction. The structure should follow the pattern of `{destination}:{scenario}`. For example, `imn-auth:timeout`. See the Mock API for more information and a list of available mock responses. in: header name: x-optum-tundro-mock-external-response schema: type: string responses: '200': headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' description: Success '400': headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' description: Bad Request. The request body is malformed or missing required information. content: application/json: schema: $ref: '#/components/schemas/Errors' '401': description: Unauthorized. No or invalid authentication details are provided headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' content: application/json: schema: $ref: '#/components/schemas/Errors' '403': headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' description: Forbidden. Authentication succeeded but authenticated user doesn't have access to the resource content: application/json: schema: $ref: '#/components/schemas/Errors' '404': headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' description: Not Found. Non-existent resource was requested content: application/json: schema: $ref: '#/components/schemas/Errors' '405': headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' description: Method Not Allowed. HTTP method is being requested that isn't allowed for the authenticated user content: application/json: schema: $ref: '#/components/schemas/Errors' '409': headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' description: Conflict with current state of the target source. content: application/json: schema: $ref: '#/components/schemas/Errors' '415': headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' description: Unsupported media type. Only application/json supported content: application/json: schema: $ref: '#/components/schemas/Errors' '422': headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' description: Unprocessable Entity. Validation errors have occurred content: application/json: schema: $ref: '#/components/schemas/Errors' '500': headers: x-amzn-trace-id: $ref: '#/components/headers/x-amzn-trace-id' description: Internal Server Error. An unexpected error has occurred. content: application/json: schema: $ref: '#/components/schemas/Errors' examples: UserSubmissionRequestSubscriber: summary: Submission Request Subscriber Only value: senderId: 201985AAS submitterTransactionIdentifier: '165932' payerId: UHC payerName: ABC PAYER umClearingHouseId: '278_217_01' requester: requesterType: 1P organizationName: XYZ AMBULANCE SVC lastName: XYZ AMBULANCE SVC npi: '1234567890' subscriber: lastName: SMITH firstName: JOE memberId: '12345689001' dateOfBirth: '19700101' genderCode: M supplementalIdentification: patientAccountNumber: '1234567890' patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '56' facilityTypeCode: '41' facilityCodeQualifier: B eventDateBegin: '20250101' ambulanceCertificationConditionIndicator: Y ambulanceCertificationConditionCode1: 09 ambulanceTransport: transportCode: X transportReasonCode: D transportDistance: '27' roundTripPurposeDescription: TRIP FROM HOME TO OFFICE VISIT TO DIALYSIS TREATMENT AND BACK HOME patientEventTransportInformation: - entityIdentifierCode: PW transportLocationName: HOME address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' - entityIdentifierCode: ND transportLocationName: DOCTOR OFFICE address1: 123 SOME AVENUE city: SACRAMENTO state: CA postalCode: '95624' - entityIdentifierCode: R3 transportLocationName: SOME DIALYSIS CENTER address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' - entityIdentifierCode: FS transportLocationName: HOME address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' serviceLevel: - professionalService: productOrServiceIDQualifier: HC procedureCode: A0428 procedureModifier1: DR unitOrBasisForMeasurementCode: UN serviceUnitCount: '14' UserSubmissionRequestDependent: summary: Submission Request Dependent value: senderId: 201985AAS submitterTransactionIdentifier: '165932' payerId: UHC payerName: ABC PAYER umClearingHouseId: '278_217_01' requester: requesterType: 1P organizationName: XYZ AMBULANCE SVC lastName: XYZ AMBULANCE SVC npi: '1234567890' subscriber: lastName: SMITH firstName: JOE memberId: '12345689001' dateOfBirth: '19700101' genderCode: M supplementalIdentification: patientAccountNumber: '1234567890' dependent: lastName: SMITH firstName: JUNE dateOfBirth: '19700101' genderCode: F supplementalIdentification: ssn: '123121234' patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '56' facilityTypeCode: '41' facilityCodeQualifier: B eventDateBegin: '20250101' ambulanceCertificationConditionIndicator: Y ambulanceCertificationConditionCode1: 09 ambulanceTransport: transportCode: X transportReasonCode: D transportDistance: '27' roundTripPurposeDescription: TRIP FROM HOME TO OFFICE VISIT TO DIALYSIS TREATMENT AND BACK HOME patientEventTransportInformation: - entityIdentifierCode: PW transportLocationName: HOME address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' - entityIdentifierCode: ND transportLocationName: DOCTOR OFFICE address1: 123 SOME AVENUE city: SACRAMENTO state: CA postalCode: '95624' - entityIdentifierCode: R3 transportLocationName: SOME DIALYSIS CENTER address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' - entityIdentifierCode: FS transportLocationName: HOME address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' serviceLevel: - professionalService: productOrServiceIDQualifier: HC procedureCode: A0428 procedureModifier1: DR unitOrBasisForMeasurementCode: UN serviceUnitCount: '14' UserNoaRequest: summary: Notice of admission Request (JSON) value: senderId: 201985AAS submitterTransactionIdentifier: 222438911WEB payerId: '60054' payerName: AETNA umClearingHouseId: IMNDIRECT source: sourceType: FA organizationName: B'enefits Health System' lastName: Benefits Health System npi: '1881650737' contactTelephone: '4064552959' subscriber: lastName: LNAME firstName: FNAME memberId: NOA-01-SUCCESS supplementalIdentification: groupNumber: 0123456789012 dateOfBirth: '19700101' patientEventDetail: requestCategoryCode: AR certificationTypeCode: I serviceTypeCode: '1' facilityTypeCode: '11' facilityCodeQualifier: A accidentDate: '20260101' lastMenstrualPeriodDate: '20260101' estimatedDateOfBirth: '20260101' onsetDate: '20260101' eventDateBegin: '20260101' admissionDateBegin: '20260101' admissionDateEnd: '20260101' dischargeDate: '20260101' certificationIssueDateBegin: '20260101' certificationExpirationDateBegin: '20260101' certificationEffectiveDateBegin: '20260101' diagnosisTypeCode1: ABJ diagnosisCode1: N1330 freeFormMessageText: AT=061500;ICD=N1330 patientEventProviderName: - entityIdentifierCode: '71' organizationName: Benefits Health System lastName: SLATER firstName: RICHARD identificationCodeQualifier: XX identifier: '1285928754' X12OrchRequestNoProcedureCodes: summary: X12 Orchestration - No procedure codes require auth value: rhPayerId: UHCDEMODV1 planId: '41' x12: ISA*00* *00* *ZZ*201985AAS *ZZ*UHCDIRECT *260220*2231*^*00501*310114548*0*P*:~GS*HI*201985AAS*UHCDIRECT*20260220*223147*549621530*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1234567890*20260220*223147~HL*1**20*1~NM1*PR*2*UHCDIRECT*****PI*UHCDIRECT~HL*2*1*21*1~NM1*1P*2*Regional Medical Center*****XX*1234567890~REF*EI*123456789~N4*Orangeburg*SC*12345~PER*IC**TE*803-555-2200~HL*3*2*22*1~NM1*IL*1*TEST*BRITTANY****MI*multi-01-approved~REF*6P*123456789~REF*SY*111223333~DMG*D8*19701231~HL*4*3*EV*1~UM*HS*I*1*11:B~DTP*AAH*RD8*20231017-20231017~NM1*SJ*1*TEST*STEVEN****XX*1234567890~NM1*DN*1*TEST*STEVEN****XX*1234567890~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:6789T~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:9876T~SE*28*0001~GE*1*549621530~IEA*1*310114548~ X12OrchRequestTwoCodesOneRequired: summary: X12 Orchestration - Two procedure codes; one requires auth value: rhPayerId: UHCDEMODV1 planId: '41' x12: ISA*00* *00* *ZZ*201985AAS *ZZ*UHCDIRECT *260220*2231*^*00501*310114548*0*P*:~GS*HI*201985AAS*UHCDIRECT*20260220*223147*549621530*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1234567890*20260220*223147~HL*1**20*1~NM1*PR*2*UHCDIRECT*****PI*UHCDIRECT~HL*2*1*21*1~NM1*1P*2*Regional Medical Center*****XX*1234567890~REF*EI*123456789~N4*Orangeburg*SC*12345~PER*IC**TE*803-555-2200~HL*3*2*22*1~NM1*IL*1*TEST*BRITTANY****MI*multi-01-approved~REF*6P*123456789~REF*SY*111223333~DMG*D8*19701231~HL*4*3*EV*1~UM*HS*I*1*11:B~DTP*AAH*RD8*20231017-20231017~NM1*SJ*1*TEST*STEVEN****XX*1234567890~NM1*DN*1*TEST*STEVEN****XX*1234567890~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:T1000~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:9876T~SE*28*0001~GE*1*549621530~IEA*1*310114548~ X12OrchRequestTwoRequiredCodesWithSplit: summary: X12 Orchestration - Two procedure codes require auth with split value: rhPayerId: UHCDEMODV1 planId: '41' x12: ISA*00* *00* *ZZ*201985AAS *ZZ*UHCDIRECT *260220*2231*^*00501*310114548*0*P*:~GS*HI*201985AAS*UHCDIRECT*20260220*223147*549621530*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1234567890*20260220*223147~HL*1**20*1~NM1*PR*2*UHCDIRECT*****PI*UHCDIRECT~HL*2*1*21*1~NM1*1P*2*Regional Medical Center*****XX*1234567890~REF*EI*123456789~N4*Orangeburg*SC*12345~PER*IC**TE*803-555-2200~HL*3*2*22*1~NM1*IL*1*TEST*BRITTANY****MI*multi-01-approved~REF*6P*123456789~REF*SY*111223333~DMG*D8*19701231~HL*4*3*EV*1~UM*HS*I*1*11:B~DTP*AAH*RD8*20231017-20231017~NM1*SJ*1*TEST*STEVEN****XX*1234567890~NM1*DN*1*TEST*STEVEN****XX*1234567890~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:T1000~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:0214T~SE*28*0001~GE*1*549621530~IEA*1*310114548~ UserInquiryRequestSubscriber: summary: Inquiry Request Subscriber Only value: senderId: 201985AAS submitterTransactionIdentifier: '1234567890' payerId: BCBSSC payerName: South Carolina Blue Cross Blue umClearingHouseId: '000000000000001' requester: requesterType: 1P organizationName: Regional Medical Center lastName: Regional Medical Center requesterIdentification: employerIdentificationNumber: '123456789' city: Orangeburg state: SC postalCode: '12345' npi: '1234567890' contactTelephone: '8033952200' subscriber: lastName: TEST firstName: BRITTANY memberId: ZCS12345678 dateOfBirth: '19701231' supplementalIdentification: groupNumber: '123456789' ssn: '111223333' patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '1' facilityTypeCode: '11' facilityCodeQualifier: B eventDateBegin: '20231017' eventDateEnd: '20231017' patientEventProviderName: - entityIdentifierCode: SJ lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' - entityIdentifierCode: DN lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' serviceLevel: - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: '71260' - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: '74177' UserInquiryRequestDependent: summary: Inquiry Request with Dependent value: senderId: 201985AAS submitterTransactionIdentifier: '1234567890' payerId: BCBSSC payerName: South Carolina Blue Cross Blue umClearingHouseId: '000000000000001' requester: requesterType: 1P organizationName: Regional Medical Center lastName: Regional Medical Center requesterIdentification: employerIdentificationNumber: '123456789' city: Orangeburg state: SC postalCode: '12345' npi: '1234567890' contactTelephone: '8033952200' subscriber: lastName: TEST firstName: BRITTANY memberId: ZCS12345678 dateOfBirth: '19701231' supplementalIdentification: groupNumber: '123456789' ssn: '111223333' dependent: lastName: TEST firstName: MARY dateOfBirth: '201001231' supplementalIdentification: ssn: '444556666' patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '1' facilityTypeCode: '11' facilityCodeQualifier: B eventDateBegin: '20231017' eventDateEnd: '20231017' patientEventProviderName: - entityIdentifierCode: SJ lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' - entityIdentifierCode: DN lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' serviceLevel: - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: '71260' - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: '74177' UserInquiryResponseDependent: summary: Inquiry Response with Dependent value: authorizationId: a14081f3-b463-449e-a9dc-7ee21aef4552 inquiry: x12: ISA*00* *00* *ZZ*INQMEDSOLUTIONS*ZZ*123456789 *240220*2059*^*00501*709893603*0*P*:~GS*HI*INQMEDSOLUTIONS*123456789*20240220*205925*148363198*X*005010X215~ST*278*0001*005010X215~BHT*0007*49*1234567890*20240220*205925*RD~HL*1**20*1~NM1*PR*2*MEDSOLUTIONS*****PI*CIGNA~PER*IC**UR*https//www.evicore.com/provider#login~HL*2*1*21*1~NM1*1P*2*WESTCHESTER MEDICAL CENTER*****XX*1234567890~REF*EI*123456789~HL*3*2*22*1~NM1*IL*1*SMITH*TOM****MI* U1234567890~REF*SY*123121234~REF*3L*12345-1702~REF*1L*CIGNA SI-PPO/OAP~N3*SOME ROAD~N4*BEDFORD*NY*12345~DMG*D8*19700101~HL*4*3*EV*1~HCR*A1*A12345678~REF*BB*A12345678~REF*NT*52598960~DTP*102*D8*20240220~DTP*036*D8*20240818~DTP*007*D8*20240220~DTP*881*D8*20240220~HI*ABK:R07.9~MSG*APPROVED~NM1*FA*2*TEST, DOMINICA*****XX*1234567890~N3*100 DEMO RD~N4*VALHALLA*NY*12345~PER*IC**TE*2223334444*FX*1112223333~NM1*DN*1*TEST*DOMINICA****XX*1234567890~N3*100 DEMO RD~N4*VALHALLA*NY*12345~PER*IC**TE*3334445555~HL*5*4*SS*0~HCR*A1*A12345678~SV1*HC:78452**UN*1~MSG*MYOCARDIAL PERFUSION IMAGING (SPECT); MULTIPLE STUDIES~SE*39*0001~GE*1*148363198~IEA*1*709893603~ json: submitterTransactionIdentifier: '1234567890' payerId: CIGNA payerName: MEDSOLUTIONS umClearingHouseId: '123456789' contactUrl: https//www.evicore.com/provider#login umRequestValidation: null requester: requesterType: 1P organizationName: WESTCHESTER MEDICAL CENTER requesterIdentification: employerIdentificationNumber: '123456789' npi: '1234567890' subscriber: lastName: SMITH firstName: TOM memberId: ' U1234567890' dateOfBirth: '19700101' address1: SOME ROAD city: BEDFORD state: NY postalCode: '12345' supplementalIdentification: policyNumber: CIGNA SI-PPO/OAP branchIdentifier: 12345-1702 ssn: '123121234' dependent: lastName: SMITH firstName: JANE dateOfBirth: '19700101' address1: SOME ROAD city: BEDFORD state: NY postalCode: '12345' supplementalIdentification: ssn: '123984321' patientEventDetail: certificationActionCode: A1 reviewIdentificationNumber: A12345678 previousReviewAuthorizationNumber: A12345678 previousAdministrativeReferenceNumber: '52598960' certificationIssueDate: '20240220' certificationExpirationDate: '20240818' certificationEffectiveDateBegin: '20240220' healthCareServicesReviewRequestDateBegin: '20240220' diagnosisTypeCode: ABK diagnosisCode: R07.9 freeFormMessageText: APPROVED patientEventProviderName: - entityIdentifierCode: FA organizationName: TEST, DOMINICA identificationCodeQualifier: XX identifier: '1234567890' address1: 100 DEMO RD city: VALHALLA state: NY postalCode: '12345' providerSupplementalInformation: {} contactFacsimile: '1112223333' contactTelephone: '2223334444' - entityIdentifierCode: DN lastName: TEST firstName: DOMINICA identificationCodeQualifier: XX identifier: '1234567890' address1: 100 DEMO RD city: VALHALLA state: NY postalCode: '12345' providerSupplementalInformation: {} contactTelephone: '3334445555' serviceLevel: - certificationActionCode: A1 reviewIdentificationNumber: A12345678 professionalService: productOrServiceIDQualifier: HC procedureCode: '78452' unitOrBasisForMeasurementCode: UN serviceUnitCount: '1' institutionalService: {} dentalService: {} freeFormMessageText: MYOCARDIAL PERFUSION IMAGING (SPECT); MULTIPLE STUDIES UserInquiryRequestSubscriberWithDetermination: summary: Inquiry Request Subscriber Only value: senderId: 201985AAS submitterTransactionIdentifier: '1234567890' payerId: BCBSSC payerName: South Carolina Blue Cross Blue rhPayerId: UHCDEMODV1 planId: '41' umClearingHouseId: '000000000000001' requester: requesterType: 1P organizationName: Regional Medical Center lastName: Regional Medical Center requesterIdentification: employerIdentificationNumber: '123456789' city: Orangeburg state: SC postalCode: '12345' npi: '1234567890' contactTelephone: '8033952200' subscriber: lastName: TEST firstName: BRITTANY memberId: TST1 dateOfBirth: '19701231' supplementalIdentification: groupNumber: '123456789' ssn: '111223333' patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '1' facilityTypeCode: '11' facilityCodeQualifier: B eventDateBegin: '20231017' eventDateEnd: '20231017' patientEventProviderName: - entityIdentifierCode: SJ lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' - entityIdentifierCode: DN lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' serviceLevel: - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: '71260' - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: 0200T UserInquiryRequestDependentWithDetermination: summary: Inquiry Request with Dependent value: senderId: 201985AAS submitterTransactionIdentifier: '1234567890' payerId: BCBSSC payerName: South Carolina Blue Cross Blue rhPayerId: UHCDEMODV1 planId: '41' umClearingHouseId: '000000000000001' requester: requesterType: 1P organizationName: Regional Medical Center lastName: Regional Medical Center requesterIdentification: employerIdentificationNumber: '123456789' city: Orangeburg state: SC postalCode: '12345' npi: '1234567890' contactTelephone: '8033952200' subscriber: lastName: TEST firstName: BRITTANY memberId: TST1 dateOfBirth: '19701231' supplementalIdentification: groupNumber: '123456789' ssn: '111223333' dependent: lastName: TEST firstName: MARY dateOfBirth: '201001231' supplementalIdentification: ssn: '444556666' patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '1' facilityTypeCode: '11' facilityCodeQualifier: B eventDateBegin: '20231017' eventDateEnd: '20231017' patientEventProviderName: - entityIdentifierCode: SJ lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' - entityIdentifierCode: DN lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' serviceLevel: - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: '71260' - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: 0200T SimplifiedDeterminationRequest: summary: Simplified Determination Request value: rhPayerId: RH Payer ID planId: Plan ID procedureCodes: Procedure Code 1 UserInquiryResponseSubscriber: summary: Inquiry Response Subscriber Only value: authorizationId: a14081f3-b463-449e-a9dc-7ee21aef4552 inquiry: x12: ISA*00* *00* *ZZ*INQMEDSOLUTIONS*ZZ*123456789 *240220*2059*^*00501*709893603*0*P*:~GS*HI*INQMEDSOLUTIONS*123456789*20240220*205925*148363198*X*005010X215~ST*278*0001*005010X215~BHT*0007*49*1234567890*20240220*205925*RD~HL*1**20*1~NM1*PR*2*MEDSOLUTIONS*****PI*CIGNA~PER*IC**UR*https//www.evicore.com/provider#login~HL*2*1*21*1~NM1*1P*2*WESTCHESTER MEDICAL CENTER*****XX*1234567890~REF*EI*123456789~HL*3*2*22*1~NM1*IL*1*SMITH*TOM****MI* U1234567890~REF*SY*123121234~REF*3L*12345-1702~REF*1L*CIGNA SI-PPO/OAP~N3*SOME ROAD~N4*BEDFORD*NY*12345~DMG*D8*19700101~HL*4*3*EV*1~HCR*A1*A12345678~REF*BB*A12345678~REF*NT*52598960~DTP*102*D8*20240220~DTP*036*D8*20240818~DTP*007*D8*20240220~DTP*881*D8*20240220~HI*ABK:R07.9~MSG*APPROVED~NM1*FA*2*TEST, DOMINICA*****XX*1234567890~N3*100 DEMO RD~N4*VALHALLA*NY*12345~PER*IC**TE*2223334444*FX*1112223333~NM1*DN*1*TEST*DOMINICA****XX*1234567890~N3*100 DEMO RD~N4*VALHALLA*NY*12345~PER*IC**TE*3334445555~HL*5*4*SS*0~HCR*A1*A12345678~SV1*HC:78452**UN*1~MSG*MYOCARDIAL PERFUSION IMAGING (SPECT); MULTIPLE STUDIES~SE*39*0001~GE*1*148363198~IEA*1*709893603~ json: submitterTransactionIdentifier: '1234567890' payerId: CIGNA payerName: MEDSOLUTIONS umClearingHouseId: '123456789' contactUrl: https//www.evicore.com/provider#login umRequestValidation: null requester: requesterType: 1P organizationName: WESTCHESTER MEDICAL CENTER requesterIdentification: employerIdentificationNumber: '123456789' npi: '1234567890' subscriber: lastName: SMITH firstName: TOM memberId: ' U1234567890' dateOfBirth: '19700101' address1: SOME ROAD city: BEDFORD state: NY postalCode: '12345' supplementalIdentification: policyNumber: CIGNA SI-PPO/OAP branchIdentifier: 12345-1702 ssn: '123121234' patientEventDetail: certificationActionCode: A1 reviewIdentificationNumber: A12345678 previousReviewAuthorizationNumber: A12345678 previousAdministrativeReferenceNumber: '52598960' certificationIssueDate: '20240220' certificationExpirationDate: '20240818' certificationEffectiveDateBegin: '20240220' healthCareServicesReviewRequestDateBegin: '20240220' diagnosisTypeCode: ABK diagnosisCode: R07.9 freeFormMessageText: APPROVED patientEventProviderName: - entityIdentifierCode: FA organizationName: TEST, DOMINICA identificationCodeQualifier: XX identifier: '1234567890' address1: 100 DEMO RD city: VALHALLA state: NY postalCode: '12345' providerSupplementalInformation: {} contactFacsimile: '1112223333' contactTelephone: '2223334444' - entityIdentifierCode: DN lastName: TEST firstName: DOMINICA identificationCodeQualifier: XX identifier: '1234567890' address1: 100 DEMO RD city: VALHALLA state: NY postalCode: '12345' providerSupplementalInformation: {} contactTelephone: '3334445555' serviceLevel: - certificationActionCode: A1 reviewIdentificationNumber: A12345678 professionalService: productOrServiceIDQualifier: HC procedureCode: '78452' unitOrBasisForMeasurementCode: UN serviceUnitCount: '1' institutionalService: {} dentalService: {} freeFormMessageText: MYOCARDIAL PERFUSION IMAGING (SPECT); MULTIPLE STUDIES UserSubmissionResponseDependent: summary: Submission Response with Dependent value: authorizationId: 16665bb7-3040-4d4d-a889-123a27b29789 submission: x12: ISA*00*6666 *00*5555 *ZZ*6546564 *ZZ*6546564 *0623 *1301*^*00501*000000001*0*T*:~GS*HI*FL0738*PERSEPVS*20090601*040612*1*X*005010X217~ST*278*0001*005010X217~BHT*0007*11*165932*20055002*0815*18~HL*1**20*1~NM1*X3*2*ABC PAYER*****PI*1234560010~HL*2*1*21*1~NM1*1P*1*XYZ AMBULANCE SVC*****24*7759621873~HL*3*2*22*1~NM1*IL*1*SMITH*JOE****MI*12345689001~REF*EJ*1234567890~DMG*D8*19700101*M~HL*4*3*EV*1~UM*HS*I*56*41:B~HCR*A1*1234567890123~DTP*AAH*D8*20250101~CR1***X**DH*27~NM1*PW*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*ND*2*DOCTOR OFFICE~N3*123 SOME AVENUE~N4*SACRAMENTO*CA*95624~NM1*R3*2*SOME DIALYSIS CENTER~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*FS*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~HL*5*4*SS*0~SV1*HC:A0428:RX**UN*5~HL*6*4*SS*0~SV1*HC:A0428:PD**UN*8~HL*7*4*SS*0~SV1*HC:A0428:DR**UN*14~SE*34*0001~GE*1*1~IEA*1*000000001~ json: submitterTransactionIdentifier: '165932' payerId: '1234560010' payerName: ABC PAYER umClearingHouseId: PERSEPVS umRequestValidation: null requester: requesterType: 1P lastName: XYZ AMBULANCE SVC requesterIdentification: {} employersId: '7759621873' subscriber: lastName: SMITH firstName: JOE memberId: '12345689001' dateOfBirth: '19700101' genderCode: M supplementalIdentification: patientAccountNumber: '1234567890' dependent: lastName: SMITH firstName: JANE dateOfBirth: '19700101' genderCode: F address1: SOME ROAD city: BEDFORD state: NY postalCode: '12345' supplementalIdentification: ssn: '123456789' patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '56' facilityTypeCode: '41' facilityCodeQualifier: B certificationActionCode: A1 reviewIdentificationNumber: '1234567890123' eventDateBegin: '20250101' ambulanceTransportCode: X ambulanceUnitOrBasisForMeasurementCode: DH ambulanceTransportDistance: '27' patientEventAdditionalPatientInformationContactName: - {} patientEventTransportInformation: - entityIdentifierCode: PW transportLocationName: HOME address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' - entityIdentifierCode: ND transportLocationName: DOCTOR OFFICE address1: 123 SOME AVENUE city: SACRAMENTO state: CA postalCode: '95624' - entityIdentifierCode: R3 transportLocationName: SOME DIALYSIS CENTER address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' - entityIdentifierCode: FS transportLocationName: HOME address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' serviceLevel: - professionalService: productOrServiceIDQualifier: HC procedureCode: A0428 procedureModifier: RX unitOrBasisForMeasurementCode: UN serviceUnitCount: '5' institutionalService: {} dentalService: {} serviceDetailAdditionalServiceInformationContactName: - {} - professionalService: productOrServiceIDQualifier: HC procedureCode: A0428 procedureModifier: PD unitOrBasisForMeasurementCode: UN serviceUnitCount: '8' institutionalService: {} dentalService: {} serviceDetailAdditionalServiceInformationContactName: - {} - professionalService: productOrServiceIDQualifier: HC procedureCode: A0428 procedureModifier: DR unitOrBasisForMeasurementCode: UN serviceUnitCount: '14' institutionalService: {} dentalService: {} serviceDetailAdditionalServiceInformationContactName: - {} UserSubmissionResponseSubscriber: summary: Submission Response Subscriber Only value: authorizationId: 16665bb7-3040-4d4d-a889-123a27b29789 submission: x12: ISA*00*6666 *00*5555 *ZZ*6546564 *ZZ*6546564 *0623 *1301*^*00501*000000001*0*T*:~GS*HI*FL0738*PERSEPVS*20090601*040612*1*X*005010X217~ST*278*0001*005010X217~BHT*0007*11*165932*20055002*0815*18~HL*1**20*1~NM1*X3*2*ABC PAYER*****PI*1234560010~HL*2*1*21*1~NM1*1P*1*XYZ AMBULANCE SVC*****24*7759621873~HL*3*2*22*1~NM1*IL*1*SMITH*JOE****MI*12345689001~REF*EJ*1234567890~DMG*D8*19700101*M~HL*4*3*EV*1~UM*HS*I*56*41:B~HCR*A1*1234567890123~DTP*AAH*D8*20250101~CR1***X**DH*27~NM1*PW*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*ND*2*DOCTOR OFFICE~N3*123 SOME AVENUE~N4*SACRAMENTO*CA*95624~NM1*R3*2*SOME DIALYSIS CENTER~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*FS*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~HL*5*4*SS*0~SV1*HC:A0428:RX**UN*5~HL*6*4*SS*0~SV1*HC:A0428:PD**UN*8~HL*7*4*SS*0~SV1*HC:A0428:DR**UN*14~SE*34*0001~GE*1*1~IEA*1*000000001~ json: submitterTransactionIdentifier: '165932' payerId: '1234560010' payerName: ABC PAYER umClearingHouseId: PERSEPVS umRequestValidation: null requester: requesterType: 1P lastName: XYZ AMBULANCE SVC requesterIdentification: {} employersId: '7759621873' subscriber: lastName: SMITH firstName: JOE memberId: '12345689001' dateOfBirth: '19700101' genderCode: M supplementalIdentification: patientAccountNumber: '1234567890' dependent: supplementalIdentification: {} patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '56' facilityTypeCode: '41' facilityCodeQualifier: B certificationActionCode: A1 reviewIdentificationNumber: '1234567890123' eventDateBegin: '20250101' ambulanceTransportCode: X ambulanceUnitOrBasisForMeasurementCode: DH ambulanceTransportDistance: '27' patientEventAdditionalPatientInformationContactName: - {} patientEventTransportInformation: - entityIdentifierCode: PW transportLocationName: HOME address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' - entityIdentifierCode: ND transportLocationName: DOCTOR OFFICE address1: 123 SOME AVENUE city: SACRAMENTO state: CA postalCode: '95624' - entityIdentifierCode: R3 transportLocationName: SOME DIALYSIS CENTER address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' - entityIdentifierCode: FS transportLocationName: HOME address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' serviceLevel: - professionalService: productOrServiceIDQualifier: HC procedureCode: A0428 procedureModifier: RX unitOrBasisForMeasurementCode: UN serviceUnitCount: '5' institutionalService: {} dentalService: {} serviceDetailAdditionalServiceInformationContactName: - {} - professionalService: productOrServiceIDQualifier: HC procedureCode: A0428 procedureModifier: PD unitOrBasisForMeasurementCode: UN serviceUnitCount: '8' institutionalService: {} dentalService: {} serviceDetailAdditionalServiceInformationContactName: - {} - professionalService: productOrServiceIDQualifier: HC procedureCode: A0428 procedureModifier: DR unitOrBasisForMeasurementCode: UN serviceUnitCount: '14' institutionalService: {} dentalService: {} serviceDetailAdditionalServiceInformationContactName: - {} UserNoaResponse: summary: Noa Response Subscriber Only value: authorizationId: 16665bb7-3040-4d4d-a889-123a27b29789 noa: x12: ISA*00*6666 *00*5555 *ZZ*6546564 *ZZ*6546564 *0623 *1301*^*00501*000000001*0*T*:~GS*HI*FL0738*PERSEPVS*20090601*040612*1*X*005010X216~ST*278*0001*005010X216~BHT*0007*11*165932*20055002*0815*18~HL*1**20*1~NM1*X3*2*ABC PAYER*****PI*1234560010~HL*2*1*21*1~NM1*1P*1*XYZ AMBULANCE SVC*****24*7759621873~HL*3*2*22*1~NM1*IL*1*SMITH*JOE****MI*12345689001~REF*EJ*1234567890~DMG*D8*19700101*M~HL*4*3*EV*1~UM*HS*I*56*41:B~HCR*A1*1234567890123~DTP*AAH*D8*20250101~CR1***X**DH*27~NM1*PW*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*ND*2*DOCTOR OFFICE~N3*123 SOME AVENUE~N4*SACRAMENTO*CA*95624~NM1*R3*2*SOME DIALYSIS CENTER~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*FS*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~HL*5*4*SS*0~SV1*HC:A0428:RX**UN*5~HL*6*4*SS*0~SV1*HC:A0428:PD**UN*8~HL*7*4*SS*0~SV1*HC:A0428:DR**UN*14~SE*34*0001~GE*1*1~IEA*1*000000001~ json: submitterTransactionIdentifier: '165932' payerId: '1234560010' payerName: ABC PAYER umClearingHouseId: PERSEPVS umRequestValidation: null requester: requesterType: 1P lastName: XYZ AMBULANCE SVC requesterIdentification: {} employersId: '7759621873' subscriber: lastName: SMITH firstName: JOE memberId: '12345689001' dateOfBirth: '19700101' genderCode: M supplementalIdentification: patientAccountNumber: '1234567890' dependent: supplementalIdentification: {} patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '56' facilityTypeCode: '41' facilityCodeQualifier: B certificationActionCode: A1 reviewIdentificationNumber: '1234567890123' eventDateBegin: '20250101' ambulanceTransportCode: X ambulanceUnitOrBasisForMeasurementCode: DH ambulanceTransportDistance: '27' patientEventAdditionalPatientInformationContactName: - {} patientEventTransportInformation: - entityIdentifierCode: PW transportLocationName: HOME address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' - entityIdentifierCode: ND transportLocationName: DOCTOR OFFICE address1: 123 SOME AVENUE city: SACRAMENTO state: CA postalCode: '95624' - entityIdentifierCode: R3 transportLocationName: SOME DIALYSIS CENTER address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' - entityIdentifierCode: FS transportLocationName: HOME address1: 123 SOME ROAD city: SACRAMENTO state: CA postalCode: '95826' serviceLevel: - professionalService: productOrServiceIDQualifier: HC procedureCode: A0428 procedureModifier: RX unitOrBasisForMeasurementCode: UN serviceUnitCount: '5' institutionalService: {} dentalService: {} serviceDetailAdditionalServiceInformationContactName: - {} - professionalService: productOrServiceIDQualifier: HC procedureCode: A0428 procedureModifier: PD unitOrBasisForMeasurementCode: UN serviceUnitCount: '8' institutionalService: {} dentalService: {} serviceDetailAdditionalServiceInformationContactName: - {} - professionalService: productOrServiceIDQualifier: HC procedureCode: A0428 procedureModifier: DR unitOrBasisForMeasurementCode: UN serviceUnitCount: '14' institutionalService: {} dentalService: {} serviceDetailAdditionalServiceInformationContactName: - {} OrchestrationJSONRequestWithSplit: summary: JSON Orchestration - Two procedure codes require auth with split value: senderId: 201985AAS submitterTransactionIdentifier: '1234567890' payerId: BCBSSC payerName: South Carolina Blue Cross Blue rhPayerId: UHCDEMODV1 planId: '41' umClearingHouseId: UHCDIRECT requester: requesterType: 1P organizationName: Regional Medical Center lastName: Regional Medical Center requesterIdentification: employerIdentificationNumber: '123456789' city: Orangeburg state: SC postalCode: '12345' npi: '1234567890' contactTelephone: '8033952200' subscriber: lastName: TEST firstName: BRITTANY memberId: multi-01-approved dateOfBirth: '19701231' supplementalIdentification: groupNumber: '123456789' ssn: '111223333' patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '1' facilityTypeCode: '11' facilityCodeQualifier: B eventDateBegin: '20231017' eventDateEnd: '20231017' patientEventProviderName: - entityIdentifierCode: SJ lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' - entityIdentifierCode: DN lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' serviceLevel: - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: T1000 - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: 0214T OrchestrationJSONRequestOneRequired: summary: JSON Orchestration - Two procedure codes; one requires auth value: senderId: 201985AAS submitterTransactionIdentifier: '1234567890' payerId: BCBSSC payerName: South Carolina Blue Cross Blue rhPayerId: UHCDEMODV1 planId: '41' umClearingHouseId: UHCDIRECT requester: requesterType: 1P organizationName: Regional Medical Center lastName: Regional Medical Center requesterIdentification: employerIdentificationNumber: '123456789' city: Orangeburg state: SC postalCode: '12345' npi: '1234567890' contactTelephone: '8033952200' subscriber: lastName: TEST firstName: BRITTANY memberId: multi-01-approved dateOfBirth: '19701231' supplementalIdentification: groupNumber: '123456789' ssn: '111223333' patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '1' facilityTypeCode: '11' facilityCodeQualifier: B eventDateBegin: '20231017' eventDateEnd: '20231017' patientEventProviderName: - entityIdentifierCode: SJ lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' - entityIdentifierCode: DN lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' serviceLevel: - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: T1000 - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: 9876T OrchestrationJSONRequestAuthNotRequired: summary: JSON Orchestration - No procedure codes require auth value: senderId: 201985AAS submitterTransactionIdentifier: '1234567890' payerId: BCBSSC payerName: South Carolina Blue Cross Blue rhPayerId: UHCDEMODV1 planId: '41' umClearingHouseId: UHCDIRECT requester: requesterType: 1P organizationName: Regional Medical Center lastName: Regional Medical Center requesterIdentification: employerIdentificationNumber: '123456789' city: Orangeburg state: SC postalCode: '12345' npi: '1234567890' contactTelephone: '8033952200' subscriber: lastName: TEST firstName: BRITTANY memberId: multi-01-approved dateOfBirth: '19701231' supplementalIdentification: groupNumber: '123456789' ssn: '111223333' patientEventDetail: requestCategoryCode: HS certificationTypeCode: I serviceTypeCode: '1' facilityTypeCode: '11' facilityCodeQualifier: B eventDateBegin: '20231017' eventDateEnd: '20231017' patientEventProviderName: - entityIdentifierCode: SJ lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' - entityIdentifierCode: DN lastName: TEST firstName: STEVEN identificationCodeQualifier: XX identifier: '1234567890' serviceLevel: - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: 6789T - requestCategoryCode: HS facilityTypeCode: '11' facilityCodeQualifier: B serviceDateBegin: '20231017' serviceDateEnd: '20231017' professionalService: productOrServiceIDQualifier: HC procedureCode: 9876T securitySchemes: bearerAuth: type: http scheme: bearer bearerFormat: JWT security: - bearerAuth: []