Claim Submission

POST https://{{url}}/medicalnetwork/institutionalclaims/v1/submission

This endpoint submits a validated institutional claim to the payer.

Request Body

{"controlNumber"=>"000000001", "tradingPartnerServiceId"=>"9496", "submitter"=>{"organizationName"=>"happy doctors group", "taxId"=>"12345", "contactInformation"=>{"name"=>"janetwo doetwo", "phoneNumber"=>"123456789", "email"=>"email@email.com", "faxNumber"=>"123456789"}}, "receiver"=>{"organizationName"=>"EXTRA HEALTHY INSURANCE", "taxId"=>"67890"}, "subscriber"=>{"memberId"=>"0000000001", "paymentResponsibilityLevelCode"=>"P", "firstName"=>"johnOne", "lastName"=>"doeOne", "gender"=>"M", "dateOfBirth"=>"19800101", "address"=>{"address1"=>"123 address1", "city"=>"city1", "state"=>"wa", "postalCode"=>"981010000"}}, "providers"=>[{"providerType"=>"BillingProvider", "npi"=>"1760854442", "employerId"=>"123456789", "organizationName"=>"HAPPY DOCTORS GROUPPRACTICE", "address"=>{"address1"=>"123 address1", "city"=>"city1", "state"=>"wa", "postalCode"=>"981010000"}}], "claimInformation"=>{"claimFilingCode"=>"CI", "patientControlNumber"=>"12345", "claimChargeAmount"=>"3.75", "placeOfServiceCode"=>"11", "claimFrequencyCode"=>"1", "signatureIndicator"=>"Y", "planParticipationCode"=>"A", "releaseInformationCode"=>"Y", "benefitsAssignmentCertificationIndicator"=>"Y", "billingNote"=>"ADD", "claimDateInformation"=>{"statementBeginDate"=>"20041209", "statementEndDate"=>"20041214", "dischargeHour"=>"1130", "admissionDateAndHour"=>"200410131242"}, "claimCodeInformation"=>{"admissionTypeCode"=>"1", "patientStatusCode"=>"10", "admissionSourceCode"=>"7"}, "serviceLines"=>[{"assignedNumber"=>"1", "institutionalService"=>{"serviceLineRevenueCode"=>"1", "lineItemChargeAmount"=>"72.50", "measurementUnit"=>"UN", "serviceUnitCount"=>"1"}}], "principalDiagnosis"=>{"qualifierCode"=>"BK", "principalDiagnosisCode"=>"99761", "presentOnAdmissionIndicator"=>"Y"}, "admittingDiagnosis"=>{"qualifierCode"=>"BJ", "admittingDiagnosisCode"=>"99762"}, "otherSubscriberInformation"=>{"paymentResponsibilityLevelCode"=>"A", "individualRelationshipCode"=>"19", "benefitsAssignmentCertificationIndicator"=>"Y", "claimFilingIndicatorCode"=>"11", "releaseOfInformationCode"=>"Y", "otherPayerName"=>{"otherPayerOrganizationName"=>"ABC Insurance Co", "otherPayerIdentifierTypeCode"=>"PI", "otherPayerIdentifier"=>"11122333"}, "otherSubscriberName"=>{"otherInsuredQualifier"=>"1", "otherInsuredLastName"=>"DOE", "otherInsuredIdentifierTypeCode"=>"MI", "otherInsuredIdentifier"=>"123456"}}}}

HEADERS