Claim Validation

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

This endpoint, prior to submitting an institutional claim, allows the submitter to run claims through extensive repositories of rules and logic to correct potential errors before sending 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