Claim Validation

POST https://{{url}}/medicalnetwork/professionalclaims/advanced/v1/validation

This endpoint checks and validates your upcoming submission. It is an enabling tool for making complex provider claims more accurate, and more likely to be accepted and adjudicated by the payer.

Request Body

{"controlNumber"=>"000000001", "tradingPartnerServiceId"=>"9496", "submitter"=>{"organizationName"=>"REGIONAL PPO NETWORK", "contactInformation"=>{"name"=>"SUBMITTER CONTACT INFO", "phoneNumber"=>"123456789"}}, "receiver"=>{"organizationName"=>"EXTRA HEALTHY INSURANCE"}, "subscriber"=>{"memberId"=>"0000000001", "paymentResponsibilityLevelCode"=>"P", "firstName"=>"johnone", "lastName"=>"doeOne", "gender"=>"M", "dateOfBirth"=>"19800102", "policyNumber"=>"00001", "address"=>{"address1"=>"123 address1", "city"=>"city1", "state"=>"wa", "postalCode"=>"981010000"}}, "dependent"=>{"memberId"=>"0000000002", "paymentResponsibilityLevelCode"=>"P", "firstName"=>"janeone", "lastName"=>"doeOne", "gender"=>"F", "dateOfBirth"=>"19800102", "policyNumber"=>"00002", "relationshipToSubscriberCode"=>"01", "address"=>{"address1"=>"123 address1", "city"=>"city1", "state"=>"wa", "postalCode"=>"981010000"}}, "providers"=>[{"providerType"=>"BillingProvider", "npi"=>"1760854442", "employerId"=>"123456789", "organizationName"=>"HAPPY DOCTORS GROUPPRACTICE", "address"=>{"address1"=>"000 address1", "city"=>"city2", "state"=>"tn", "postalCode"=>"372030000"}, "contactInformation"=>{"name"=>"janetwo doetwo", "phoneNumber"=>"0000000001"}}, {"providerType"=>"ReferringProvider", "npi"=>"1942788757", "firstName"=>"johntwo", "lastName"=>"doetwo", "employerId"=>"123456"}, {"providerType"=>"RenderingProvider", "npi"=>"1942788757", "firstName"=>"janetwo", "lastName"=>"doetwo", "middleName"=>"middletwo", "ssn"=>"000000000"}], "claimInformation"=>{"claimFilingCode"=>"CI", "patientControlNumber"=>"12345", "claimChargeAmount"=>"28.75", "placeOfServiceCode"=>"11", "claimFrequencyCode"=>"1", "signatureIndicator"=>"Y", "planParticipationCode"=>"A", "benefitsAssignmentCertificationIndicator"=>"Y", "releaseInformationCode"=>"Y", "claimSupplementalInformation"=>{"repricedClaimNumber"=>"00001", "claimNumber"=>"12345"}, "healthCareCodeInformation"=>[{"diagnosisTypeCode"=>"BK", "diagnosisCode"=>"496"}, {"diagnosisTypeCode"=>"BF", "diagnosisCode"=>"25000"}], "serviceFacilityLocation"=>{"organizationName"=>"HAPPY DOCTORS GROUP", "address"=>{"address1"=>"000 address1", "city"=>"city2", "state"=>"tn", "postalCode"=>"372030000"}}, "serviceLines"=>[{"serviceDate"=>"20050514", "professionalService"=>{"procedureIdentifier"=>"HC", "lineItemChargeAmount"=>"25", "procedureCode"=>"E0570", "measurementUnit"=>"UN", "serviceUnitCount"=>"1", "compositeDiagnosisCodePointers"=>{"diagnosisCodePointers"=>["1", "2"]}}}, {"serviceDate"=>"20050514", "professionalService"=>{"procedureIdentifier"=>"HC", "lineItemChargeAmount"=>"3.75", "procedureCode"=>"A7003", "measurementUnit"=>"UN", "serviceUnitCount"=>"1", "compositeDiagnosisCodePointers"=>{"diagnosisCodePointers"=>["1"]}}}]}}

HEADERS