Claim Validation

POST https://{{url}}/medicalnetwork/professionalclaims/v3/validation

Use this endpoint to check and validate your upcoming claim submission before sending your claims to 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