Validate Claim
Validate Claims through Discharge Summary Analysis: This endpoint is designed to analyze hospital discharge summaries for the clinical validation of claims, ensuring accuracy and compliance in claim processing. It returns a determination, confidence score, and supporting evidence. The determination is based on the clinical criteria and the evidence found in the discharge summary. The confidence score is a value between 0 and 1, with 1 being the highest confidence. The supporting evidence is the clinical criteria and the source of the evidence.
curl --request POST \
--url https://dev.api.slingshotml.com/v2/validate \
--header 'Content-Type: application/json' \
--header 'SLINGSHOT_KEY: <api-key>' \
--data '{
"claim": {
"date_of_service_start": "2023-12-10",
"date_of_service_end": "2023-12-20",
"plan_id": "1234AB56789",
"billing_provider_npi": 1457450116,
"principal_diagnosis": {
"code": "A40.9",
"present_on_admission": "Y"
},
"secondary_diagnosis": [
{
"code": "J18. 9",
"present_on_admission": "Y"
}
],
"admitting_diagnosis": {
"code": "J18. 9",
"present_on_admission": "Y"
},
"procedures": [],
"discharge_status": 1
},
"discharge_summary": {
"text": "Patient Name: John Doe Patient ID: 123456 Date of Birth: 01/01/1980 Date of Admission: 12/10/2023 Date of Discharge: 12/20/2023 Attending Physician: Dr. Jane Smith\nAdmission Diagnosis:\nPneumonia\nSurgical Procedure: None Hospital Course: Mr. John Doe, a 40-year-old male, was admitted to the hospital with symptoms of high fever, cough, shortness of breath, and chest pain. Based on clinical examination and chest X-ray findings, he was diagnosed with bacterial pneumonia..."
}
}'{
"claim_id": "e4eaaaf2-d142-11e1-b3e4-080027620cdd",
"validation": [
{
"diagnosis": {
"code": "A40.9",
"present_on_admission": "Y"
},
"determination": {
"result": "Unsupported",
"confidence": 0.88,
"reasoning": "Diagnosis not supported as the SOFA score threshold was not met when account for baseline creatinine",
"evidence": [
{
"criteria": "Renal Dysfunction",
"source": {
"start_index": 1319,
"end_index": 1362,
"text": "CKD baseline 1.3 elevated to 2.1 creatinine"
},
"evaluation": "Rejects"
}
]
}
}
]
}Authorizations
Body
"2023-12-10"
Same as discharge date
"2023-12-20"
Identifier for a plan. Allows distringuishing rule sets specific for plans.
"1234AB56789"
Identifier for a provider
1457450116
ICD-10-CM code, can be passed with or without the decimal A40.9 or A409 are both acceptable.
Y = Yes, N = No, U = Unknown, W = Clinically Undetermined, 1 = Exempt from POA reporting
Y, N, U, W, 1 {
"code": "A40.9",
"present_on_admission": "Y"
}
ICD-10-CM code, can be passed with or without the decimal A40.9 or A409 are both acceptable.
Y = Yes, N = No, U = Unknown, W = Clinically Undetermined, 1 = Exempt from POA reporting
Y, N, U, W, 1 [
{
"code": "J18. 9",
"present_on_admission": "Y"
}
]
ICD-10-CM code, can be passed with or without the decimal A40.9 or A409 are both acceptable.
Y = Yes, N = No, U = Unknown, W = Clinically Undetermined, 1 = Exempt from POA reporting
Y, N, U, W, 1 {
"code": "J18. 9",
"present_on_admission": "Y"
}
ICD-10-PCS code.
"10D00Z0"
[{ "code": "10D00Z0" }]
Diagnosis Related Group
"872"
Medical record's raw text
"Patient Name: John Doe Patient ID: 123456 Date of Birth: 01/01/1980 Date of Admission: 12/10/2023 Date of Discharge: 12/20/2023 Attending Physician: Dr. Jane Smith\nAdmission Diagnosis:\nPneumonia\nSurgical Procedure: None Hospital Course: Mr. John Doe, a 40-year-old male, was admitted to the hospital with symptoms of high fever, cough, shortness of breath, and chest pain. Based on clinical examination and chest X-ray findings, he was diagnosed with bacterial pneumonia..."
Response
Unique Identifier
"e4eaaaf2-d142-11e1-b3e4-080027620cdd"
Supported, Unsupported, NoDetermination 0 <= x <= 10.88
Reasoning for determiniation
"Diagnosis not supported as the SOFA score threshold was not met when account for baseline creatinine"
Clinical criteria assessed against
"Renal Dysfunction"
Start index of text as function of the medical record input text
1319
End index of text as function of the medical record input text
1362
"CKD baseline 1.3 elevated to 2.1 creatinine"
Evaluation of the clinical critera due to the source
Supports, Rejects, Other "Rejects"
curl --request POST \
--url https://dev.api.slingshotml.com/v2/validate \
--header 'Content-Type: application/json' \
--header 'SLINGSHOT_KEY: <api-key>' \
--data '{
"claim": {
"date_of_service_start": "2023-12-10",
"date_of_service_end": "2023-12-20",
"plan_id": "1234AB56789",
"billing_provider_npi": 1457450116,
"principal_diagnosis": {
"code": "A40.9",
"present_on_admission": "Y"
},
"secondary_diagnosis": [
{
"code": "J18. 9",
"present_on_admission": "Y"
}
],
"admitting_diagnosis": {
"code": "J18. 9",
"present_on_admission": "Y"
},
"procedures": [],
"discharge_status": 1
},
"discharge_summary": {
"text": "Patient Name: John Doe Patient ID: 123456 Date of Birth: 01/01/1980 Date of Admission: 12/10/2023 Date of Discharge: 12/20/2023 Attending Physician: Dr. Jane Smith\nAdmission Diagnosis:\nPneumonia\nSurgical Procedure: None Hospital Course: Mr. John Doe, a 40-year-old male, was admitted to the hospital with symptoms of high fever, cough, shortness of breath, and chest pain. Based on clinical examination and chest X-ray findings, he was diagnosed with bacterial pneumonia..."
}
}'{
"claim_id": "e4eaaaf2-d142-11e1-b3e4-080027620cdd",
"validation": [
{
"diagnosis": {
"code": "A40.9",
"present_on_admission": "Y"
},
"determination": {
"result": "Unsupported",
"confidence": 0.88,
"reasoning": "Diagnosis not supported as the SOFA score threshold was not met when account for baseline creatinine",
"evidence": [
{
"criteria": "Renal Dysfunction",
"source": {
"start_index": 1319,
"end_index": 1362,
"text": "CKD baseline 1.3 elevated to 2.1 creatinine"
},
"evaluation": "Rejects"
}
]
}
}
]
}