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
Same as discharge date
Identifier for a plan. Allows distringuishing rule sets specific for plans.
Identifier for a provider
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 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 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 Patient's discharge status. Possible values
0 <= x <= 100Diagnosis Related Group
Response
Unique Identifier
Supported, Unsupported, NoDetermination 0 <= x <= 1Reasoning for determiniation
Clinical criteria assessed against
Evaluation of the clinical critera due to the source
Supports, Rejects, Other 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"
}
]
}
}
]
}