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API Reference

Validate Claim

API Reference

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.

POST

validate

SLINGSHOT_KEY

string

SLINGSHOT_KEY

Required

string

ValidateRequest · object

object

Add Example Value

claim

Claim · object

claim

object

date_of_service_start

string

date_of_service_start

string

Add Example Value

date_of_service_end

string

date_of_service_end

string

Same as discharge date

Add Example Value

plan_id

string

plan_id

string

Identifier for a plan. Allows distringuishing rule sets specific for plans.

Add Example Value

billing_provider_npi

integer

billing_provider_npi

integer

Identifier for a provider

Add Example Value

principal_diagnosis

Diagnosis · object

principal_diagnosis

object

Add Example Value

code

string

code

string

ICD-10-CM code, can be passed with or without the decimal A40.9 or A409 are both acceptable.

present_on_admission

PresentOnAdmission · enum<string>

present_on_admission

enum<string>

Y = Yes, N = No, U = Unknown, W = Clinically Undetermined, 1 = Exempt from POA reporting

secondary_diagnosis

array

secondary_diagnosis

array

Add Example Value

admitting_diagnosis

Diagnosis · object

admitting_diagnosis

object

Add Example Value

code

string

code

string

ICD-10-CM code, can be passed with or without the decimal A40.9 or A409 are both acceptable.

present_on_admission

PresentOnAdmission · enum<string>

present_on_admission

enum<string>

Y = Yes, N = No, U = Unknown, W = Clinically Undetermined, 1 = Exempt from POA reporting

procedures

array

procedures

array

Add Example Value

discharge_status

integer

discharge_status

integer

Patient's discharge status. Possible values

Add Example Value

drg

string

drg

string

Diagnosis Related Group

Add Example Value

discharge_summary

MedicalRecord · object

discharge_summary

object

text

string

text

string

Medical record's raw text

Add Example Value

Authorizations

SLINGSHOT_KEY

string

headerrequired

Body

application/json

claim

object

claim.date_of_service_start

string

claim.date_of_service_end

string

Same as discharge date

claim.plan_id

string

Identifier for a plan. Allows distringuishing rule sets specific for plans.

claim.billing_provider_npi

integer

Identifier for a provider

claim.principal_diagnosis

object

claim.principal_diagnosis.code

string

ICD-10-CM code, can be passed with or without the decimal A40.9 or A409 are both acceptable.

claim.principal_diagnosis.present_on_admission

enum<string>

Y = Yes, N = No, U = Unknown, W = Clinically Undetermined, 1 = Exempt from POA reporting

Available options:

Y,

N,

U,

W,

1

claim.secondary_diagnosis

object[]

claim.secondary_diagnosis.code

string

ICD-10-CM code, can be passed with or without the decimal A40.9 or A409 are both acceptable.

claim.secondary_diagnosis.present_on_admission

enum<string>

Y = Yes, N = No, U = Unknown, W = Clinically Undetermined, 1 = Exempt from POA reporting

Available options:

Y,

N,

U,

W,

1

claim.admitting_diagnosis

object

claim.admitting_diagnosis.code

string

ICD-10-CM code, can be passed with or without the decimal A40.9 or A409 are both acceptable.

claim.admitting_diagnosis.present_on_admission

enum<string>

Y = Yes, N = No, U = Unknown, W = Clinically Undetermined, 1 = Exempt from POA reporting

Available options:

Y,

N,

U,

W,

1

claim.procedures

object[]

claim.procedures.code

string

ICD-10-PCS code.

claim.discharge_status

integer

Patient's discharge status. Possible values

claim.drg

string

Diagnosis Related Group

discharge_summary

object

discharge_summary.text

string

Medical record's raw text

Response

200 - application/json

claim_id

string

Unique Identifier

validation

object[]

validation.diagnosis

object

validation.diagnosis.code

string

ICD-10-CM code, can be passed with or without the decimal A40.9 or A409 are both acceptable.

validation.diagnosis.present_on_admission

enum<string>

Y = Yes, N = No, U = Unknown, W = Clinically Undetermined, 1 = Exempt from POA reporting

Available options:

Y,

N,

U,

W,

1

validation.determination

object

validation.determination.result

enum<string>

Available options:

Supported,

Unsupported,

NoDetermination

validation.determination.confidence

number

validation.determination.reasoning

string

Reasoning for determiniation

validation.determination.evidence

object[]

validation.determination.evidence.criteria

string

Clinical criteria assessed against

validation.determination.evidence.source

object

validation.determination.evidence.source.start_index

integer

Start index of text as function of the medical record input text

validation.determination.evidence.source.end_index

integer

End index of text as function of the medical record input text

validation.determination.evidence.source.text

string

validation.determination.evidence.evaluation

enum<string>

Evaluation of the clinical critera due to the source

Available options:

Supports,

Rejects,

Other

Changelog Query Claim

Overview

API Reference

Schemas

Authorizations

Body

Response