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.
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
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
Patient's discharge status. Possible values
Diagnosis Related Group
Medical record's raw text
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 ICD-10-PCS code.
Patient's discharge status. Possible values
Diagnosis Related Group
Medical record's raw text
Response
Unique Identifier
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 Supported, Unsupported, NoDetermination Reasoning for determiniation
Clinical criteria assessed against
Start index of text as function of the medical record input text
End index of text as function of the medical record input text
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"
}
]
}
}
]
}