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API Reference

Validate Claim

Overview

Introduction
Rollouts
Supported Entities
Security
Changelog

API Reference

POST
Validate Claim
POST
Query Claim
POST
Update Claim

Schemas

Claim
Diagnosis
Procedure
Evidence
Determination
ValidateRequest
ValidateResponse
QueryRequest
QueryResponse
UpdateClaimStatusRequest

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

object

Add Example Value

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

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

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

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

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

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

Required range: 0 < x < 100

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

Required range: 0 < x < 1

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