ValidateRequest

claim

Claim · object

Show child attributes

claim.date_of_service_start

string<date>

Example:

"2023-12-10"

claim.date_of_service_end

string<date>

Same as discharge date

Example:

"2023-12-20"

claim.plan_id

string

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

Example:

"1234AB56789"

claim.billing_provider_npi

integer<int32>

Identifier for a provider

Example:

1457450116

claim.principal_diagnosis

Diagnosis · object

Show child attributes

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

Example:

{
  "code": "A40.9",
  "present_on_admission": "Y"
}

claim.secondary_diagnosis

Diagnosis · object[]

Show child attributes

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

Example:

[
  {
    "code": "J18. 9",
    "present_on_admission": "Y"
  }
]

claim.admitting_diagnosis

Diagnosis · object

Show child attributes

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

Example:

{
  "code": "J18. 9",
  "present_on_admission": "Y"
}

claim.procedures

Procedure · object[]

Show child attributes

claim.procedures.code

string

ICD-10-PCS code.

Example:

"10D00Z0"

Example:

[{ "code": "10D00Z0" }]

claim.discharge_status

integer<int32>

Patient's discharge status. Possible values

Required range: 0 <= x <= 100

Example:

1

claim.drg

string

Diagnosis Related Group

Example:

"872"

discharge_summary

MedicalRecord · object

Show child attributes

discharge_summary.text

string

Medical record's raw text

Example:

"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..."

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