Insurance Claim

An insurance claim is a claim that you submit to payers for reimbursement.

The insurance claim model

Properties

Name
id
Type
string
Description
Unique identifier for the insurance claim.
Name
object
Type
string
Description
Always 'insurance_claim'.
Name
name
Type
string
Description
Name of the insurance claim
Name
patient
Type
string
Description
Patient this insurance claim is associated with.
Name
appointment
Type
string
Description
Appointment this insurance claim is associated. If there is no appointment this superbill is associated, leave this parameter blank.
Name
visit_note
Type
string
Description
Visit note this insurance claim is associated with. If there is no visit note this superbill is associated with, leave this parameter blank.
Name
primary_insurance
Type
string
Description
Patient’s primary insurance policy.
Name
secondary_insurance
Type
string
Description
Patient’s secondary insurance policy.
Name
rendering_provider
Type
string
Description
Provider that provided the medical services.
Name
rendering_provider
Type
string
Description
Provider who directed the patient for care to the provider rendering the services being reported..
Name
service_facility
Type
string
Description
Location a medical service was rendered, such as the provider office of hospital.
Name
billing_provider
Type
string
Description
Provider or business entity submitting the superbill and representing the person or entity being reimbursed.
Name
prior_authorization
Type
string
Description
Number indicating that the services provided on the claim have been authorized by the payer. If there is no prior authorization number, leave this entry blank.
Name
patient_authorized_release
Type
boolean
Description
Patient has authorized release of medical information for billing purposes
Name
benefits_assigned_to_provider
Type
boolean
Description
Patient has authorized payments to be made to the billing provider.
Name
provider_accepts_assignment
Type
boolean
Description
You have accepted patient's authorization for payments to be made to the billing provider.
Name
diagnoses
Type
array of objects
Description
Relevant diagnoses for insurance claim.
Name
billing_items
Type
array of objects
Description
Relevant billing items for insurance claim.
Name
comments
Type
array of strings
Description
Comments on this insurance claim.
Name
reviews
Type
array of objects
Description
Review history of the insurance claim.
Name
status_history
Type
array of objects
Description
Status history of the insurance claim.
Name
created_by
Type
string
Description
Creator of the insurance claim.
Name
created_at
Type
date-time
Description
Timestamp (in ISO 8601 format) of when the insurance claim was created.
Name
last_updated_at
Type
date-time
Description
Timestamp (in ISO 8601 format) of when this insurance claim was last updated.

Response

{
    "id": "iclm_GHY5mso3NpQP90bNHhpp",
    "object": "insurance_claim",
    "name": "Insurance Claim — May 10, 2023",
    "patient": "user_Z1zXZKvqrpwxbznuW6lJ",
    "appointment": "appt_iXijTmvKZayeKgLvUEUf",
    "visit_note": "note_JAgHSJHuSodCZ7IhTMqT",
    "primary_insurance": "iply_j0wL6D3LxTeFtzSkvHwJ",
    "secondary_insurance": "iply_GHcjpn0OZ66iRJgT1yeM",
    "rendering_provider": "user_idjkvxZTqfJD734feQHa",
    "referring_provider": "rprv_xZct8V6yLpFGuSs8a8vf",
    "service_facility": "sfac_tJFm1YU2tWDhpgUhXSZ5",
    "billing_provider": "bprv_9g36hEN5wgew2M59eIrF",
    "prior_authorization": "1987472876",
    "patient_authorized_release": true,
    "benefits_assigned_to_provider": true,
    "provider_accepts_assignment": true,
    "diagnoses": [
        {
            "diagnosis": "E11.9",
            "active": true,
            "onset_date": "2022-04-07",
        }
    ],
    "billing_items": [
        {
            "date_of_service_start": "2024-04-10T13:20:21.724Z",
            "date_of_service_end": "2024-04-10T13:20:21.724Z",
            "procedure": "92012",
            "modifiers": [],
            "quantity": 1,
            "fee": 115,
            "associated_diagnoses": ["E11.9"],
            "allowed": 115,
            "denial_reason": ""
        }
    ],
    "comments": [
        "cmmt_18Efdm5UBJduDbioH1kp"
    ],
    "reviews": [
        {
            "status": "needs_review",
            "requested_by": "user_idjkvxZTqfJD734feQHa",
            "reviewer": "user_QtD0YaeDw4VyS9UPBpX4",
            "requested_at": 1684220332000,
            "review_deadline": 1686220332000,
            "reviewed_at": 1684220992000
        }
    ],
    "status_history": [
        {
            "status": "in_progress",
            "changed_by": "user_idjkvxZTqfJD734feQHa",
            "changed_at": "2024-04-10T13:20:21.724Z"
        },
        {
            "status": "submitted",
            "changed_by": "user_idjkvxZTqfJD734feQHa",
            "changed_at": "2024-05-10T13:20:21.724Z"
        }
    ],
    "created_by": "user_Z1zXZKvqrpwxbznuW6lJ",
    "created_at": "2024-04-10T13:20:21.724Z",
    "last_updated_at": "2024-05-10T13:20:21.724Z"
}

POST/v2/insurance_claims

Create an insurance claim

Creates a new insurance claim.

Required attributes

Name
patient
Type
string
Description
Patient this insurance claim is associated with.

Optional attributes

Name
name
Type
string
Description
Name of the insurance claim
Name
appointment
Type
string
Description
Appointment this insurance claim is associated. If there is no appointment this superbill is associated, leave this parameter blank.
Name
visit_note
Type
string
Description
Visit note this insurance claim is associated with. If there is no visit note this superbill is associated with, leave this parameter blank.
Name
primary_insurance
Type
string
Description
Patient’s primary insurance policy.
Name
secondary_insurance
Type
string
Description
Patient’s secondary insurance policy.
Name
rendering_provider
Type
string
Description
Provider that provided the medical services.
Name
rendering_provider
Type
string
Description
Provider who directed the patient for care to the provider rendering the services being reported..
Name
service_facility
Type
string
Description
Location a medical service was rendered, such as the provider office of hospital.
Name
billing_provider
Type
string
Description
Provider or business entity submitting the superbill and representing the person or entity being reimbursed.
Name
prior_authorization
Type
string
Description
Number indicating that the services provided on the claim have been authorized by the payer. If there is no prior authorization number, leave this entry blank.
Name
patient_authorized_release
Type
boolean
Description
Patient has authorized release of medical information for billing purposes
Name
benefits_assigned_to_provider
Type
boolean
Description
Patient has authorized payments to be made to the billing provider.
Name
provider_accepts_assignment
Type
boolean
Description
You have accepted patient's authorization for payments to be made to the billing provider.

Response

 {
    "id": "iclm_GHY5mso3NpQP90bNHhpp",
    "object": "insurance_claim",
    "name": "Insurance Claim — May 10, 2023",
    "patient": "user_Z1zXZKvqrpwxbznuW6lJ",
    "appointment": "appt_iXijTmvKZayeKgLvUEUf",
    "visit_note": "note_JAgHSJHuSodCZ7IhTMqT",
    "primary_insurance": "iply_j0wL6D3LxTeFtzSkvHwJ",
    "secondary_insurance": "iply_GHcjpn0OZ66iRJgT1yeM",
    "rendering_provider": "user_idjkvxZTqfJD734feQHa",
    "referring_provider": "rprv_xZct8V6yLpFGuSs8a8vf",
    "service_facility": "sfac_tJFm1YU2tWDhpgUhXSZ5",
    "billing_provider": "bprv_9g36hEN5wgew2M59eIrF",
    "prior_authorization": "1987472876",
    "patient_authorized_release": true,
    "benefits_assigned_to_provider": true,
    "provider_accepts_assignment": true,
    "diagnoses": [
        {
            "diagnosis": "E11.9",
            "active": true,
            "onset_date": "2022-04-07",
        }
    ],
    "billing_items": [
        {
            "date_of_service_start": "2024-04-10T13:20:21.724Z",
            "date_of_service_end": "2024-04-10T13:20:21.724Z",
            "procedure": "92012",
            "modifiers": [],
            "quantity": 1,
            "fee": 115,
            "associated_diagnoses": ["E11.9"],
            "allowed": 115,
            "denial_reason": ""
        }
    ],
    "comments": [
        "cmmt_18Efdm5UBJduDbioH1kp"
    ],
    "reviews": [
        {
            "status": "needs_review",
            "requested_by": "user_idjkvxZTqfJD734feQHa",
            "reviewer": "user_QtD0YaeDw4VyS9UPBpX4",
            "requested_at": 1684220332000,
            "review_deadline": 1686220332000,
            "reviewed_at": 1684220992000
        }
    ],
    "status_history": [
        {
            "status": "in_progress",
            "changed_by": "user_idjkvxZTqfJD734feQHa",
            "changed_at": "2024-04-10T13:20:21.724Z"
        },
        {
            "status": "submitted",
            "changed_by": "user_idjkvxZTqfJD734feQHa",
            "changed_at": "2024-05-10T13:20:21.724Z"
        }
    ],
    "created_by": "user_Z1zXZKvqrpwxbznuW6lJ",
    "created_at": "2024-04-10T13:20:21.724Z",
    "last_updated_at": "2024-05-10T13:20:21.724Z"
}

GET/v2/insurance_claims/:id

Retrieve an insurance claim

Retrieves the specified insurance claim.

Response


 {
   "id": "iclm_GHY5mso3NpQP90bNHhpp",
   "object": "insurance_claim",
   "name": "Insurance Claim — May 10, 2023",
   "patient": "user_Z1zXZKvqrpwxbznuW6lJ",
   "appointment": "appt_iXijTmvKZayeKgLvUEUf",
   "visit_note": "note_JAgHSJHuSodCZ7IhTMqT",
   "primary_insurance": "iply_j0wL6D3LxTeFtzSkvHwJ",
   "secondary_insurance": "iply_GHcjpn0OZ66iRJgT1yeM",
   "rendering_provider": "user_idjkvxZTqfJD734feQHa",
   "referring_provider": "rprv_xZct8V6yLpFGuSs8a8vf",
   "service_facility": "sfac_tJFm1YU2tWDhpgUhXSZ5",
   "billing_provider": "bprv_9g36hEN5wgew2M59eIrF",
   "prior_authorization": "1987472876",
   "patient_authorized_release": true,
   "benefits_assigned_to_provider": true,
   "provider_accepts_assignment": true,
   "diagnoses": [
       {
           "diagnosis": "E11.9",
           "active": true,
           "onset_date": "2022-04-07",
       }
   ],
   "billing_items": [
       {
           "date_of_service_start": "2024-04-10T13:20:21.724Z",
           "date_of_service_end": "2024-04-10T13:20:21.724Z",
           "procedure": "92012",
           "modifiers": [],
           "quantity": 1,
           "fee": 115,
           "associated_diagnoses": ["E11.9"],
           "allowed": 115,
           "denial_reason": ""
       }
   ],
   "comments": [
       "cmmt_18Efdm5UBJduDbioH1kp"
   ],
   "reviews": [
       {
           "status": "needs_review",
           "requested_by": "user_idjkvxZTqfJD734feQHa",
           "reviewer": "user_QtD0YaeDw4VyS9UPBpX4",
           "requested_at": 1684220332000,
           "review_deadline": 1686220332000,
           "reviewed_at": 1684220992000
       }
   ],
   "status_history": [
       {
           "status": "in_progress",
           "changed_by": "user_idjkvxZTqfJD734feQHa",
           "changed_at": "2024-04-10T13:20:21.724Z"
       },
       {
           "status": "submitted",
           "changed_by": "user_idjkvxZTqfJD734feQHa",
           "changed_at": "2024-05-10T13:20:21.724Z"
       }
   ],
   "created_by": "user_Z1zXZKvqrpwxbznuW6lJ",
   "created_at": "2024-04-10T13:20:21.724Z",
   "last_updated_at": "2024-05-10T13:20:21.724Z"
 }

POST/v2/insurance_claims/:id

Update an insurance claim

Updates the specified insurance claim object by setting the values of the parameters passed. Any other parameters not provided will not be modified.

Required attributes

Optional attributes

Name
name
Type
string
Description
Name of the insurance claim
Name
appointment
Type
string
Description
Appointment this insurance claim is associated. If there is no appointment this superbill is associated, leave this parameter blank.
Name
visit_note
Type
string
Description
Visit note this insurance claim is associated with. If there is no visit note this superbill is associated with, leave this parameter blank.
Name
primary_insurance
Type
string
Description
Patient’s primary insurance policy.
Name
secondary_insurance
Type
string
Description
Patient’s secondary insurance policy.
Name
rendering_provider
Type
string
Description
Provider that provided the medical services.
Name
rendering_provider
Type
string
Description
Provider who directed the patient for care to the provider rendering the services being reported..
Name
service_facility
Type
string
Description
Location a medical service was rendered, such as the provider office of hospital.
Name
billing_provider
Type
string
Description
Provider or business entity submitting the superbill and representing the person or entity being reimbursed.
Name
prior_authorization
Type
string
Description
Number indicating that the services provided on the claim have been authorized by the payer. If there is no prior authorization number, leave this entry blank.
Name
patient_authorized_release
Type
boolean
Description
Patient has authorized release of medical information for billing purposes
Name
benefits_assigned_to_provider
Type
boolean
Description
Patient has authorized payments to be made to the billing provider.
Name
provider_accepts_assignment
Type
boolean
Description
You have accepted patient's authorization for payments to be made to the billing provider.

Response


  {
    "id": "iclm_GHY5mso3NpQP90bNHhpp",
    "object": "insurance_claim",
    "name": "Insurance Claim — May 10, 2023",
    "patient": "user_Z1zXZKvqrpwxbznuW6lJ",
    "appointment": "appt_iXijTmvKZayeKgLvUEUf",
    "visit_note": "note_JAgHSJHuSodCZ7IhTMqT",
    "primary_insurance": "iply_j0wL6D3LxTeFtzSkvHwJ",
    "secondary_insurance": "iply_GHcjpn0OZ66iRJgT1yeM",
    "rendering_provider": "user_idjkvxZTqfJD734feQHa",
    "referring_provider": "rprv_xZct8V6yLpFGuSs8a8vf",
    "service_facility": "sfac_tJFm1YU2tWDhpgUhXSZ5",
    "billing_provider": "bprv_9g36hEN5wgew2M59eIrF",
    "prior_authorization": "1987472876",
    "patient_authorized_release": true,
    "benefits_assigned_to_provider": true,
    "provider_accepts_assignment": true,
    "diagnoses": [
        {
            "diagnosis": "E11.9",
            "active": true,
            "onset_date": "2022-04-07",
        }
    ],
    "billing_items": [
        {
            "date_of_service_start": "2024-04-10T13:20:21.724Z",
            "date_of_service_end": "2024-04-10T13:20:21.724Z",
            "procedure": "92012",
            "modifiers": [],
            "quantity": 1,
            "fee": 115,
            "associated_diagnoses": ["E11.9"],
            "allowed": 115,
            "denial_reason": ""
        }
    ],
    "comments": [
        "cmmt_18Efdm5UBJduDbioH1kp"
    ],
    "reviews": [
        {
            "status": "needs_review",
            "requested_by": "user_idjkvxZTqfJD734feQHa",
            "reviewer": "user_QtD0YaeDw4VyS9UPBpX4",
            "requested_at": 1684220332000,
            "review_deadline": 1686220332000,
            "reviewed_at": 1684220992000
        }
    ],
    "status_history": [
        {
            "status": "in_progress",
            "changed_by": "user_idjkvxZTqfJD734feQHa",
            "changed_at": "2024-04-10T13:20:21.724Z"
        },
        {
            "status": "submitted",
            "changed_by": "user_idjkvxZTqfJD734feQHa",
            "changed_at": "2024-05-10T13:20:21.724Z"
        }
    ],
    "created_by": "user_Z1zXZKvqrpwxbznuW6lJ",
    "created_at": "2024-04-10T13:20:21.724Z",
    "last_updated_at": "2024-05-10T13:20:21.724Z"
  }

GET/v2/insurance_claims

List all insurance claims

Optional query parameters

Name
patient
Type
string
Description
Patient to filter by.
Name
patients
Type
array of strings
Description
Patients to filter by.
Name
visit_note
Type
string
Description
Visit note to filter by.
Name
rendering_provider
Type
string
Description
Rendering provider to filter by.
Name
rendering_providers
Type
array of strings
Description
Rendering providers to filter by.
Name
referring_provider
Type
string
Description
Referring provider to filter by.
Name
referring_providers
Type
array of strings
Description
Referring providers to filter by.
Name
service_facility
Type
string
Description
Service facility to filter by.
Name
service_facilities
Type
array of strings
Description
Service facilities to filter by.
Name
created_by
Type
string
Description
Created by to filter by.
Name
tags
Type
array of strings
Description
Tags to filter by.

Request

GET

/v2/insurance_claims

curl https://{{base_subdomain}}.avonhealth.com/v2/insurance_claims?patient=user_Z1zXZKvqrpwxbznuW6lJ \
  -H "Authorization: Bearer {{token}}" \
  -H "x-jwt: {{jwt}}"

Response

{
  "object": "list",
  "data": [
    {
        "id": "iclm_GHY5mso3NpQP90bNHhpp",
        "object": "insurance_claim",
        "name": "Insurance Claim — May 10, 2023",
        "patient": "user_Z1zXZKvqrpwxbznuW6lJ",
        "appointment": "appt_iXijTmvKZayeKgLvUEUf",
        "visit_note": "note_JAgHSJHuSodCZ7IhTMqT",
        "primary_insurance": "iply_j0wL6D3LxTeFtzSkvHwJ",
        "secondary_insurance": "iply_GHcjpn0OZ66iRJgT1yeM",
        "rendering_provider": "user_idjkvxZTqfJD734feQHa",
        "referring_provider": "rprv_xZct8V6yLpFGuSs8a8vf",
        "service_facility": "sfac_tJFm1YU2tWDhpgUhXSZ5",
        "billing_provider": "bprv_9g36hEN5wgew2M59eIrF",
        "prior_authorization": "1987472876",
        "patient_authorized_release": true,
        "benefits_assigned_to_provider": true,
        "provider_accepts_assignment": true,
        "diagnoses": [
            {
                "diagnosis": "E11.9",
                "active": true,
                "onset_date": "2022-04-07",
            }
        ],
        "billing_items": [
            {
                "date_of_service_start": "2024-04-10T13:20:21.724Z",
                "date_of_service_end": "2024-04-10T13:20:21.724Z",
                "procedure": "92012",
                "modifiers": [],
                "quantity": 1,
                "fee": 115,
                "associated_diagnoses": ["E11.9"],
                "allowed": 115,
                "denial_reason": ""
            }
        ],
        "comments": [
            "cmmt_18Efdm5UBJduDbioH1kp"
        ],
        "reviews": [
            {
                "status": "needs_review",
                "requested_by": "user_idjkvxZTqfJD734feQHa",
                "reviewer": "user_QtD0YaeDw4VyS9UPBpX4",
                "requested_at": 1684220332000,
                "review_deadline": 1686220332000,
                "reviewed_at": 1684220992000
            }
        ],
        "status_history": [
            {
                "status": "in_progress",
                "changed_by": "user_idjkvxZTqfJD734feQHa",
                "changed_at": "2024-04-10T13:20:21.724Z"
            },
            {
                "status": "submitted",
                "changed_by": "user_idjkvxZTqfJD734feQHa",
                "changed_at": "2024-05-10T13:20:21.724Z"
            }
        ],
        "created_by": "user_Z1zXZKvqrpwxbznuW6lJ",
        "created_at": "2024-04-10T13:20:21.724Z",
        "last_updated_at": "2024-05-10T13:20:21.724Z"
    },
  ]
}

DELETE/v2/insurance_claims/:id

Delete an insurance claim

Deletes the specified insurance claim.

Required attributes

Optional attributes

Response

{
    "id": "iclm_GHY5mso3NpQP90bNHhpp",
    "object": "insurance_claim",
    "delete": true
}