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
    external_info
    Type
    object
    Description
    External info for external_info.
  • Name
    created_by
    Type
    string
    Description

    Creator of the superbill.

  • Name
    created_at
    Type
    number
    Description

    Timestamp (in Unix epoch time in milliseconds) of when the insurance claim was created.

  • Name
    last_updated_at
    Type
    number
    Description

    Timestamp (in Unix epoch time in milliseconds) of when this insurance claim was last updated.

Response

{
    "id": "iclm_GHY5mso3NpQP90bNHhpp",
    "object": "insurance_claim",
    "name": "Mental Health Visit — May 10, 2023",
    "patient": "user_Z1zXZKvqrpwxbznuW6lJ",
    "appointment": "appt_iXijTmvKZayeKgLvUEUf",
    "visit_note": "note_JAgHSJHuSodCZ7IhTMqT",
    "primary_insurance": "ins_j0wL6D3LxTeFtzSkvHwJ",
    "secondary_insurance": "ins_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": 1680000073000,
        }
    ],
    "billing_items": [
        {
            "date_of_service": 1684220126000,
            "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": 1653798303000
        },
        {
            "status": "submitted",
            "changed_by": "user_idjkvxZTqfJD734feQHa",
            "changed_at": 1684220992000
        }
    ],
    "external_info": {
      "partner_info": [
        {
          "partner": "candid", 
          "encounter": "VCkPCknNEYMa3gMJxVZR", 
          "claim": "uPRhwgMKWhLcO5wymbZe"
        }
      ]
    },
    "created_by": "user_Z1zXZKvqrpwxbznuW6lJ",
    "created_at": 1653798303000,
    "last_updated_at": 1653798303000
}