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
change_log
- Type
- string
- Description
Change log containing a record of all the changes to the insurance claim.
- 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"
}
]
},
"change_log": "clog_24B8OMJAIR2SiWqGQDrc",
"created_by": "user_Z1zXZKvqrpwxbznuW6lJ",
"created_at": 1653798303000,
"last_updated_at": 1653798303000
}