POST /v1/claims

Submit a claim through Contract Modeling Go Back

Request body parameters

Parameter Type Mandatory Description
requestKey UUID Yes A unique ID that Quadax will create and send. To be returned in the response to ensure matching response to request.
accountNumber String Yes The CLM number – AKA the account number.
facilityName String Yes Facility name.
npi String Yes Facility NPI number.
contractId Integer Yes The contract Id assigned to the claim.
accountType String Yes IP (Inpatient) or OP (Outpatient)
admitDate Date Yes Format: YYYYMMDD
dischargeDate Date Yes Format: YYYYMMDD
dischargeDisp Number Yes This is needed due to commercial and government payers basing reimbursement off discharge disposition.
payerName String Yes Payer Name
payerCode String Yes Quadax Insurance Master payer key.
payerInsuranceType String Optional Quadax Insurance Master insurance type key.
payerPlanCode String Optional Quadax Insurance Master plan key.
charges Decimal Yes Total for claim level.
billType String Yes e.g. 11B1 or 131 or 22A2
lastName String Yes Patient, not subscriber.
firstName String Yes Patient, not subscriber.
gender String Yes M or F. Patient, not subscriber.
dateOfBirth Date Yes Patient, not subscriber, Format: YYYYMMDD
drg String Optional
diagnosisCodes Array Optional e.g. ["2189", "6262"]
clinicalData Array Yes Ubcpt details of the claim
claimLineId UUID Yes The clinical data unique ID
admitDate Date Yes Format: YYYYMMDD
serviceDateFrom Date Yes Format: YYYYMMDD
revenueCode String Optional
hcpcs String Optional
quantity Integer Yes
charge Decimal Yes Line item fee
modifiers Array Optional e.g. ["F6", "59"]
physicianNpi String Optional

Request body example

{
    "header": {
        "Authorization: ": "Bearer api-token-here"
    },
    "body": {
        "requestKey": "513009d2-c070-4f83-8aee-8e686a696874",
        "accountNumber": "10366356400",
        "facilityName": "SOUTHWEST GENERAL HEALTH",
        "npi": "1154353993",
        "contractId": "7",
        "accountType": "OP",
        "admitDate": "20170216",
        "dischargeDate": "20170216",
        "dischargeDisp": "8",
        "payerName": "CARESOURCE",
        "payerCode": "123",
        "payerInsuranceType": "456",
        "payerPlanCode": "789",
        "charges": 39037.080000000001746229827404022216796875,
        "billType": "131",
        "lastName": "DOE",
        "firstName": "JANE",
        "gender": "F",
        "dateOfBirth": "19600227",
        "drg": "",
        "diagnosisCodes": [
            "2189",
            "6262",
            "7935",
            "6239"
        ],
        "clinicalData": [
            {
                "claimLineId": "03df3015-f65b-3760-8c9d-2663bfe32b7b",
                "admitDate": "20170216",
                "serviceDateFrom": "20170216",
                "revenueCode": "0270",
                "hcpcs": "",
                "quantity": 2,
                "charge": 637.6000000000000227373675443232059478759765625
            },
            {
                "claimLineId": "550bf669-541d-3810-9503-6ad983a6f0e3",
                "admitDate": "20170216",
                "serviceDateFrom": "20170216",
                "revenueCode": "0272",
                "hcpcs": "64635",
                "quantity": 3,
                "charge": 7370,
                "modifiers": [
                    "SG",
                    "LT"
                ],
                "physicianNpi": "1234567890"
            }
        ]
    }
}

Response body parameters

Parameter Type Description
message String Resource created

Response body example

 

{
    "message": "claim_accepted",
    "code": 62
}