Process Claim Indepth

POST

/claim/process/indepth

Process Claim

This endpoint employs i-Claims' advanced algorithms to
meticulously analyze claims indepth, identifying potential fraud, errors and questionable anomalies within them.

Request

Body Params application/json

member_id

string

Member Id

required

Unique id used to identify patient claims

policy_id

string

Policy Id

required

Unique id used to identify policy used by patient

provider_id

string

Provider Id

required

Unique id used to service provider

period

string

Period

required

Period of claim

auth_code

string

Auth Code

required

Authorization code

claim_data

array[object (ClaimDataSchema) {7}]

Claim Data

required

tariff_type

enum<string>

Tariff Type

required

Type of tariff eg TPHAU, ZRVS

Allowed values:

ZRVSTPHAU

tariff_code

string

Tariff Code

required

Tariff code

start_date

string

Start Date

required

Start date of treatment

end_date

string

End Date

required

End date of treatment

quantity

number

Quantity

required

Quantity of treatment

mods

string

Mods

required

Modifier

amount_charged

number

Amount Charged

required

Total amount charged

additional_items

array[object (AdditionalItems) {3}]

Additional Items

required

code

string

Code

required

Unknown/custom tariff codes

item

string

Item

required

Item name/Description of claimed item

charge

number

Charge

required

Total Charge

icd_codes

array[string]

Icd Codes

required

ICD codes

date_submitted

string

Date Submitted

required

Date claim was submitted

reason

string

Reason

required

Reason for claim

notes

string

Notes

required

Notes on claim

Example

{
  "member_id": "string",
  "policy_id": "string",
  "provider_id": "string",
  "period": "string",
  "auth_code": "string",
  "claim_data": [
    {
      "tariff_type": "ZRVS",
      "tariff_code": "string",
      "start_date": "string",
      "end_date": "string",
      "quantity": 0,
      "mods": "string",
      "amount_charged": 0
    }
  ],
  "additional_items": [
    {
      "code": "string",
      "item": "string",
      "charge": 0
    }
  ],
  "icd_codes": [
    "string"
  ],
  "date_submitted": "string",
  "reason": "string",
  "notes": "string"
}

Request samples

Shell

JavaScript

Java

Swift

PHP

Python

HTTP

Objective-C

Ruby

OCaml

Dart

curl --location --request POST '/claim/process/indepth' \
--header 'Content-Type: application/json' \
--data-raw '{
    "member_id": "string",
    "policy_id": "string",
    "provider_id": "string",
    "period": "string",
    "auth_code": "string",
    "claim_data": [
        {
            "tariff_type": "ZRVS",
            "tariff_code": "string",
            "start_date": "string",
            "end_date": "string",
            "quantity": 0,
            "mods": "string",
            "amount_charged": 0
        }
    ],
    "additional_items": [
        {
            "code": "string",
            "item": "string",
            "charge": 0
        }
    ],
    "icd_codes": [
        "string"
    ],
    "date_submitted": "string",
    "reason": "string",
    "notes": "string"
}'

Responses

🟢200OK

application/json

Successful Response

Body

No schema defined

Example

null

🟠422Parameter Error

Modified at 2024-12-07 17:10:47

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