Submission

Description

The Submission message is employed to transmit a payment request, typically from a healthcare provider to an insurer. It is commonly transmitted as an EDI 837 form by healthcare providers.

API Endpoints for Submission

Sync REST API Endpoint to call the API: https://{base_url}/api/v1/claim/submission.

Async REST API Endpoint to call the API: https://{base_url}/api/v1/endpoint

Data Model JSON for Submission

Submission - Sample Payload

{
  "Meta": {
    "DataModel": "Claim",
    "EventType": "Submission",
    "EventDateTime": "2022-08-16T14:21:20.233Z",
    "Test": true,
    "Source": {
      "ID": "ebaa610d-9b1d-4c7c-90e1-7c90e073a767 ",
      "Name": "EHR Bridge Dev Tools"
    },
    "Destinations": [
      {
        "ID": "685ba673-d488-47e3-8567-15b86088ae4c ",
        "Name": "Destinations EMR"
      }
    ],
    "Logs": [
      {
        "ID": "4f00b480-456e-4c71-a084-3ae81552afd1 ",
        "AttemptID": "61d2e07a-6f5f-40b0-bf58-4a47208f63c7 "
      }
    ],
    "Message": {
      "ID": 5565
    },
    "Transmission": {
      "ID": 12414
    },
    "FacilityCode": null
  },
  "Transaction": {
    "ID": "94151100100",
    "IDType": null,
    "Type": "Professional",
    "Submitter": {
      "ID": null,
      "IDType": null,
      "Name": null,
      "EmailAddress": null,
      "PhoneNumber": {
        "Office": null,
        "Fax": null
      }
    },
    "Receiver": {
      "ID": null,
      "IDType": null,
      "Name": null
    }
  },
  "BillingProvider": {
    "ID": "4356789876",
    "IDType": "NPI",
    "TIN": null,
    "FirstName": "John",
    "MiddleName": "A",
    "LastName": "Paul",
    "OrganizationName": null,
    "Specialty": {
      "ID": null,
      "Description": null
    },
    "Address": {
      "StreetAddress": "123 Main St.",
      "City": "San Jose",
      "State": "CA",
      "ZIP": "53703",
      "County": "Santa Clara",
      "Country": "USA"
    },
    "EmailAddress": null,
    "PhoneNumber": {
      "Office": "+16085551267",
      "Fax": null
    }
  },
  "Subscriber": {
    "ID": null,
    "IDType": null,
    "FirstName": "Ronnie",
    "MiddleName": "Patricks",
    "LastName": "Oliver",
    "OrganizationName": null,
    "Address": {
      "StreetAddress": "4762 Wallgate Avenue",
      "City": "San Jose",
      "State": "CA",
      "ZIP": "53566",
      "County": "Santa Clara",
      "Country": "USA"
    },
    "DOB": "2008-01-06",
    "Sex": "Male",
    "RelationToPatient": "Self",
    "ResponsibilityLevel": "Primary",
    "Insurance": {
      "Plan": {
        "ID": "31572",
        "IDType": "Payor ID",
        "Name": "HMO Plan",
        "Type": null
      },
      "MemberNumber": null,
      "Company": {
        "ID": "60054",
        "IDType": null,
        "Name": "Newbell(90054 0131)",
        "Address": {
          "StreetAddress": "PO Box 14080",
          "City": "San Jose"",
          "State": "CA",
          "ZIP": "40512-4079",
          "County": "Santa Clara",
          "Country": "USA"
        },
        "PhoneNumber": "+18089541123"
      },
      "GroupNumber": "847025-024-0009",
      "GroupName": "Proness Labs",
      "EffectiveDate": "2015-01-01",
      "ExpirationDate": "2020-12-31",
      "PolicyNumber": "9140860055",
      "Priority": null,
      "AgreementType": null,
      "CoverageType": null
    }
  },
  "Patient": {
    "Identifiers": [
      {
        "ID": "0000000001",
        "IDType": "MR"
      },
      {
        "ID": "0c331ab4-f32f-40b3-8004-fc434eec2ad0",
        "IDType": "EHRID"
      },
      {
        "ID": "10a09849-3b99-4548-9ffa-c561d4e84b6d ",
        "IDType": "NIST"
      }
    ],
    "Demographics": {
      "FirstName": "Ronnie",
      "MiddleName": "Patricks",
      "LastName": "Oliver",
      "DOB": "2008-01-06",
      "SSN": "101-01-0001",
      "Sex": "Male",
      "Race": "White",
      "IsHispanic": null,
      "Religion": null,
      "MaritalStatus": "Single",
      "IsDeceased": null,
      "DeathDateTime": null,
      "PhoneNumber": {
        "Home": "+18088675301",
        "Office": null,
        "Mobile": null
      },
      "EmailAddresses": [

      ],
      "Language": "en",
      "Citizenship": [

      ],
      "Address": {
        "StreetAddress": "4762 Wallgate Avenue",
        "City": "San Jose",
        "State": "CA",
        "ZIP": "53566",
        "County": "Santa Clara",
        "Country": "USA"
      }
    },
    "Notes": [

    ],
    "Weight": null,
    "IsPregnant": null
  },
  "Claims": [
    {
      "ID": "123456789",
      "Type": "Admission by Discharge Claim",
      "TotalAmount": "200.00",
      "CopayAmount": "10.00",
      "IsProviderSignatureOnFile": true,
      "IsReleaseOfInformationOnFile": true,
      "ReferenceNumbers": [
        {
          "ID": "AUTH000000",
          "Type": null
        }
      ],
      "Visit": {
        "VisitNumber": null,
        "DateTime": "2016-10-08",
        "DischargeDateTime": null,
        "Type": null,
        "Location": {
          "Type": "Outpatient Clinic",
          "Facility": "ABC Vision Clinic",
          "Department": "Vision Clinic",
          "Room": null
        },
        "PreviousLocation": {
          "Type": null,
          "Facility": null,
          "Department": null,
          "Room": null
        }
      },
      "AdditionalDates": [
        {
          "Type": "Service Period Start",
          "DateTime": "2016-10-08"
        }
      ],
      "Diagnoses": [
        {
          "Code": "M54.5",
          "Codeset": "ICD-10",
          "Name": "Lower back pain",
          "Type": null
        },
        {
          "Code": "J45.909",
          "Codeset": "ICD-10",
          "Name": "Unspecified asthma, uncomplicated",
          "Type": null
        }
      ],
      "DiagnosisRelatedGroup": null,
      "Procedures": [

      ],
      "Lines": [
        {
          "ID": "12345678",
          "Amount": "100.00",
          "Diagnoses": [

          ],
          "Procedure": {
            "Code": "73560",
            "CodeSet": "CPT",
            "Name": null,
            "Modifiers": [

            ]
          },
          "ServiceDateTime": "2016-10-5",
          "ServiceEndDateTime": null,
          "RevenueCode": null,
          "UnitCount": "1",
          "Units": "Units",
          "IsEmergency": false,
          "Notes": null
        }
      ],
      "Providers": [
        {
          "ID": "4236464757",
          "IDType": "NPI",
          "Role": "Attending",
          "FirstName": "John",
          "MiddleName": null,
          "LastName": "Slate",
          "Specialty": {
            "ID": "1223G0001X",
            "Description": "General Practice"
          }
        }
      ]
    }
  ]
}