Redox | Claim

Claim

Claims are sent from a healthcare provider to an insurer detailing the services provided. Claim transactions between a payor and provider can include: a submission of a payment request, the status of that submission, the details of the payment, and the explanation of benefits (EOB).

Claims FAQ^

Submission
Payment

Submission

BETA

A Submission message is used to send a payment request, typically from a healthcare provider to an insurer. This is commonly sent as an EDI 837 form by healthcare providers.

Fields

Show Required Fields Only

Meta
- Meta.DataModel
  String
  Reliable
  Required
  Claim
- Meta.EventType
  String
  Reliable
  Required
  Submission
- Meta.EventDateTime
  DateTime
  Reliable
  DateTime of the event.
  ISO 8601 Format
- Meta.Test
  Boolean
  Reliable
  Flag as a test message
- Meta.Source
  String
  Reliable
  Where the message originated.
  Included in messages from Redox
- Meta.Source.ID
  String
  Reliable
  ID of the source.
  UUID
- Meta.Source.Name
  String
  Reliable
  Name of the source
- Meta.Destinations[]
  Array of Objects
  Reliable
  List of destinations to send your message to. All messages must have at least one destination. Queries accept only one destination.
  Required when sending data to Redox
- Meta.Destinations[].ID
  String
  Reliable
  ID of the destination.
  UUID
- Meta.Destinations[].Name
  String
  Reliable
  Name of the destination
- Meta.Message
  String
  Reliable
  Record in Redox that corresponds to the communication sent from the source to Redox.
  Included in messages from Redox
- Meta.Message.ID
  Numeric
  Reliable
  ID of the message created in Redox
- Meta.Transmission
  String
  Reliable
  Record in Redox that corresponds to the communication sent from Redox to your destination.
  Included in messages from Redox
- Meta.Transmission.ID
  Numeric
  Reliable
  ID of the transmission created in Redox
- Meta.FacilityCode
  String
  Possible
  Code for the facility related to the message.
  Only use this field if a health system indicates you should. The code is specific to the health system's EHR and might not be unique across health systems. In general, the facility fields within the data models (e.g. OrderingFacility) are more reliable and informative.
Transaction
- Transaction.ID
  String
  Reliable
  ID used by Sender to reference this claim
- Transaction.IDType
  String
  Reliable
  Type of ID
- Transaction.Type
  String
  Reliable
  The type of claim, Instituional or Professional.
- Transaction.Submitter.ID
  String
  Reliable
  ID of the submitter
- Transaction.Submitter.IDType
  String
  Reliable
  Type of ID
- Transaction.Submitter.Name
  String
  Reliable
  Name of submitter
- Transaction.Submitter.EmailAddress
  String
  Reliable
  Email address
- Transaction.Submitter.PhoneNumber.Office
  String
  Reliable
  Submitter's office phone number.
  In E. 164 Format. (e.g. +16085551234)
- Transaction.Submitter.PhoneNumber.Fax
  String
  Reliable
  Submitter's fax number.
  In E. 164 Format. (e.g. +16085551234)
- Transaction.Receiver.ID
  String
  Reliable
  ID of transaction recipient
- Transaction.Receiver.IDType
  String
  Reliable
  Type of ID
- Transaction.Receiver.Name
  String
  Reliable
  Name of transaction recipient
BillingProvider
- BillingProvider.ID
  String
  Reliable
  ID of billing provider
- BillingProvider.IDType
  String
  Reliable
  Type of ID
- BillingProvider.TIN
  String
  Possible
  Tax Identification Number of Billing Provider
- BillingProvider.FirstName
  String
  Reliable
- BillingProvider.MiddleName
  String
  Reliable
- BillingProvider.LastName
  String
  Reliable
- BillingProvider.OrganizationName
  String
  Reliable
- BillingProvider.Specialty.ID
  String
  Reliable
  Billing provider's specialty.
  Commonly the taxonomy ID
- BillingProvider.Specialty.Description
  String
  Reliable
  Billing provider's specialty description
- BillingProvider.Address
  Object
  Possible
  Billing provider's address
- BillingProvider.Address.StreetAddress
  String
  Possible
  Street address
- BillingProvider.Address.City
  String
  Possible
  City
- BillingProvider.Address.State
  String
  Possible
  State
- BillingProvider.Address.ZIP
  String
  Possible
  ZIP
- BillingProvider.Address.County
  String
  Possible
  County
- BillingProvider.Address.Country
  String
  Possible
  Country
- BillingProvider.EmailAddress
  String
  Reliable
- BillingProvider.PhoneNumber.Office
  String
  Reliable
  Billing provider's office phone number.
  In E. 164 Format. (e.g. +16085551234)
- BillingProvider.PhoneNumber.Fax
  String
  Reliable
  Billing provider's fax number.
  In E. 164 Format. (e.g. +16085551234)
Subscriber
- Subscriber.ID
  String
  Reliable
  ID of the subscriber
- Subscriber.IDType
  String
  Reliable
  Type of ID
- Subscriber.FirstName
  String
  Reliable
- Subscriber.MiddleName
  String
  Reliable
- Subscriber.LastName
  String
  Reliable
- Subscriber.OrganizationName
  String
  Reliable
  If the subscriber is not a person, this will contain the organization name
- Subscriber.Address
  Object
  Possible
  Subscriber's address
- Subscriber.Address.StreetAddress
  String
  Possible
  Street address
- Subscriber.Address.City
  String
  Possible
  City
- Subscriber.Address.State
  String
  Possible
  State
- Subscriber.Address.ZIP
  String
  Possible
  ZIP
- Subscriber.Address.County
  String
  Possible
  County
- Subscriber.Address.Country
  String
  Possible
  Country
- Subscriber.DOB
  String
  Reliable
  Subscriber's date of birth.
  In YYYY-MM-DD format
- Subscriber.Sex
  String
  Reliable
  Subscriber's sex
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Subscriber.RelationToPatient
  String
  Reliable
  Relation to the patient.
  E.x. Self, Parent
- Subscriber.ResponsibilityLevel
  String
  Reliable
  Payor responsibilty level.
  E.x. Primary, Secondary, Tertiary
- Subscriber.Insurance
  Array of Objects
  Probable
- Subscriber.Insurance.Plan.ID
  String
  Probable
  Identifier of insurance plan
- Subscriber.Insurance.Plan.IDType
  String
  Probable
  ID type of insurance plan
- Subscriber.Insurance.Plan.Name
  String
  Probable
  Name of insurance plan
- Subscriber.Insurance.Plan.Type
  String
  Possible
  Type of insurance plan
- Subscriber.Insurance.MemberNumber
  String
  Possible
  Patient member number
- Subscriber.Insurance.Company.ID
  String
  Probable
  ID of insurance company (payor)
- Subscriber.Insurance.Company.IDType
  String
  Probable
  ID type of insurance company (payor)
- Subscriber.Insurance.Company.Name
  String
  Probable
  Name of insurance company (payor)
- Subscriber.Insurance.Company.Address
  Object
  Probable
  Insurance company's address
- Subscriber.Insurance.Company.Address.StreetAddress
  String
  Probable
  Street address
- Subscriber.Insurance.Company.Address.City
  String
  Probable
  City
- Subscriber.Insurance.Company.Address.State
  String
  Probable
  State
- Subscriber.Insurance.Company.Address.ZIP
  String
  Probable
  ZIP
- Subscriber.Insurance.Company.Address.County
  String
  Possible
  County
- Subscriber.Insurance.Company.Address.Country
  String
  Possible
  Country
- Subscriber.Insurance.Company.PhoneNumber
  String
  Probable
  Insurance companys phone number.
  In E. 164 Format (i.e. +16085551234)
- Subscriber.Insurance.GroupNumber
  String
  Probable
  Insurance policy group number
- Subscriber.Insurance.GroupName
  String
  Probable
  Insurance policy group name
- Subscriber.Insurance.EffectiveDate
  String
  Probable
  Effect date of this insurance policy.
  In YYYY-MM-DD format
- Subscriber.Insurance.ExpirationDate
  String
  Probable
  Expiration date of this insurance policy.
  In YYYY-MM-DD format
- Subscriber.Insurance.PolicyNumber
  String
  Probable
  Insurance policy number
- Subscriber.Insurance.AgreementType
  String
  Probable
  Type of insurance agreement.
  One of the following: "Standard", "Unified", "Maternity"
- Subscriber.Insurance.CoverageType
  String
  Probable
  Type of insurance agreement.
  One of the following: "Patient", "Clinic", "Insurance", "Other". Indicates who will be receiving the bill for the service.
Patient
- Patient.Identifiers[]
  Array of Objects
  Reliable
  List of IDs and ID types that identify the patient
- Patient.Identifiers[].ID
  String
  Reliable
  ID for the patient
- Patient.Identifiers[].IDType
  String
  Reliable
  Type of ID.
  E.g. MRN, EPI
- Patient.Demographics.FirstName
  String
  Reliable
  Patient's first name
- Patient.Demographics.MiddleName
  String
  Possible
  Patient's middle name or middle initial. For patients with multiple middle names, all their middle names are included in this field.
- Patient.Demographics.LastName
  String
  Reliable
  Patient's last name
- Patient.Demographics.DOB
  String
  Reliable
  Patient's date of birth.
  In ISO 8601 format
- Patient.Demographics.SSN
  String
  Probable
  Patient's social security number
- Patient.Demographics.Sex
  String
  Reliable
  Patient's sex
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Patient.Demographics.Race
  String
  Possible
  Patient's race.
  Supported Values
- Patient.Demographics.IsHispanic
  Boolean
  Possible
  Indicates if the patient is of hispanic origin.
- Patient.Demographics.MaritalStatus
  String
  Possible
  Patient's marital status
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Patient.Demographics.IsDeceased
  Boolean
  Possible
  Indicates if the patient is deceased
- Patient.Demographics.DeathDateTime
  DateTime
  Possible
  Date and Time the patient was proclaimed deceased.
  ISO 8601 Format
- Patient.Demographics.PhoneNumber.Home
  String
  Probable
  Patient's home phone number.
  In E. 164 Format. (e.g. +16085551234)
- Patient.Demographics.PhoneNumber.Office
  String
  Probable
  Patient's office phone number.
  In E. 164 Format. (e.g. +16085551234)
- Patient.Demographics.PhoneNumber.Mobile
  String
  Probable
  Patient's mobile phone number.
  In E. 164 Format. (e.g. +16085551234)
- Patient.Demographics.EmailAddresses[]
  Array of Strings
  Probable
  Patient's email address(es)
- Patient.Demographics.Language
  String
  Possible
  Patient's primary spoken language.
  In ISO 639-1 alpha values (e.g. 'en'). Supported Values
- Patient.Demographics.Citizenship[]
  Array of strings
  Possible
  Patient's nation(s) of citizenship.
  *In ISO 3166 alpha 2 format (e.g. 'US'). Reference Table.
  
  Note: The valid set of citizenships is a smaller list than the list of IS0 3166 country codes, and should be limited to the 193 United Nations countries plus 6 states: ROC Taiwan, Macao (SAR China), Hong Kong (SAR China), Kosovo, Palestinian Territory and the Vatican.*
- Patient.Demographics.Address
  Object
  Probable
  Patient's home address
- Patient.Demographics.Address.StreetAddress
  String
  Probable
  Street address
- Patient.Demographics.Address.City
  String
  Probable
  City
- Patient.Demographics.Address.State
  String
  Probable
  State
- Patient.Demographics.Address.ZIP
  String
  Probable
  ZIP
- Patient.Demographics.Address.County
  String
  Possible
  County
- Patient.Demographics.Address.Country
  String
  Possible
  Country
- Patient.Notes[]
  Array of strings
  Possible
  Patient-level notes
- Patient.Weight
  String
  Probable
  One of the following: "Patient", "Clinic", "Insurance", "Other". Indicates who will be receiving the bill for the service.
- Patient.IsPregnant
  String
  Probable
  One of the following: "Yes", "No", "Not Specified"
Claims
- Claims[]
  Array of Object
  Probable
  Array of claims on this transaction.
- Claims[].ID
  String
  Probable
  Identifier for this particular claim.
- Claims[].Type
  String
  Probable
  Type of Claim (Instituional only).
  E.x. 'Admit thru Discharge Claim', 'Replacement of Prior Claim ', Void/Cancel of Prior Claim '. May be referred to as the Bill Type Frequency
- Claims[].TotalAmount
  String
  Probable
  Total amount of all lines on the claim.
- Claims[].CopayAmount
  String
  Probable
  Amount the patient has paid or still owes.
- Claims[].IsProviderSignatureOnFile
  Boolean
  Probable
  Whether or not the provider signature is on file for the claim.
- Claims[].IsReleaseOfInformationOnFile
  Boolean
  Probable
  Whether or not the submitter has a signed ROI form for the patient.
- Claims[].ReferenceNumbers[].ID
  String
  Probable
  May include Prior Auth numbers, CLIA numbers, etc
- Claims[].ReferenceNumbers[].Type
  String
  Probable
- Claims[].Visit.VisitNumber
  String
  Reliable
  Visit Number.
  Unique ID of a single visit
- Claims[].Visit.DateTime
  String
  Probable
  DateTime of admission.
  ISO 8601 Format
- Claims[].Visit.DischargeDateTime
  String
  Probable
  DateTime of discharge.
  ISO 8601 Format
- Claims[].Visit.Type
  String
  Probable
  Type of inpatient admission.
  Only populated for inpatient admissions. E.x. Elective, Emergency
- Claims[].Visit.Location
  Object
  Probable
- Claims[].Visit.Location.Type
  String
  Probable
  Type of location.
  Examples: Clinic, Department, Home, Nursing Unit, Provider's Office, Phone
- Claims[].Visit.Location.Facility
  String
  Probable
  Facility.
  Example: Community Hospital
- Claims[].Visit.Location.Department
  String
  Probable
  Department
- Claims[].Visit.Location.Room
  String
  Probable
  Room.
  Example: 136
- Claims[].Visit.PreviousLocation
  Object
  Probable
- Claims[].Visit.PreviousLocation.Type
  String
  Probable
  Type of location.
  Examples: Clinic, Department, Home, Nursing Unit, Provider's Office, Phone
- Claims[].Visit.PreviousLocation.Facility
  String
  Probable
  Facility.
  Example: Community Hospital
- Claims[].Visit.PreviousLocation.Department
  String
  Probable
  Department
- Claims[].Visit.PreviousLocation.Room
  String
  Probable
  Room.
  Example: 136
- Claims[].AdditionalDates[].Type
  String
  Probable
  Type of date value.
  e.x. Service Period Start (https://ushik.ahrq.gov/ViewItemDetails?system=sdo&itemKey=133121000)
- Claims[].AdditionalDates[].DateTime
  String
  Probable
  ISO 8601 Format
- Claims[].Diagnoses[].Code
  String
  Probable
  Diagnosis code.
  First index in array indicates primary diagnosis
- Claims[].Diagnoses[].Codeset
  String
  Probable
  Code set used to identify the diagnosis code.
  e.x. ICD-10, ICD-9
- Claims[].Diagnoses[].Name
  String
  Probable
  Diagnosis name
- Claims[].Diagnoses[].Type
  String
  Probable
  Type of diagnosis.
  One of the following: Admitting, Working, or Final
- Claims[].DiagnosisRelatedGroup
  String
  Probable
  CMS Diagnsis Related Group for an inpatient admission
- Claims[].Procedures[].Code
  String
  Probable
  Procedure codes associated with this claim
- Claims[].Procedures[].CodeSet
  String
  Probable
  Code set used to identify the procedure code.
  e.x. CPT, HCPCS, SNOMED, or LOINC
- Claims[].Procedures[].Name
  String
  Probable
  Name of procedure
- Claims[].Procedures[].Modifiers[]
  String
  Probable
  Array of procedure modifiers
- Claims[].Lines[]
  String
  Probable
- Claims[].Lines[].ID
  String
  Probable
  Identifier for the line item.
- Claims[].Lines[].Amount
  String
  Probable
  Total dollar amount for this line item.
- Claims[].Lines[].Diagnoses[].Code
  String
  Probable
  Diagnosis code.
  First index in array indicates primary diagnosis associated with this service line item.
- Claims[].Lines[].Diagnoses[].Codeset
  String
  Probable
  Code set used to identify the diagnosis code.
  e.x. ICD-10, ICD-9
- Claims[].Lines[].Diagnoses[].Name
  String
  Probable
  Diagnosis name
- Claims[].Lines[].Diagnoses[].Type
  String
  Probable
  Type of diagnosis.
  One of the following: Admitting, Working, or Final
- Claims[].Lines[].Procedure.Code
  String
  Probable
  Procedure codes associated with this service line item.
- Claims[].Lines[].Procedure.CodeSet
  String
  Probable
  Code set used to identify the procedure code.
  e.x. CPT, HCPCS, SNOMED, or LOINC
- Claims[].Lines[].Procedure.Name
  String
  Probable
  Name of procedure
- Claims[].Lines[].Procedure.Modifiers[]
  String
  Probable
  Array of procedure modifiers
- Claims[].Lines[].ServiceDateTime
  String
  Probable
  When the procedure conveyed in this line item began.
- Claims[].Lines[].ServiceEndDateTime
  String
  Probable
  When the procedure conveyed in this line item ended.
- Claims[].Lines[].RevenueCode
  String
  Probable
  Instituional only.
- Claims[].Lines[].UnitCount
  String
  Probable
  Numeric value for units of service rendered.
- Claims[].Lines[].Units
  String
  Probable
  Units corresponding to UnitCount, (days, units, etc.)
- Claims[].Lines[].IsEmergency
  Boolean
  Probable
  Whether or not this service was performed in an emergency setting.
- Claims[].Lines[].Notes
  String
  Probable
  Additonal notes for this line
- Claims[].Providers[].ID
  String
  Probable
  ID of billing provider
- Claims[].Providers[].IDType
  String
  Probable
  Type of ID.
  Commonly 'NPI'
- Claims[].Providers[].Role
  String
  Probable
  The role this provider has in patient care.
  E.x. Attending, Referring, Operating
- Claims[].Providers[].FirstName
  String
  Probable
- Claims[].Providers[].MiddleName
  String
  Probable
- Claims[].Providers[].LastName
  String
  Probable
- Claims[].Providers[].Specialty.ID
  String
  Probable
  ID of specialty.
  Commonly the taxonomy ID
- Claims[].Providers[].Specialty.Description
  String
  Probable
  Description/name of specialty

Sample MessageDownload JSON Schema

{
   "Meta": {
      "DataModel": "Claim",
      "EventType": "Submission",
      "EventDateTime": "2020-07-08T18:58:45.177Z",
      "Test": true,
      "Source": {
         "ID": "7ce6f387-c33c-417d-8682-81e83628cbd9",
         "Name": "Redox Dev Tools"
      },
      "Destinations": [
         {
            "ID": "af394f14-b34a-464f-8d24-895f370af4c9",
            "Name": "Redox EMR"
         }
      ],
      "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": "Pat",
      "MiddleName": null,
      "LastName": "Granite",
      "OrganizationName": null,
      "Specialty": {
         "ID": null,
         "Description": null
      },
      "Address": {
         "StreetAddress": "123 Main St.",
         "City": "Madison",
         "State": "WI",
         "ZIP": "53703",
         "County": "Dane",
         "Country": "USA"
      },
      "EmailAddress": null,
      "PhoneNumber": {
         "Office": "+16085551234",
         "Fax": null
      }
   },
   "Subscriber": {
      "ID": null,
      "IDType": null,
      "FirstName": "Timothy",
      "MiddleName": "Paul",
      "LastName": "Bixby",
      "OrganizationName": null,
      "Address": {
         "StreetAddress": "4762 Hickory Street",
         "City": "Monroe",
         "State": "WI",
         "ZIP": "53566",
         "County": "Green",
         "Country": "US"
      },
      "DOB": "2008-01-06",
      "Sex": "Male",
      "RelationToPatient": "Self",
      "ResponsibilityLevel": "Primary",
      "Insurance": {
         "Plan": {
            "ID": "31572",
            "IDType": "Payor ID",
            "Name": "HMO Deductable Plan",
            "Type": null
         },
         "MemberNumber": null,
         "Company": {
            "ID": "60054",
            "IDType": null,
            "Name": "aetna (60054 0131)",
            "Address": {
               "StreetAddress": "PO Box 14080",
               "City": "Lexington",
               "State": "KY",
               "ZIP": "40512-4079",
               "County": "Fayette",
               "Country": "US"
            },
            "PhoneNumber": "+18089541123"
         },
         "GroupNumber": "847025-024-0009",
         "GroupName": "Accelerator Labs",
         "EffectiveDate": "2015-01-01",
         "ExpirationDate": "2020-12-31",
         "PolicyNumber": "9140860055",
         "AgreementType": null,
         "CoverageType": null
      }
   },
   "Patient": {
      "Identifiers": [
         {
            "ID": "0000000001",
            "IDType": "MR"
         },
         {
            "ID": "e167267c-16c9-4fe3-96ae-9cff5703e90a",
            "IDType": "EHRID"
         },
         {
            "ID": "a1d4ee8aba494ca",
            "IDType": "NIST"
         }
      ],
      "Demographics": {
         "FirstName": "Timothy",
         "MiddleName": "Paul",
         "LastName": "Bixby",
         "DOB": "2008-01-06",
         "SSN": "101-01-0001",
         "Sex": "Male",
         "Race": "White",
         "IsHispanic": null,
         "MaritalStatus": "Married",
         "IsDeceased": null,
         "DeathDateTime": null,
         "PhoneNumber": {
            "Home": "+18088675301",
            "Office": null,
            "Mobile": null
         },
         "EmailAddresses": [],
         "Language": "en",
         "Citizenship": [],
         "Address": {
            "StreetAddress": "4762 Hickory Street",
            "City": "Monroe",
            "State": "WI",
            "ZIP": "53566",
            "County": "Green",
            "Country": "US"
         }
      },
      "Notes": [],
      "Weight": null,
      "IsPregnant": null
   },
   "Claims": [
      {
         "ID": "123456789",
         "Type": "Admit thru Discharge Claim",
         "TotalAmount": "200.00",
         "CopayAmount": "10.00",
         "IsProviderSignatureOnFile": true,
         "IsReleaseOfInformationOnFile": true,
         "ReferenceNumbers": [
            {
               "ID": "AUTH000000",
               "Type": "Prior Authorization"
            }
         ],
         "Visit": {
            "VisitNumber": null,
            "DateTime": "2016-10-08",
            "DischargeDateTime": null,
            "Type": null,
            "Location": {
               "Type": "Outpatient Clinic",
               "Facility": "RHS Vista Oaks Clinic",
               "Department": "Vista Oaks 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"
               }
            }
         ]
      }
   ]
}

Payment

BETA

A Payment message is used to send a payment notification, typically from a payer to a healthcare provider, but it may be used in other situations where funds are transferred from one party to another. This is commonly sent as an EDI 835.

Fields

Show Required Fields Only

Meta
- Meta.DataModel
  String
  Reliable
  Required
  Claim
- Meta.EventType
  String
  Reliable
  Required
  Payment
- Meta.EventDateTime
  DateTime
  Reliable
  DateTime of the event.
  ISO 8601 Format
- Meta.Test
  Boolean
  Reliable
  Flag as a test message
- Meta.Source
  String
  Reliable
  Where the message originated.
  Included in messages from Redox
- Meta.Source.ID
  String
  Reliable
  ID of the source.
  UUID
- Meta.Source.Name
  String
  Reliable
  Name of the source
- Meta.Destinations[]
  Array of Objects
  Reliable
  List of destinations to send your message to. All messages must have at least one destination. Queries accept only one destination.
  Required when sending data to Redox
- Meta.Destinations[].ID
  String
  Reliable
  ID of the destination.
  UUID
- Meta.Destinations[].Name
  String
  Reliable
  Name of the destination
- Meta.Message
  String
  Reliable
  Record in Redox that corresponds to the communication sent from the source to Redox.
  Included in messages from Redox
- Meta.Message.ID
  Numeric
  Reliable
  ID of the message created in Redox
- Meta.Transmission
  String
  Reliable
  Record in Redox that corresponds to the communication sent from Redox to your destination.
  Included in messages from Redox
- Meta.Transmission.ID
  Numeric
  Reliable
  ID of the transmission created in Redox
- Meta.FacilityCode
  String
  Possible
  Code for the facility related to the message.
  Only use this field if a health system indicates you should. The code is specific to the health system's EHR and might not be unique across health systems. In general, the facility fields within the data models (e.g. OrderingFacility) are more reliable and informative.
Transaction
- Transaction.ID
  String
  Reliable
  ID used by Sender to reference this claim
- Transaction.IDType
  String
  Reliable
  Type of ID
- Transaction.Type
  String
  Reliable
  The type of claim, Instituional or Professional.
- Transaction.Submitter.ID
  String
  Reliable
  ID of the submitter
- Transaction.Submitter.IDType
  String
  Reliable
  Type of ID
- Transaction.Submitter.Name
  String
  Reliable
  Name of submitter
- Transaction.Submitter.EmailAddress
  String
  Reliable
  Email address
- Transaction.Submitter.PhoneNumber.Office
  String
  Reliable
  Submitter's office phone number.
  In E. 164 Format. (e.g. +16085551234)
- Transaction.Submitter.PhoneNumber.Fax
  String
  Reliable
  Submitter's fax number.
  In E. 164 Format. (e.g. +16085551234)
- Transaction.Receiver.ID
  String
  Reliable
  ID of transaction recipient
- Transaction.Receiver.IDType
  String
  Reliable
  Type of ID
- Transaction.Receiver.Name
  String
  Reliable
  Name of transaction recipient
- Transaction.TotalPaymentAmount
  String
  Probable
  The total amount of all of the payments listed in the Payments array.
  Redox can calculate this for you, but we recommend sending it as an additional layer of validation.
- Transaction.CreditOrDebit
  String
  Probable
  A flag indicating whether the monetary amount in Transaction.TotalPaymentAmount is a credit or debit.
  Send either "Credit" or "Debit" in this field.
- Transaction.PaymentMethod
  String
  Probable
  How the payment was/will be transferred.
  We currently support "Check" and "ACH".
- Transaction.PaymentDateTime
  DateTime
  Probable
  When the transaction should be processed by the destination.
  For example, if the "Check" is used in Transaction.PaymentMethod this would be the date on the check.
- Transaction.TrackingNumber
  String
  Probable
  A number used to by the Payer to trace the payment.
  For example, if the "Check" is used in Transaction.PaymentMethod this would be the check number.
Payer
- Payer
  String
  Probable
- Payer.ID
  String
  Probable
- Payer.IDType
  String
  Probable
- Payer.Name
  String
  Probable
- Payer.Address
  String
  Probable
- Payer.Address.StreetAddress
  String
  Probable
  Street address
- Payer.Address.City
  String
  Probable
  City
- Payer.Address.State
  String
  Probable
  State
- Payer.Address.ZIP
  String
  Probable
  ZIP
- Payer.Address.County
  String
  Probable
  County
- Payer.Address.Country
  String
  Probable
  Country
- Payer.EmailAddress
  String
  Probable
  Email address
- Payer.PhoneNumber.Office
  String
  Probable
  Submitter's office phone number.
  In E. 164 Format. (e.g. +16085551234)
- Payer.PhoneNumber.Fax
  String
  Probable
  Submitter's fax number.
  In E. 164 Format. (e.g. +16085551234)
Payee
- Payee
  String
  Probable
- Payee.ID
  String
  Probable
- Payee.IDType
  String
  Probable
- Payee.Name
  String
  Probable
- Payee.Address
  String
  Probable
- Payee.Address.StreetAddress
  String
  Probable
  Street address
- Payee.Address.City
  String
  Probable
  City
- Payee.Address.State
  String
  Probable
  State
- Payee.Address.ZIP
  String
  Probable
  ZIP
- Payee.Address.County
  String
  Probable
  County
- Payee.Address.Country
  String
  Probable
  Country
- Payee.EmailAddress
  String
  Probable
  Email address
- Payee.PhoneNumber.Office
  String
  Probable
  Submitter's office phone number.
  In E. 164 Format. (e.g. +16085551234)
- Payee.PhoneNumber.Fax
  String
  Probable
  Submitter's fax number.
  In E. 164 Format. (e.g. +16085551234)
Payments
- Payments[]
  String
  Probable
- Payments[].DateTime
  DateTime
  Probable
  The DateTime this payment was processed
- Payments[].Patient.Identifiers[]
  Array of Objects
  Reliable
  List of IDs and ID types that identify the patient
- Payments[].Patient.Identifiers[].ID
  String
  Reliable
  Required
  ID for the patient
- Payments[].Patient.Identifiers[].IDType
  String
  Reliable
  Required
  Type of ID.
  E.g. MRN, EPI
- Payments[].Patient.Demographics.FirstName
  String
  Reliable
  Patient's first name
- Payments[].Patient.Demographics.MiddleName
  String
  Possible
  Patient's middle name or middle initial. For patients with multiple middle names, all their middle names are included in this field.
- Payments[].Patient.Demographics.LastName
  String
  Reliable
  Patient's last name
- Payments[].Patient.Demographics.DOB
  String
  Reliable
  Patient's date of birth.
  In ISO 8601 format
- Payments[].Patient.Demographics.SSN
  String
  Probable
  Patient's social security number
- Payments[].Patient.Demographics.Sex
  String
  Reliable
  Patient's sex
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Payments[].Patient.Demographics.Race
  String
  Possible
  Patient's race.
  Supported Values
- Payments[].Patient.Demographics.IsHispanic
  Boolean
  Possible
  Indicates if the patient is of hispanic origin.
- Payments[].Patient.Demographics.MaritalStatus
  String
  Possible
  Patient's marital status
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Payments[].Patient.Demographics.IsDeceased
  Boolean
  Possible
  Indicates if the patient is deceased
- Payments[].Patient.Demographics.DeathDateTime
  DateTime
  Possible
  Date and Time the patient was proclaimed deceased.
  ISO 8601 Format
- Payments[].Patient.Demographics.PhoneNumber.Home
  String
  Probable
  Patient's home phone number.
  In E. 164 Format. (e.g. +16085551234)
- Payments[].Patient.Demographics.PhoneNumber.Office
  String
  Probable
  Patient's office phone number.
  In E. 164 Format. (e.g. +16085551234)
- Payments[].Patient.Demographics.PhoneNumber.Mobile
  String
  Probable
  Patient's mobile phone number.
  In E. 164 Format. (e.g. +16085551234)
- Payments[].Patient.Demographics.EmailAddresses[]
  Array of Strings
  Probable
  Patient's email address(es)
- Payments[].Patient.Demographics.Language
  String
  Possible
  Patient's primary spoken language.
  In ISO 639-1 alpha values (e.g. 'en'). Supported Values
- Payments[].Patient.Demographics.Citizenship[]
  Array of strings
  Possible
  Patient's nation(s) of citizenship.
  *In ISO 3166 alpha 2 format (e.g. 'US'). Reference Table.
  
  Note: The valid set of citizenships is a smaller list than the list of IS0 3166 country codes, and should be limited to the 193 United Nations countries plus 6 states: ROC Taiwan, Macao (SAR China), Hong Kong (SAR China), Kosovo, Palestinian Territory and the Vatican.*
- Payments[].Patient.Demographics.Address
  Object
  Probable
  Patient's home address
- Payments[].Patient.Demographics.Address.StreetAddress
  String
  Probable
  Street address
- Payments[].Patient.Demographics.Address.City
  String
  Probable
  City
- Payments[].Patient.Demographics.Address.State
  String
  Probable
  State
- Payments[].Patient.Demographics.Address.ZIP
  String
  Probable
  ZIP
- Payments[].Patient.Demographics.Address.County
  String
  Possible
  County
- Payments[].Patient.Demographics.Address.Country
  String
  Possible
  Country
- Payments[].Patient.Notes[]
  Array of strings
  Possible
  Patient-level notes
- Payments[].Claim.Number
  String
  Probable
  The Payer's reference number
- Payments[].Claim.SubmissionNumber
  String
  Probable
  This will generally be the claim number sent on the Submission (837).
- Payments[].Claim.ReceivedDate
  String
  Probable
  Date the claim was submitted
- Payments[].Claim.ServiceDateTime
  DateTime
  Probable
  Date the statement period started
- Payments[].Claim.ServiceEndDateTime
  DateTime
  Probable
  Date the statement period ended
- Payments[].Claim.Status
  String
  Probable
  Status of the claim
- Payments[].Claim.ChargedAmount
  String
  Probable
  Total monetary amount of the claim
- Payments[].Claim.PaymentAmount
  String
  Probable
  Monetary amount of the claim paid
- Payments[].Claim.PatientResponsibilityAmount
  String
  Probable
  Monetary amount of the claim the patient is responsible for
- Payments[].Claim.Adjustments[]
  String
  Probable
  Adjustments explain why a claim was paid differently than it was billed.
- Payments[].Claim.Adjustments[].Amount
  String
  Probable
  Monetary amount of the adjustment.
  A negative number indicates a payment increase, while a positive number indicates a payment reduction.
- Payments[].Claim.Adjustments[].ReasonGroup
  String
  Probable
  Adjustment group.
  E.x. Contractual Obligation, Other Adjustments, Payer Initiated Reductions, Patient Responsibility
- Payments[].Claim.Adjustments[].Quantity
  String
  Probable
- Payments[].Claim.Adjustments[].Reason
  String
  Probable
  Adjustment reason
- Payments[].Claim.ReferenceNumbers[].ID
  String
  Probable
  May include Prior Auth numbers, CLIA numbers, etc
- Payments[].Claim.ReferenceNumbers[].IDType
  String
  Probable
- Payments[].Claim.Services[]
  String
  Probable
  This array will provide additional detail for claims processed at the line level.
- Payments[].Claim.Services[].ChargedAmount
  String
  Probable
  The monetory amount charged
- Payments[].Claim.Services[].PaymentAmount
  String
  Probable
  The monetory amount paid
- Payments[].Claim.Services[].ChargedUnits
  String
  Probable
  The number of units of service charged for
- Payments[].Claim.Services[].PaymentUnits
  String
  Probable
  The number of units of service paid for
- Payments[].Claim.Services[].AllowedAmount
  String
  Probable
  Maximum monetary amount of payment
- Payments[].Claim.Services[].DeductibleAmount
  String
  Probable
  Monetary amount of patient deductible
- Payments[].Claim.Services[].SubmittedProcedure.Code
  String
  Probable
  Procedure codes associated with this service.
- Payments[].Claim.Services[].SubmittedProcedure.CodeSet
  String
  Probable
  Code set used to identify the procedure code
- Payments[].Claim.Services[].SubmittedProcedure.Name
  String
  Probable
  Name of procedure
- Payments[].Claim.Services[].SubmittedProcedure.Modifiers[]
  String
  Probable
  Array of procedure modifiers
- Payments[].Claim.Services[].AdjudicatedProcedure.Code
  String
  Probable
  Adjudicated procedure codes associated with this service.
- Payments[].Claim.Services[].AdjudicatedProcedure.CodeSet
  String
  Probable
  Code set used to identify the procedure code
- Payments[].Claim.Services[].AdjudicatedProcedure.Name
  String
  Probable
  Name of procedure
- Payments[].Claim.Services[].AdjudicatedProcedure.Modifiers[]
  String
  Probable
  Array of procedure modifiers
- Payments[].Claim.Services[].ServiceDateTime
  DateTime
  Probable
  Date the claim was submitted
- Payments[].Claim.Services[].ServiceEndDateTime
  DateTime
  Probable
  Date the statement period started
- Payments[].Claim.Services[].ReferenceNumbers[].ID
  String
  Probable
  May include Prior Auth numbers, CLIA numbers, etc
- Payments[].Claim.Services[].ReferenceNumbers[].IDType
  String
  Probable

Sample MessageDownload JSON Schema

{
   "Meta": {
      "DataModel": "Claim",
      "EventType": "Payment",
      "EventDateTime": "2020-07-08T18:58:45.177Z",
      "Test": true,
      "Source": {
         "ID": "7ce6f387-c33c-417d-8682-81e83628cbd9",
         "Name": "Redox Dev Tools"
      },
      "Destinations": [
         {
            "ID": "af394f14-b34a-464f-8d24-895f370af4c9",
            "Name": "Redox EMR"
         }
      ],
      "Message": {
         "ID": 5565
      },
      "Transmission": {
         "ID": 12414
      },
      "FacilityCode": null
   },
   "Transaction": {
      "ID": "000000001",
      "IDType": null,
      "Type": null,
      "Submitter": {
         "ID": null,
         "IDType": null,
         "Name": null,
         "EmailAddress": null,
         "PhoneNumber": {
            "Office": null,
            "Fax": null
         }
      },
      "Receiver": {
         "ID": null,
         "IDType": null,
         "Name": null
      },
      "TotalPaymentAmount": "580.00",
      "CreditOrDebit": "Credit",
      "PaymentMethod": "Check",
      "PaymentDateTime": "2016-11-11T02:11:03.111Z",
      "TrackingNumber": "8675309"
   },
   "Payer": {
      "ID": "999999999",
      "IDType": "HPID",
      "Name": "Cherdabee Insurance Corp",
      "Address": {
         "StreetAddress": "123 fake street",
         "City": "Los Angeles",
         "State": "CA",
         "ZIP": "90210",
         "County": null,
         "Country": null
      },
      "EmailAddress": null,
      "PhoneNumber": {
         "Office": null,
         "Fax": null
      }
   },
   "Payee": {
      "ID": "51531312",
      "IDType": null,
      "Name": "Redox Health System",
      "Address": {
         "StreetAddress": "2020 Eastwood Drive",
         "City": "Madison",
         "State": "WI",
         "ZIP": "53704",
         "County": null,
         "Country": null
      },
      "EmailAddress": null,
      "PhoneNumber": {
         "Office": null,
         "Fax": null
      }
   },
   "Payments": [
      {
         "DateTime": "2016-11-08T02:11:03.111Z",
         "Patient": {
            "Identifiers": [
               {
                  "ID": "0000000001",
                  "IDType": "MR"
               },
               {
                  "ID": "e167267c-16c9-4fe3-96ae-9cff5703e90a",
                  "IDType": "EHRID"
               },
               {
                  "ID": "a1d4ee8aba494ca",
                  "IDType": "NIST"
               }
            ],
            "Demographics": {
               "FirstName": "Timothy",
               "MiddleName": "Paul",
               "LastName": "Bixby",
               "DOB": "2008-01-06",
               "SSN": "101-01-0001",
               "Sex": "Male",
               "Race": "White",
               "IsHispanic": null,
               "MaritalStatus": "Married",
               "IsDeceased": null,
               "DeathDateTime": null,
               "PhoneNumber": {
                  "Home": "+18088675301",
                  "Office": null,
                  "Mobile": null
               },
               "EmailAddresses": [],
               "Language": "en",
               "Citizenship": [],
               "Address": {
                  "StreetAddress": "4762 Hickory Street",
                  "City": "Monroe",
                  "State": "WI",
                  "ZIP": "53566",
                  "County": "Green",
                  "Country": "US"
               }
            },
            "Notes": []
         },
         "Claim": {
            "Number": "94151100100",
            "SubmissionNumber": null,
            "ReceivedDate": "2016-10-31",
            "ServiceDateTime": "2016-10-08T08:58:03.125Z",
            "ServiceEndDateTime": "2016-10-11T14:58:03.532Z",
            "Status": "Processed as Primary",
            "ChargedAmount": "100.00",
            "PaymentAmount": "80.00",
            "PatientResponsibilityAmount": "20.00",
            "Adjustments": [],
            "ReferenceNumbers": [],
            "Services": [
               {
                  "ChargedAmount": "100.00",
                  "PaymentAmount": "80.00",
                  "ChargedUnits": null,
                  "PaymentUnits": null,
                  "AllowedAmount": null,
                  "DeductibleAmount": "20.00",
                  "SubmittedProcedure": {
                     "Code": "55454-3",
                     "CodeSet": "LOINC",
                     "Name": null,
                     "Modifiers": []
                  },
                  "AdjudicatedProcedure": {
                     "Code": "55454-3",
                     "CodeSet": "LOINC",
                     "Name": null,
                     "Modifiers": []
                  },
                  "ServiceDateTime": "2016-10-08T08:58:03.624Z",
                  "ServiceEndDateTime": "2016-10-08T14:58:03.263Z",
                  "ReferenceNumbers": []
               }
            ]
         }
      },
      {
         "DateTime": "2016-11-08T02:11:03.111Z",
         "Patient": {
            "Identifiers": [
               {
                  "ID": "0000000001",
                  "IDType": "MR"
               },
               {
                  "ID": "e167267c-16c9-4fe3-96ae-9cff5703e90a",
                  "IDType": "EHRID"
               },
               {
                  "ID": "a1d4ee8aba494ca",
                  "IDType": "NIST"
               }
            ],
            "Demographics": {
               "FirstName": "Timothy",
               "MiddleName": "Paul",
               "LastName": "Bixby",
               "DOB": "2008-01-06",
               "SSN": "101-01-0001",
               "Sex": "Male",
               "Race": "White",
               "IsHispanic": null,
               "MaritalStatus": "Married",
               "IsDeceased": null,
               "DeathDateTime": null,
               "PhoneNumber": {
                  "Home": "+18088675301",
                  "Office": null,
                  "Mobile": null
               },
               "EmailAddresses": [],
               "Language": "en",
               "Citizenship": [],
               "Address": {
                  "StreetAddress": "4762 Hickory Street",
                  "City": "Monroe",
                  "State": "WI",
                  "ZIP": "53566",
                  "County": "Green",
                  "Country": "US"
               }
            },
            "Notes": []
         },
         "Claim": {
            "Number": "94151100100",
            "SubmissionNumber": null,
            "ReceivedDate": "2016-10-31",
            "ServiceDateTime": "2016-10-08T08:58:03.125Z",
            "ServiceEndDateTime": "2016-10-11T14:58:03.532Z",
            "Status": "Processed as Primary",
            "ChargedAmount": "500.00",
            "PaymentAmount": "500.00",
            "PatientResponsibilityAmount": "0.00",
            "Adjustments": [],
            "ReferenceNumbers": [],
            "Services": [
               {
                  "ChargedAmount": "100.00",
                  "PaymentAmount": "80.00",
                  "ChargedUnits": null,
                  "PaymentUnits": null,
                  "AllowedAmount": null,
                  "DeductibleAmount": "20.00",
                  "SubmittedProcedure": {
                     "Code": "99211",
                     "CodeSet": "LOINC",
                     "Name": null,
                     "Modifiers": []
                  },
                  "AdjudicatedProcedure": {
                     "Code": "99211",
                     "CodeSet": "LOINC",
                     "Name": null,
                     "Modifiers": []
                  },
                  "ServiceDateTime": "2016-10-08T08:58:03.624Z",
                  "ServiceEndDateTime": "2016-10-08T14:58:03.263Z",
                  "ReferenceNumbers": []
               }
            ]
         }
      }
   ]
}

Claim

Submissionlink

Fields

Meta

Transaction

BillingProvider

Subscriber

Patient

Claims

Paymentlink

Fields

Meta

Transaction

Payer

Payee

Payments

Submission

Payment