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).

SubmissionBETAlink

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

  • Meta
    • Meta.DataModel

      String

      Reliable
      Required

      Data model. E.g. Scheduling, Results

    • Meta.EventType

      String

      Reliable
      Required

      Type of event. E.g. New, Update

    • 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.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.Sex

      String

      Reliable

      Subscriber's sex. One of the following: Female, Male, Unknown, Other

    • 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. One of the following: Female, Male, Unknown, Other

    • Patient.Demographics.IsHispanic

      Boolean

      Possible

      Indicates if the patient is of hispanic origin.

    • Patient.Demographics.MaritalStatus

      String

      Possible

      Patient's marital status. Supported Values

    • 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.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[].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[].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

      String

      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 BETA
{
   "Meta": {
      "DataModel": "Claim",
      "EventType": "Submission",
      "EventDateTime": "2017-10-10T15:07:21.362Z",
      "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",
      "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": "Asian",
         "IsHispanic": null,
         "MaritalStatus": "Single",
         "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": {
            "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",
               "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"
               }
            }
         ]
      }
   ]
}

PaymentBETAlink

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

  • Meta
    • Meta.DataModel

      String

      Reliable
      Required

      Data model. E.g. Scheduling, Results

    • Meta.EventType

      String

      Reliable
      Required

      Type of event. E.g. New, Update

    • 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

      Numeric

      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

      Numeric

      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. One of the following: Female, Male, Unknown, Other

    • 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

    • 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 BETA
{
   "Meta": {
      "DataModel": "Claim",
      "EventType": "Payment",
      "EventDateTime": "2017-10-10T15:07:21.362Z",
      "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": "Asian",
               "IsHispanic": null,
               "MaritalStatus": "Single",
               "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": "Asian",
               "IsHispanic": null,
               "MaritalStatus": "Single",
               "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": []
               }
            ]
         }
      }
   ]
}