Claim
The Claim data model is used for transactions between a healthcare organization and a payer, which can include a preauthorization for patient services, payment request, claim status, payment details, and the explanation of benefits (EOB).
We support submitting claims and sending payment notifications in batches. Typically, the claims workflow kicks off with healthcare organizations grouping (i.e., batching) and sending claims to payers with details about services rendered to a patient and a request for payment. After processing the claims, payers send batched payment notifications to the healthcare organization with a status of whether the payment request was accepted or denied. In some cases, the status may indicate that a third party transferred funds to the healthcare organization.
The Claim data model differs from the Financial data model in that claims are generally a summary of patient care that's sent or received after an admission or encounter is concluded. If you're looking for handling financial charges on the fly during a patient's care, check out the Financial data model.
SubmissionBatchlink
DEV PREVIEWA healthcare organization can typically use this event type to send claims to a payer. A batch message contains multiple claims with payment requests for multiple patient services in one message.
Fields
Meta
Meta.DataModel
String
ReliableRequiredClaim
Meta.EventType
String
ReliableRequiredSubmissionBatch
Meta.EventDateTime
DateTime
ReliableDisplays the UTC date and time that an outgoing request is delivered or an incoming request is received.
ISO 8601 Format
Meta.Test
Boolean
ReliableIndicates whether the request is a test or not.
Meta.Source
String
ReliableContains the information for the system initiating the message, including the source ID and name.
Included in messages from Redox
Meta.Source.ID
String
ReliableIdentifies the system initiating the message. If you have multiple OAuth API keys per environment type, this value is required. If you have only one OAuth API key per environment type, or you're using legacy API keys, this value is optional.
UUID
Meta.Source.Name
String
ReliableDisplays the name of the system initiating the message.
Meta.Destinations[]
Array of Objects
ReliableContains the information for the endpoint(s) receiving the request. A request must contain at least one destination, but asynchronous requests can have more than one destination. Synchronous requests like queries can only support one destination.
Required when sending data to Redox.
Meta.Destinations[].ID
String
ReliableIdentifies the endpoint that the request is directed to.
UUID
Meta.Destinations[].Name
String
ReliableDisplays the name of the endpoint that the request is directed to.
Meta.Logs[]
Array of Objects
ReliableContains the log identifier(s) for the request.
Meta.Logs[].ID
String
ReliableIdentifies the request log(s) that correspond to this request. You can use this value to locate the relevant log in the Redox dashboard for support and reference.
UUID
Meta.Logs[].AttemptID
String
ReliableIdentifies the request log attempt value, which is useful when retries are possible.
UUID
Meta.FacilityCode
String
PossibleCode 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.
Transactions
Transactions[].ID
String
ReliableID used by submitter to reference this Claim Submission
Transactions[].IDType
String
ReliableType of ID
Transactions[].Type
String
ReliableValueSetThe type of Claim Submission, Institutional or Professional
-
Additional values may be added by Redox in the future.
-
Transactions[].Submitter
Object
ReliableSubmitter of a Claim Submission
Transactions[].Submitter.Identifiers[]
Array of Objects
ReliableList of IDs and ID Types that identify the concept
Transactions[].Submitter.Identifiers[].ID
String
ReliableID for the submitter
Transactions[].Submitter.Identifiers[].IDType
String
ReliableThe type of ID
Transactions[].Submitter.Name
String
Reliable
Transactions[].Submitter.Address
Object
ProbableAddress of the Submitter
Transactions[].Submitter.Address.StreetAddress
String
ProbableStreet address
Transactions[].Submitter.Address.City
String
ProbableCity
Transactions[].Submitter.Address.State
String
ProbableState
Transactions[].Submitter.Address.ZIP
String
ProbableZIP
Transactions[].Submitter.Address.County
String
PossibleCounty
Transactions[].Submitter.Address.Country
String
PossibleValueSetCountry
-
Additional values may be added by Redox in the future.
-
Transactions[].Submitter.EmailAddress
String
Probable
Transactions[].Submitter.PhoneNumber.Office
String
ProbableIn E. 164 Format. (e.g. +16085551234)
Transactions[].Submitter.PhoneNumber.Fax
String
ProbableIn E. 164 Format. (e.g. +16085551234)
Transactions[].Receiver
Object
ReliableReceiver of a Claim Submission
Transactions[].Receiver.Identifiers[]
Array of Objects
ReliableList of IDs and ID Types that identify the concept
Transactions[].Receiver.Identifiers[].ID
String
ReliableID for the receiver
Transactions[].Receiver.Identifiers[].IDType
String
ReliableThe type of ID
Transactions[].Receiver.Name
String
Reliable
Transactions[].Receiver.Address
Object
ProbableAddress of the Receiver
Transactions[].Receiver.Address.StreetAddress
String
ProbableStreet address
Transactions[].Receiver.Address.City
String
ProbableCity
Transactions[].Receiver.Address.State
String
ProbableState
Transactions[].Receiver.Address.ZIP
String
ProbableZIP
Transactions[].Receiver.Address.County
String
PossibleCounty
Transactions[].Receiver.Address.Country
String
PossibleValueSetCountry
-
Additional values may be added by Redox in the future.
-
Transactions[].Receiver.EmailAddress
String
Probable
Transactions[].Receiver.PhoneNumber.Office
String
ProbableIn E. 164 Format. (e.g. +16085551234)
Transactions[].Receiver.PhoneNumber.Fax
String
ProbableIn E. 164 Format. (e.g. +16085551234)
Transactions[].Submissions[]
Array of Objects
ReliableA collection of claims submissions from a provider for services provided to patients.
Transactions[].Submissions[].BillingProvider
Object
ReliableBilling Provider
Transactions[].Submissions[].BillingProvider.Identifiers[]
Array of Objects
ReliableList of IDs and ID Types that identify the concept
Transactions[].Submissions[].BillingProvider.Identifiers[].ID
String
ReliableID for the business
Transactions[].Submissions[].BillingProvider.Identifiers[].IDType
String
ReliableThe type of ID
Transactions[].Submissions[].BillingProvider.Name
String
Reliable
Transactions[].Submissions[].BillingProvider.Address
Object
ProbableAddress of the business
Transactions[].Submissions[].BillingProvider.Address.StreetAddress
String
ProbableStreet address
Transactions[].Submissions[].BillingProvider.Address.City
String
ProbableCity
Transactions[].Submissions[].BillingProvider.Address.State
String
ProbableState
Transactions[].Submissions[].BillingProvider.Address.ZIP
String
ProbableZIP
Transactions[].Submissions[].BillingProvider.Address.County
String
PossibleCounty
Transactions[].Submissions[].BillingProvider.Address.Country
String
PossibleValueSetCountry
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].BillingProvider.EmailAddress
String
Probable
Transactions[].Submissions[].BillingProvider.PhoneNumber.Office
String
ProbableIn E. 164 Format. (e.g. +16085551234)
Transactions[].Submissions[].BillingProvider.PhoneNumber.Fax
String
ProbableIn E. 164 Format. (e.g. +16085551234)
Transactions[].Submissions[].BillingProvider.Specialty.ID
String
ReliableBilling provider's specialty.
Commonly the taxonomy ID
Transactions[].Submissions[].BillingProvider.Specialty.Description
String
ReliableBilling provider's specialty description
Transactions[].Submissions[].Subscribers[]
Array of Objects
PossibleThe subscriber is the individual who is contracted with the insurance plan
Transactions[].Submissions[].Subscribers[].Identifiers[]
Array of Objects
ReliableList of IDs and ID Types that identify the concept
Transactions[].Submissions[].Subscribers[].Identifiers[].ID
String
ReliableID for the subscriber
Transactions[].Submissions[].Subscribers[].Identifiers[].IDType
String
ReliableThe type of ID
Transactions[].Submissions[].Subscribers[].Demographics.FirstName
String
PossibleFirst name of the Subscriber
Transactions[].Submissions[].Subscribers[].Demographics.MiddleName
String
PossibleMiddle name of the Subscriber
Transactions[].Submissions[].Subscribers[].Demographics.LastName
String
PossibleLast name of the Subscriber
Transactions[].Submissions[].Subscribers[].Demographics.Address
Object
PossibleAddress of the Subscriber
Transactions[].Submissions[].Subscribers[].Demographics.Address.StreetAddress
String
PossibleStreet address
Transactions[].Submissions[].Subscribers[].Demographics.Address.City
String
PossibleCity
Transactions[].Submissions[].Subscribers[].Demographics.Address.State
String
PossibleState
Transactions[].Submissions[].Subscribers[].Demographics.Address.ZIP
String
PossibleZIP
Transactions[].Submissions[].Subscribers[].Demographics.Address.County
String
PossibleCounty
Transactions[].Submissions[].Subscribers[].Demographics.Address.Country
String
PossibleValueSetCountry
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Demographics.PhoneNumber.Home
String
PossibleHome phone number.
In E. 164 Format. (e.g. +16085551234)
Transactions[].Submissions[].Subscribers[].Demographics.PhoneNumber.Office
String
PossibleOffice phone number.
In E. 164 Format. (e.g. +16085551234)
Transactions[].Submissions[].Subscribers[].Demographics.PhoneNumber.Mobile
String
ProbableMobile phone number.
In E. 164 Format. (e.g. +16085551234)
Transactions[].Submissions[].Subscribers[].Demographics.DOB
String
ReliableSubscriber's date of birth.
In YYYY-MM-DD format
Transactions[].Submissions[].Subscribers[].Demographics.Sex
String
ReliableValueSetSubscriber's sex
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].OrganizationName
String
ReliableIf the subscriber is not a person, this will contain the organization name
Transactions[].Submissions[].Subscribers[].ResponsibilityLevel
String
ReliableValueSetPayor responsibility level
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Insurance
Array of Objects
Probable
Transactions[].Submissions[].Subscribers[].Insurance.Plan.ID
String
ProbableIdentifier of insurance plan
Transactions[].Submissions[].Subscribers[].Insurance.Plan.IDType
String
ProbableID type of insurance plan
Transactions[].Submissions[].Subscribers[].Insurance.Plan.Name
String
ProbableName of insurance plan
Transactions[].Submissions[].Subscribers[].Insurance.Plan.Type
String
PossibleType of insurance plan
Transactions[].Submissions[].Subscribers[].Insurance.MemberNumber
String
PossiblePatient member number
Transactions[].Submissions[].Subscribers[].Insurance.Company.ID
String
ProbableID of insurance company (payor)
Transactions[].Submissions[].Subscribers[].Insurance.Company.IDType
String
ProbableID type of insurance company (payor)
Transactions[].Submissions[].Subscribers[].Insurance.Company.Name
String
ProbableName of insurance company (payor)
Transactions[].Submissions[].Subscribers[].Insurance.Company.Address
Object
ProbableInsurance company's address
Transactions[].Submissions[].Subscribers[].Insurance.Company.Address.StreetAddress
String
ProbableStreet address
Transactions[].Submissions[].Subscribers[].Insurance.Company.Address.City
String
ProbableCity
Transactions[].Submissions[].Subscribers[].Insurance.Company.Address.State
String
ProbableState
Transactions[].Submissions[].Subscribers[].Insurance.Company.Address.ZIP
String
ProbableZIP
Transactions[].Submissions[].Subscribers[].Insurance.Company.Address.County
String
PossibleCounty
Transactions[].Submissions[].Subscribers[].Insurance.Company.Address.Country
String
PossibleValueSetCountry
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Insurance.Company.PhoneNumber
String
ProbableInsurance companys phone number.
In E. 164 Format (i.e. +16085551234)
Transactions[].Submissions[].Subscribers[].Insurance.GroupNumber
String
ProbableInsurance policy group number
Transactions[].Submissions[].Subscribers[].Insurance.GroupName
String
ProbableInsurance policy group name
Transactions[].Submissions[].Subscribers[].Insurance.EffectiveDate
String
ProbableEffect date of this insurance policy.
In YYYY-MM-DD format
Transactions[].Submissions[].Subscribers[].Insurance.ExpirationDate
String
ProbableExpiration date of this insurance policy.
In YYYY-MM-DD format
Transactions[].Submissions[].Subscribers[].Insurance.PolicyNumber
String
ProbableInsurance policy number
Transactions[].Submissions[].Subscribers[].Insurance.Priority
String
PossibleValueSetThe insurance priority sequence.
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Insurance.AgreementType
String
ProbableValueSetType of insurance agreement.
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Insurance.CoverageType
String
ProbableValueSetType of insurance agreement.
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Patients[].Identifiers[]
Array of Objects
ReliableList of IDs and ID types that identify the patient
Transactions[].Submissions[].Subscribers[].Patients[].Identifiers[].ID
String
ReliableID for the patient
Transactions[].Submissions[].Subscribers[].Patients[].Identifiers[].IDType
String
ReliableType of ID.
E.g. MRN, EPI
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.FirstName
String
ReliablePatient's first name
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.MiddleName
String
PossiblePatient's middle name or middle initial. For patients with multiple middle names, all their middle names are included in this field.
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.LastName
String
ReliablePatient's last name
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.DOB
String
ReliablePatient's date of birth.
In ISO 8601 format
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.SSN
String
ProbablePatient's social security number
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Sex
String
ReliableValueSetPatient's sex
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Race
String
PossibleValueSetPatient's race
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.IsHispanic
Boolean
PossibleValueSetIndicates if the patient is of hispanic origin.
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Religion
String
PossibleValueSetPatient's religious affiliation
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.MaritalStatus
String
PossibleValueSetPatient's marital status
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.IsDeceased
Boolean
PossibleIndicates if the patient is deceased
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.DeathDateTime
DateTime
PossibleDate and Time the patient was proclaimed deceased.
ISO 8601 Format
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.PhoneNumber.Home
String
ProbablePatient's home phone number.
In E. 164 Format. (e.g. +16085551234)
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.PhoneNumber.Office
String
ProbablePatient's office phone number.
In E. 164 Format. (e.g. +16085551234)
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.PhoneNumber.Mobile
String
ProbablePatient's mobile phone number.
In E. 164 Format. (e.g. +16085551234)
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.EmailAddresses[]
Array of Strings
ProbablePatient's email address(es)
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Language
String
PossibleValueSetPatient's primary spoken language
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Citizenship[]
Array of strings
PossibleValueSetPatient's nation(s) of citizenship
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Address
Object
ProbablePatient's home address
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Address.StreetAddress
String
ProbableStreet address
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Address.City
String
ProbableCity
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Address.State
String
ProbableState
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Address.ZIP
String
ProbableZIP
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Address.County
String
PossibleCounty
Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Address.Country
String
PossibleValueSetCountry
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Patients[].Notes[]
Array of strings
PossiblePatient-level notes
Transactions[].Submissions[].Subscribers[].Patients[].RelationToSubscriber
String
ReliableValueSetRelation to the subscriber
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Patients[].Claims[]
Array of Object
ReliableArray of claims for the given subscriber/patient.
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].SubmissionNumber
String
ReliableThis will generally be the claim number sent on the initial claim submission.
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Type
String
ProbableValueSetType of Claim (Institutional only)
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].TotalAmount
String
ProbableTotal amount of all lines on the claim.
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].CopayAmount
String
ProbableAmount the patient has paid or still owes.
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].IsProviderSignatureOnFile
Boolean
ProbableWhether or not the provider signature is on file for the claim.
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].IsReleaseOfInformationOnFile
Boolean
ProbableWhether or not the submitter has a signed ROI form for the patient.
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].ProviderAcceptanceCode
String
PossibleCode indicating whether the provider accepts assignment.
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].BenefitsAssignmentCode
Boolean
ProbableValueSetCode indicates whether the patient has or has not assigned benefits to the provider.
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].AdditionalDates[]
Array of Objects
ProbableCollection of additional dates related to the claim
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].AdditionalDates[].DateTime
String
Probable
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].AdditionalDates[].Type
String
ProbableType of date value.
e.x. Service Period Start (https://ushik.ahrq.gov/ViewItemDetails?system=sdo&itemKey=133121000)
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].ReferenceNumbers[]
Array of Objects
ProbableReference numbers associated to the claim like Prior Auth Number, Member ID, and Provider IDs
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].ReferenceNumbers[].ID
String
ProbableID for the claim
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].ReferenceNumbers[].IDType
String
ProbableThe type of ID
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Diagnoses[].Code
String
ProbableDiagnosis code.
First index in array indicates primary diagnosis
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Diagnoses[].Codeset
String
ProbableCode set used to identify the diagnosis code.
e.x. ICD-10, ICD-9
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Diagnoses[].Description
String
ProbableDiagnosis name
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Diagnoses[].Type
String
ProbableType of diagnosis.
One of the following: Admitting, Working, or Final
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].DiagnosisRelatedGroup
String
ProbableCMS Diagnosis Related Group for an inpatient admission
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].ID
String
PossibleID of the provider.
This ID is often required for Inpatient Visits.
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].IDType
String
PossibleID type of the ID for the provider
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].FirstName
String
PossibleFirst name of the undefined
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].LastName
String
PossibleLast name of the undefined
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Credentials[]
Array of Strings
PossibleList of credentials for the undefined.
e.g. MD, PhD
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Address
Object
PossibleProvider's address
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Address.StreetAddress
String
PossibleStreet address
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Address.City
String
PossibleCity
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Address.State
String
PossibleState
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Address.ZIP
String
PossibleZIP
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Address.County
String
PossibleCounty
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Address.Country
String
PossibleValueSetCountry
-
Additional values may be added by Redox in the future.
-
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].EmailAddresses[]
Array of Strings
ProbableProvider's email address(es)
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].PhoneNumber.Office
String
PossibleProvider's office phone number.
In E. 164 Format. (e.g. +16085551234)
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location
Object
PossibleProvider's location
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.Type
String
PossibleType of location.
Examples: Clinic, Department, Home, Nursing Unit, Provider's Office, Phone
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.Facility
String
PossibleFacility.
Example: Community Hospital
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.FacilityIdentifiers[]
Array of Objects
PossibleList of IDs specific to this facility
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.FacilityIdentifiers[].ID
String
PossibleAn ID specific to this facility
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.FacilityIdentifiers[].IDType
String
PossibleThe source or system to which this ID pertains.
Could be an OID or a human-readable name
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.Department
String
PossibleDepartment
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.DepartmentIdentifiers[]
Array of Objects
PossibleList of IDs specific to this department
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.DepartmentIdentifiers[].ID
String
PossibleAn ID specific to this department
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.DepartmentIdentifiers[].IDType
String
PossibleThe source or system to which this ID pertains.
Could be an OID or a human-readable name
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.Room
String
PossibleRoom.
Example: 136
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Role
String
ProbableThe role this provider has in patient care.
E.x. Attending, Referring, Operating
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Specialty.ID
String
ProbableID of specialty.
Commonly the taxonomy ID
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Specialty.Description
String
ProbableDescription/name of specialty
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[]
Array of Objects
ReliableServices associated with this claim
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Code
String
ProbableCode for the service line
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Codeset
String
ProbableCode set used to identify the service line
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Description
String
ProbableDescription of the service line
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Modifiers[]
String
ProbableArray of service modifiers
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Amount
String
ProbableTotal dollar amount for this line item
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].StartDateTime
String
ProbableWhen the service conveyed began
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].EndDateTime
String
ProbableWhen the service conveyed ended
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].RevenueCode
String
ProbableInstitutional only.
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Quantity.Value
String
ProbableService line quantity.
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Quantity.Units
String
ProbableAssociated units to the quantity
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].IsEmergency
Boolean
ProbableWhether or not this service was performed in an emergency setting.
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].ReferenceNumbers[]
Array of Objects
ProbableReference numbers associated to the claim service line
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].ReferenceNumbers[].ID
String
ProbableID for the service line
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].ReferenceNumbers[].IDType
String
ProbableThe type of ID
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Diagnoses[].Code
String
ProbableDiagnosis code.
First index in array indicates primary diagnosis associated with this service line item.
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Diagnoses[].Codeset
String
ProbableCode set used to identify the diagnosis code.
e.x. ICD-10, ICD-9
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Diagnoses[].Description
String
ProbableDiagnosis name
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Diagnoses[].Type
String
ProbableType of diagnosis.
One of the following: Admitting, Working, or Final
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Drug
Object
ProbableDrug information related to the service of an institutional claim
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Drug.PrescriptionID
String
ProbablePharmacy Prescription ID associated to the the drug
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Drug.NDC
String
ProbableNDC ID
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Drug.Quantity.Value
String
ProbableDrug Quantity
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Drug.Quantity.Units
String
ProbableAssociated Units to the quantity
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Notes
String
ProbableAdditional notes for this line
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.DateTime
String
ProbableDateTime of admission.
ISO 8601 Format
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.DischargeDateTime
String
ProbableDateTime of discharge.
ISO 8601 Format
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location
Object
Probable
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.Type
String
ProbableType of location.
Examples: Clinic, Department, Home, Nursing Unit, Provider's Office, Phone
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.Facility
String
ProbableFacility.
Example: Community Hospital
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.FacilityIdentifiers[]
Array of Objects
ProbableList of IDs specific to this facility
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.FacilityIdentifiers[].ID
String
ProbableAn ID specific to this facility
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.FacilityIdentifiers[].IDType
String
ProbableThe source or system to which this ID pertains.
Could be an OID or a human-readable name
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.Department
String
ProbableDepartment
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.DepartmentIdentifiers[]
Array of Objects
ProbableList of IDs specific to this department
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.DepartmentIdentifiers[].ID
String
ProbableAn ID specific to this department
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.DepartmentIdentifiers[].IDType
String
ProbableThe source or system to which this ID pertains.
Could be an OID or a human-readable name
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.Room
String
ProbableRoom.
Example: 136
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation
Object
Probable
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.Type
String
ProbableType of location.
Examples: Clinic, Department, Home, Nursing Unit, Provider's Office, Phone
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.Facility
String
ProbableFacility.
Example: Community Hospital
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.FacilityIdentifiers[]
Array of Objects
ProbableList of IDs specific to this facility
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.FacilityIdentifiers[].ID
String
ProbableAn ID specific to this facility
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.FacilityIdentifiers[].IDType
String
ProbableThe source or system to which this ID pertains.
Could be an OID or a human-readable name
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.Department
String
ProbableDepartment
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.DepartmentIdentifiers[]
Array of Objects
ProbableList of IDs specific to this department
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.DepartmentIdentifiers[].ID
String
ProbableAn ID specific to this department
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.DepartmentIdentifiers[].IDType
String
ProbableThe source or system to which this ID pertains.
Could be an OID or a human-readable name
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.Room
String
ProbableRoom.
Example: 136
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Type
String
ProbableType of inpatient admission.
Only populated for inpatient admissions. E.x. Elective, Emergency
Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.VisitNumber
String
PossibleVisit Number.
Unique ID of a single visit
{
"Meta": {
"DataModel": "Claim",
"EventType": "SubmissionBatch",
"EventDateTime": "2024-09-26T13:09:20.653Z",
"Test": true,
"Source": {
"ID": "7ce6f387-c33c-417d-8682-81e83628cbd9",
"Name": "Redox Dev Tools"
},
"Destinations": [
{
"ID": "af394f14-b34a-464f-8d24-895f370af4c9",
"Name": "Redox EMR"
}
],
"Logs": [
{
"ID": "d9f5d293-7110-461e-a875-3beb089e79f3",
"AttemptID": "925d1617-2fe0-468c-a14c-f8c04b572c54"
}
],
"FacilityCode": null
},
"Transactions": [
{
"ID": "000000001",
"IDType": null,
"Type": "Institutional",
"Submitter": {
"Identifiers": [
{
"ID": "8675309",
"IDType": "TIN"
}
],
"Name": "Redox Health System",
"Address": {
"StreetAddress": null,
"City": null,
"State": null,
"ZIP": null,
"County": null,
"Country": null
},
"EmailAddress": null,
"PhoneNumber": {
"Office": null,
"Fax": null
}
},
"Receiver": {
"Identifiers": [
{
"ID": "123456",
"IDType": "TIN"
}
],
"Name": "National Insurance Company of Redox",
"Address": {
"StreetAddress": null,
"City": null,
"State": null,
"ZIP": null,
"County": null,
"Country": null
},
"EmailAddress": null,
"PhoneNumber": {
"Office": null,
"Fax": null
}
},
"Submissions": [
{
"BillingProvider": {
"Identifiers": [],
"Name": null,
"Address": {
"StreetAddress": null,
"City": null,
"State": null,
"ZIP": null,
"County": null,
"Country": null
},
"EmailAddress": null,
"PhoneNumber": {
"Office": null,
"Fax": null
},
"Specialty": {
"ID": null,
"Description": null
}
},
"Subscribers": [
{
"Identifiers": [
{
"ID": "0000000001",
"IDType": "MR"
},
{
"ID": "e167267c-16c9-4fe3-96ae-9cff5703e90a",
"IDType": "EHRID"
},
{
"ID": "a1d4ee8aba494ca",
"IDType": "NIST"
}
],
"Demographics": {
"FirstName": "Timothy",
"MiddleName": "Paul",
"LastName": "Bixby",
"Address": {
"StreetAddress": "4762 Hickory Street",
"City": "Monroe",
"State": "WI",
"ZIP": "53566",
"County": "Green",
"Country": "US"
},
"PhoneNumber": {
"Home": "+18088675301",
"Office": null,
"Mobile": null
},
"DOB": "2008-01-06",
"Sex": "Male"
},
"OrganizationName": null,
"ResponsibilityLevel": "Primary",
"Insurance": {
"Plan": {
"ID": "31572",
"IDType": "Payor ID",
"Name": "HMO Deductible 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",
"Priority": null,
"AgreementType": null,
"CoverageType": null
},
"Patients": [
{
"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,
"Religion": 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": [],
"RelationToSubscriber": null,
"Claims": [
{
"SubmissionNumber": "66729659983",
"Type": "Admit Through Discharge",
"TotalAmount": "200.00",
"CopayAmount": "10.00",
"IsProviderSignatureOnFile": true,
"IsReleaseOfInformationOnFile": true,
"ProviderAcceptanceCode": null,
"BenefitsAssignmentCode": null,
"AdditionalDates": [
{
"DateTime": "2016-10-08",
"Type": "Service Period Start"
},
{
"DateTime": "2016-10-11",
"Type": "Service Period End"
}
],
"ReferenceNumbers": [
{
"ID": "AUTH000000",
"IDType": "Prior Authorization"
}
],
"Diagnoses": [
{
"Code": "M54.5",
"Codeset": "ICD-10",
"Description": null,
"Type": "Admitting"
},
{
"Code": "J45.909",
"Codeset": "ICD-10",
"Description": null,
"Type": null
}
],
"DiagnosisRelatedGroup": "551",
"Providers": [
{
"ID": "4236464757",
"IDType": "NPI",
"FirstName": "John",
"LastName": "Slate",
"Credentials": [
"DO"
],
"Address": {
"StreetAddress": "500 First St.",
"City": "Clayton",
"State": "MO",
"ZIP": "63105",
"County": "Saint Louis",
"Country": "USA"
},
"EmailAddresses": [],
"PhoneNumber": {
"Office": null
},
"Location": {
"Type": null,
"Facility": null,
"FacilityIdentifiers": [],
"Department": null,
"DepartmentIdentifiers": [],
"Room": null
},
"Role": "Attending",
"Specialty": {
"ID": "1223G0001X",
"Description": "General Practice"
}
}
],
"Services": [
{
"Code": "73560",
"Codeset": null,
"Description": "X-Ray knee 1 or 2 views",
"Modifiers": [],
"Amount": "100.00",
"StartDateTime": null,
"EndDateTime": null,
"RevenueCode": null,
"Quantity": {
"Value": 1,
"Units": "Unit"
},
"IsEmergency": false,
"ReferenceNumbers": [
{
"ID": "1",
"IDType": "Control Number"
}
],
"Diagnoses": [],
"Drug": {
"PrescriptionID": null,
"NDC": null,
"Quantity": {
"Value": null,
"Units": null
}
},
"Notes": null
},
{
"Code": "J9202",
"Codeset": "HCPCS",
"Description": "Zoladex",
"Modifiers": [],
"Amount": "3.50",
"StartDateTime": null,
"EndDateTime": null,
"RevenueCode": null,
"Quantity": {
"Value": "1",
"Units": "Unit"
},
"IsEmergency": false,
"ReferenceNumbers": [
{
"ID": "2",
"IDType": "Control Number"
}
],
"Diagnoses": [],
"Drug": {
"PrescriptionID": "ABC123456",
"NDC": "00310095036",
"Quantity": {
"Value": "1",
"Units": "Unit"
}
},
"Notes": null
}
],
"Visit": {
"DateTime": "2016-10-08",
"DischargeDateTime": "2016-10-11",
"Location": {
"Type": "Inpatient",
"Facility": "RES General Hospital",
"FacilityIdentifiers": [],
"Department": "3N",
"DepartmentIdentifiers": [],
"Room": "136"
},
"PreviousLocation": {
"Type": "Critical Access Hospital",
"Facility": null,
"FacilityIdentifiers": [],
"Department": null,
"DepartmentIdentifiers": [],
"Room": null
},
"Type": "Elective",
"VisitNumber": null
}
}
]
}
]
}
]
}
]
}
]
}
PaymentBatchlink
DEV PREVIEWA payer can typically use this event type to send payment notifications or statuses to a healthcare organization. For statuses, a payment notification could confirm if funds were transferred from a third party to the healthcare organization, or if a payment request was denied. A batch message contains multiple payment notifications for multiple claims in one message.
Fields
Meta
Meta.DataModel
String
ReliableRequiredClaim
Meta.EventType
String
ReliableRequiredPaymentBatch
Meta.EventDateTime
DateTime
ReliableDisplays the UTC date and time that an outgoing request is delivered or an incoming request is received.
ISO 8601 Format
Meta.Test
Boolean
ReliableIndicates whether the request is a test or not.
Meta.Source
String
ReliableContains the information for the system initiating the message, including the source ID and name.
Included in messages from Redox
Meta.Source.ID
String
ReliableIdentifies the system initiating the message. If you have multiple OAuth API keys per environment type, this value is required. If you have only one OAuth API key per environment type, or you're using legacy API keys, this value is optional.
UUID
Meta.Source.Name
String
ReliableDisplays the name of the system initiating the message.
Meta.Destinations[]
Array of Objects
ReliableContains the information for the endpoint(s) receiving the request. A request must contain at least one destination, but asynchronous requests can have more than one destination. Synchronous requests like queries can only support one destination.
Required when sending data to Redox.
Meta.Destinations[].ID
String
ReliableIdentifies the endpoint that the request is directed to.
UUID
Meta.Destinations[].Name
String
ReliableDisplays the name of the endpoint that the request is directed to.
Meta.Logs[]
Array of Objects
ReliableContains the log identifier(s) for the request.
Meta.Logs[].ID
String
ReliableIdentifies the request log(s) that correspond to this request. You can use this value to locate the relevant log in the Redox dashboard for support and reference.
UUID
Meta.Logs[].AttemptID
String
ReliableIdentifies the request log attempt value, which is useful when retries are possible.
UUID
Meta.FacilityCode
String
PossibleCode 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.
Transactions
Transactions[].ID
String
ReliableID used by submitter to reference this Claims
Transactions[].IDType
String
ReliableType of ID
Transactions[].Type
String
ReliableValueSetThe type of Claims, Institutional or Professional
-
Additional values may be added by Redox in the future.
-
Transactions[].TotalPaymentAmount
String
ProbableThe total amount of all of the payments listed in the Payments array.
Redox recommends sending it as an additional layer of validation.
Transactions[].CreditOrDebit
String
ProbableValueSetA flag indicating whether the monetary amount in Transaction.TotalPaymentAmount is a credit or debit.
-
Additional values may be added by Redox in the future.
-
Transactions[].PaymentMethod
String
ProbableValueSetHow the payment was/will be transferred.
-
Additional values may be added by Redox in the future.
-
Transactions[].PaymentDateTime
String
ProbableWhen 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. ISO 8601 Format
Transactions[].TrackingNumber
String
ProbableA 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.
Transactions[].Submitter
Object
ReliableSubmitter of a Claims
Transactions[].Submitter.Identifiers[]
Array of Objects
ReliableList of IDs and ID Types that identify the concept
Transactions[].Submitter.Identifiers[].ID
String
ReliableID for the submitter
Transactions[].Submitter.Identifiers[].IDType
String
ReliableThe type of ID
Transactions[].Submitter.Name
String
Reliable
Transactions[].Submitter.Address
Object
ProbableAddress of the Submitter
Transactions[].Submitter.Address.StreetAddress
String
ProbableStreet address
Transactions[].Submitter.Address.City
String
ProbableCity
Transactions[].Submitter.Address.State
String
ProbableState
Transactions[].Submitter.Address.ZIP
String
ProbableZIP
Transactions[].Submitter.Address.County
String
PossibleCounty
Transactions[].Submitter.Address.Country
String
PossibleValueSetCountry
-
Additional values may be added by Redox in the future.
-
Transactions[].Submitter.EmailAddress
String
Probable
Transactions[].Submitter.PhoneNumber.Office
String
ProbableIn E. 164 Format. (e.g. +16085551234)
Transactions[].Submitter.PhoneNumber.Fax
String
ProbableIn E. 164 Format. (e.g. +16085551234)
Transactions[].Receiver
Object
ReliableReceiver of a Claims
Transactions[].Receiver.Identifiers[]
Array of Objects
ReliableList of IDs and ID Types that identify the concept
Transactions[].Receiver.Identifiers[].ID
String
ReliableID for the receiver
Transactions[].Receiver.Identifiers[].IDType
String
ReliableThe type of ID
Transactions[].Receiver.Name
String
Reliable
Transactions[].Receiver.Address
Object
ProbableAddress of the Receiver
Transactions[].Receiver.Address.StreetAddress
String
ProbableStreet address
Transactions[].Receiver.Address.City
String
ProbableCity
Transactions[].Receiver.Address.State
String
ProbableState
Transactions[].Receiver.Address.ZIP
String
ProbableZIP
Transactions[].Receiver.Address.County
String
PossibleCounty
Transactions[].Receiver.Address.Country
String
PossibleValueSetCountry
-
Additional values may be added by Redox in the future.
-
Transactions[].Receiver.EmailAddress
String
Probable
Transactions[].Receiver.PhoneNumber.Office
String
ProbableIn E. 164 Format. (e.g. +16085551234)
Transactions[].Receiver.PhoneNumber.Fax
String
ProbableIn E. 164 Format. (e.g. +16085551234)
Transactions[].Payments[]
Array of Objects
Probable
Transactions[].Payments[].DateTime
String
ProbableThe DateTime this payment was processed.
ISO 8601 Format
Transactions[].Payments[].Patient.Identifiers[]
Array of Objects
ReliableList of IDs and ID types that identify the patient
Transactions[].Payments[].Patient.Identifiers[].ID
String
ReliableID for the patient
Transactions[].Payments[].Patient.Identifiers[].IDType
String
ReliableType of ID.
E.g. MRN, EPI
Transactions[].Payments[].Patient.Demographics.FirstName
String
ReliablePatient's first name
Transactions[].Payments[].Patient.Demographics.MiddleName
String
PossiblePatient's middle name or middle initial. For patients with multiple middle names, all their middle names are included in this field.
Transactions[].Payments[].Patient.Demographics.LastName
String
ReliablePatient's last name
Transactions[].Payments[].Patient.Demographics.DOB
String
ReliablePatient's date of birth.
In ISO 8601 format
Transactions[].Payments[].Patient.Demographics.SSN
String
ProbablePatient's social security number
Transactions[].Payments[].Patient.Demographics.Sex
String
ReliableValueSetPatient's sex
-
Additional values may be added by Redox in the future.
-
Transactions[].Payments[].Patient.Demographics.Race
String
PossibleValueSetPatient's race
-
Additional values may be added by Redox in the future.
-
Transactions[].Payments[].Patient.Demographics.IsHispanic
Boolean
PossibleValueSetIndicates if the patient is of hispanic origin.
-
Additional values may be added by Redox in the future.
-
Transactions[].Payments[].Patient.Demographics.Religion
String
PossibleValueSetPatient's religious affiliation
-
Additional values may be added by Redox in the future.
-
Transactions[].Payments[].Patient.Demographics.MaritalStatus
String
PossibleValueSetPatient's marital status
-
Additional values may be added by Redox in the future.
-
Transactions[].Payments[].Patient.Demographics.IsDeceased
Boolean
PossibleIndicates if the patient is deceased
Transactions[].Payments[].Patient.Demographics.DeathDateTime
DateTime
PossibleDate and Time the patient was proclaimed deceased.
ISO 8601 Format
Transactions[].Payments[].Patient.Demographics.PhoneNumber.Home
String
ProbablePatient's home phone number.
In E. 164 Format. (e.g. +16085551234)
Transactions[].Payments[].Patient.Demographics.PhoneNumber.Office
String
ProbablePatient's office phone number.
In E. 164 Format. (e.g. +16085551234)
Transactions[].Payments[].Patient.Demographics.PhoneNumber.Mobile
String
ProbablePatient's mobile phone number.
In E. 164 Format. (e.g. +16085551234)
Transactions[].Payments[].Patient.Demographics.EmailAddresses[]
Array of Strings
ProbablePatient's email address(es)
Transactions[].Payments[].Patient.Demographics.Language
String
PossibleValueSetPatient's primary spoken language
-
Additional values may be added by Redox in the future.
-
Transactions[].Payments[].Patient.Demographics.Citizenship[]
Array of strings
PossibleValueSetPatient's nation(s) of citizenship
-
Additional values may be added by Redox in the future.
-
Transactions[].Payments[].Patient.Demographics.Address
Object
ProbablePatient's home address
Transactions[].Payments[].Patient.Demographics.Address.StreetAddress
String
ProbableStreet address
Transactions[].Payments[].Patient.Demographics.Address.City
String
ProbableCity
Transactions[].Payments[].Patient.Demographics.Address.State
String
ProbableState
Transactions[].Payments[].Patient.Demographics.Address.ZIP
String
ProbableZIP
Transactions[].Payments[].Patient.Demographics.Address.County
String
PossibleCounty
Transactions[].Payments[].Patient.Demographics.Address.Country
String
PossibleValueSetCountry
-
Additional values may be added by Redox in the future.
-
Transactions[].Payments[].Patient.Notes[]
Array of strings
PossiblePatient-level notes
Transactions[].Payments[].Claims[]
Array of Objects
Probable
Transactions[].Payments[].Claims[].ControlNumber
String
ReliableThe Payer's reference number
Transactions[].Payments[].Claims[].SubmissionNumber
String
ReliableThis will generally be the claim number sent on the initial claim submission.
Transactions[].Payments[].Claims[].ReceivedDate
String
ProbableDate the claim was submitted.
ISO 8601 Format
Transactions[].Payments[].Claims[].StartDateTime
String
ProbableDate the statement period started.
ISO 8601 Format
Transactions[].Payments[].Claims[].EndDateTime
String
ProbableDate the statement period ended.
ISO 8601 Format
Transactions[].Payments[].Claims[].Status
String
ReliableValueSetStatus of the claim
-
Additional values may be added by Redox in the future.
-
Transactions[].Payments[].Claims[].ChargedAmount
String
ReliableTotal monetary amount of the claim
Transactions[].Payments[].Claims[].PaymentAmount
String
ProbableMonetary amount of the claim paid
Transactions[].Payments[].Claims[].PatientResponsibilityAmount
String
ReliableMonetary amount of the claim the patient is responsible for
Transactions[].Payments[].Claims[].ReferenceNumbers[]
Array of Objects
ProbableReference numbers associated to the claim like Prior Auth Number, Member ID, and Provider IDs
Transactions[].Payments[].Claims[].ReferenceNumbers[].ID
String
ProbableID for the claim
Transactions[].Payments[].Claims[].ReferenceNumbers[].IDType
String
ProbableThe type of ID
Transactions[].Payments[].Claims[].Adjustments[]
Object
ReliableAdjustments explain why a claim was paid differently than it was billed.
Adjustments may not exist at the claim level if they exist at the service level
Transactions[].Payments[].Claims[].Adjustments[].Amount
String
ProbableMonetary amount of the adjustment.
A negative number indicates a payment increase, while a positive number indicates a payment reduction.
Transactions[].Payments[].Claims[].Adjustments[].Quantity
String
Probable
Transactions[].Payments[].Claims[].Adjustments[].Type
String
ProbableValueSetType of Adjustment
-
Additional values may be added by Redox in the future.
-
Transactions[].Payments[].Claims[].Adjustments[].Reason
String
ProbableValueSetAdjustment reason
-
Additional values may be added by Redox in the future.
-
Transactions[].Payments[].Claims[].Services[]
String
ProbableThis array will provide additional detail for claims processed at the line level.
Transactions[].Payments[].Claims[].Services[].ChargedAmount
String
ProbableThe monetory amount charged
Transactions[].Payments[].Claims[].Services[].PaymentAmount
String
ReliableThe monetory amount paid
Transactions[].Payments[].Claims[].Services[].ChargedUnits
String
ProbableThe number of units of service charged for
Transactions[].Payments[].Claims[].Services[].PaymentUnits
String
ProbableThe number of units of service paid for
Transactions[].Payments[].Claims[].Services[].AllowedAmount
String
ReliableMaximum monetary amount of payment
Transactions[].Payments[].Claims[].Services[].SubmittedService
Object
ProbableSubmitted service information
Transactions[].Payments[].Claims[].Services[].SubmittedService.Code
String
ProbableCode for the submitted service
Transactions[].Payments[].Claims[].Services[].SubmittedService.Codeset
String
ProbableCode set used to identify the submitted service
Transactions[].Payments[].Claims[].Services[].SubmittedService.Description
String
ProbableDescription of the submitted service
Transactions[].Payments[].Claims[].Services[].SubmittedService.Modifiers[]
String
ProbableArray of modifiers
Transactions[].Payments[].Claims[].Services[].AdjudicatedService
Object
ProbableAdjudicated service information
Transactions[].Payments[].Claims[].Services[].AdjudicatedService.Code
String
ProbableCode for the adjudicated service
Transactions[].Payments[].Claims[].Services[].AdjudicatedService.Codeset
String
ProbableCode set used to identify the adjudicated service
Transactions[].Payments[].Claims[].Services[].AdjudicatedService.Description
String
ProbableDescription of the adjudicated service
Transactions[].Payments[].Claims[].Services[].AdjudicatedService.Modifiers[]
String
ProbableArray of modifiers
Transactions[].Payments[].Claims[].Services[].Adjustments[]
Object
ReliableAdjustments explain why a claim was paid differently than it was billed.
Transactions[].Payments[].Claims[].Services[].Adjustments[].Amount
String
ProbableMonetary amount of the adjustment.
A negative number indicates a payment increase, while a positive number indicates a payment reduction.
Transactions[].Payments[].Claims[].Services[].Adjustments[].Quantity
String
Probable
Transactions[].Payments[].Claims[].Services[].Adjustments[].Type
String
ProbableValueSetType of Adjustment
-
Additional values may be added by Redox in the future.
-
Transactions[].Payments[].Claims[].Services[].Adjustments[].Reason
String
ProbableValueSetAdjustment reason
-
Additional values may be added by Redox in the future.
-
Transactions[].Payments[].Claims[].Services[].StartDateTime
String
ProbableDate the claim was submitted.
ISO 8601 Format
Transactions[].Payments[].Claims[].Services[].EndDateTime
String
ProbableDate the statement period started.
ISO 8601 Format
Transactions[].Payments[].Claims[].Services[].ReferenceNumbers[]
Array of Objects
ProbableReference numbers associated to the claim service line
Transactions[].Payments[].Claims[].Services[].ReferenceNumbers[].ID
String
ProbableID for the service line
Transactions[].Payments[].Claims[].Services[].ReferenceNumbers[].IDType
String
ProbableThe type of ID
{
"Meta": {
"DataModel": "Claim",
"EventType": "PaymentBatch",
"EventDateTime": "2024-09-26T13:09:20.653Z",
"Test": true,
"Source": {
"ID": "7ce6f387-c33c-417d-8682-81e83628cbd9",
"Name": "Redox Dev Tools"
},
"Destinations": [
{
"ID": "af394f14-b34a-464f-8d24-895f370af4c9",
"Name": "Redox EMR"
}
],
"Logs": [
{
"ID": "d9f5d293-7110-461e-a875-3beb089e79f3",
"AttemptID": "925d1617-2fe0-468c-a14c-f8c04b572c54"
}
],
"FacilityCode": null
},
"Transactions": [
{
"ID": "000000001",
"IDType": null,
"Type": "Profressional",
"TotalPaymentAmount": "580.00",
"CreditOrDebit": "Credit",
"PaymentMethod": "Check",
"PaymentDateTime": "2016-11-11T02:11:03.111Z",
"TrackingNumber": "8675309",
"Submitter": {
"Identifiers": [
{
"ID": "123456",
"IDType": "TIN"
}
],
"Name": "National Insurance Company of Redox",
"Address": {
"StreetAddress": null,
"City": null,
"State": null,
"ZIP": null,
"County": null,
"Country": null
},
"EmailAddress": null,
"PhoneNumber": {
"Office": null,
"Fax": null
}
},
"Receiver": {
"Identifiers": [
{
"ID": "8675309",
"IDType": "TIN"
}
],
"Name": "Redox Health System",
"Address": {
"StreetAddress": null,
"City": null,
"State": null,
"ZIP": null,
"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,
"Religion": 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": []
},
"Claims": [
{
"ControlNumber": "94151100100",
"SubmissionNumber": "66729659983",
"ReceivedDate": "2016-10-31",
"StartDateTime": null,
"EndDateTime": null,
"Status": "Processed as Primary",
"ChargedAmount": "100.00",
"PaymentAmount": "65.00",
"PatientResponsibilityAmount": "20.00",
"ReferenceNumbers": [
{
"ID": "AUTH000000",
"IDType": "Prior Authorization"
}
],
"Adjustments": [],
"Services": [
{
"ChargedAmount": "100.00",
"PaymentAmount": "65.00",
"ChargedUnits": null,
"PaymentUnits": null,
"AllowedAmount": "85.00",
"SubmittedService": {
"Code": null,
"Codeset": null,
"Description": null,
"Modifiers": []
},
"AdjudicatedService": {
"Code": null,
"Codeset": null,
"Description": null,
"Modifiers": []
},
"Adjustments": [
{
"Amount": "20.00",
"Quantity": null,
"Type": "Patient responsibility",
"Reason": "Deductible amount"
},
{
"Amount": "15.00",
"Quantity": null,
"Type": "Contractual obligations",
"Reason": "Claim specific negotiated discount"
}
],
"StartDateTime": null,
"EndDateTime": null,
"ReferenceNumbers": [
{
"ID": "1",
"IDType": "Control Number"
}
]
}
]
}
]
},
{
"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,
"Religion": 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": []
},
"Claims": [
{
"ControlNumber": "94151100200",
"SubmissionNumber": "774466586",
"ReceivedDate": "2016-10-31",
"StartDateTime": null,
"EndDateTime": null,
"Status": "Processed as Primary",
"ChargedAmount": "100.00",
"PaymentAmount": "75.00",
"PatientResponsibilityAmount": "20.00",
"ReferenceNumbers": [
{
"ID": "AUTH000000",
"IDType": "Prior Authorization"
}
],
"Adjustments": [],
"Services": [
{
"ChargedAmount": "100.00",
"PaymentAmount": "75.00",
"ChargedUnits": null,
"PaymentUnits": null,
"AllowedAmount": "95.00",
"SubmittedService": {
"Code": null,
"Codeset": null,
"Description": null,
"Modifiers": []
},
"AdjudicatedService": {
"Code": null,
"Codeset": null,
"Description": null,
"Modifiers": []
},
"Adjustments": [
{
"Amount": "20.00",
"Quantity": null,
"Type": "Patient responsibility",
"Reason": "Deductible amount"
},
{
"Amount": "5.00",
"Quantity": null,
"Type": "Contractual obligations",
"Reason": "Claim specific negotiated discount"
}
],
"StartDateTime": null,
"EndDateTime": null,
"ReferenceNumbers": [
{
"ID": "1",
"IDType": "Control Number"
}
]
}
]
}
]
}
]
}
]
}