Redox | Claim

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.

SubmissionBatch
PaymentBatch

SubmissionBatch

DEV PREVIEW

A 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

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Meta
- Meta.DataModel
  String
  Reliable
  Required
  Claim
- Meta.EventType
  String
  Reliable
  Required
  SubmissionBatch
- Meta.EventDateTime
  DateTime
  Reliable
  Displays the UTC date and time that an outgoing request is delivered or an incoming request is received.
  ISO 8601 Format
- Meta.Test
  Boolean
  Reliable
  Indicates whether the request is a test or not.
- Meta.Source
  String
  Reliable
  Contains the information for the system initiating the message, including the source ID and name.
  Included in messages from Redox
- Meta.Source.ID
  String
  Reliable
  Identifies 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
  Reliable
  Displays the name of the system initiating the message.
- Meta.Destinations[]
  Array of Objects
  Reliable
  Contains 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
  Reliable
  Identifies the endpoint that the request is directed to.
  UUID
- Meta.Destinations[].Name
  String
  Reliable
  Displays the name of the endpoint that the request is directed to.
- Meta.Logs[]
  Array of Objects
  Reliable
  Contains the log identifier(s) for the request.
- Meta.Logs[].ID
  String
  Reliable
  Identifies 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
  Reliable
  Identifies the request log attempt value, which is useful when retries are possible.
  UUID
- 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.
Transactions
- Transactions[].ID
  String
  Reliable
  ID used by submitter to reference this Claim Submission
- Transactions[].IDType
  String
  Reliable
  Type of ID
- Transactions[].Type
  String
  Reliable
  ValueSet
  The type of Claim Submission, Institutional or Professional
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submitter
  Object
  Reliable
  Submitter of a Claim Submission
- Transactions[].Submitter.Identifiers[]
  Array of Objects
  Reliable
  List of IDs and ID Types that identify the concept
- Transactions[].Submitter.Identifiers[].ID
  String
  Reliable
  ID for the submitter
- Transactions[].Submitter.Identifiers[].IDType
  String
  Reliable
  The type of ID
- Transactions[].Submitter.Name
  String
  Reliable
- Transactions[].Submitter.Address
  Object
  Probable
  Address of the Submitter
- Transactions[].Submitter.Address.StreetAddress
  String
  Probable
  Street address
- Transactions[].Submitter.Address.City
  String
  Probable
  City
- Transactions[].Submitter.Address.State
  String
  Probable
  State
- Transactions[].Submitter.Address.ZIP
  String
  Probable
  ZIP
- Transactions[].Submitter.Address.County
  String
  Possible
  County
- Transactions[].Submitter.Address.Country
  String
  Possible
  ValueSet
  Country
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submitter.EmailAddress
  String
  Probable
- Transactions[].Submitter.PhoneNumber.Office
  String
  Probable
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Submitter.PhoneNumber.Fax
  String
  Probable
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Receiver
  Object
  Reliable
  Receiver of a Claim Submission
- Transactions[].Receiver.Identifiers[]
  Array of Objects
  Reliable
  List of IDs and ID Types that identify the concept
- Transactions[].Receiver.Identifiers[].ID
  String
  Reliable
  ID for the receiver
- Transactions[].Receiver.Identifiers[].IDType
  String
  Reliable
  The type of ID
- Transactions[].Receiver.Name
  String
  Reliable
- Transactions[].Receiver.Address
  Object
  Probable
  Address of the Receiver
- Transactions[].Receiver.Address.StreetAddress
  String
  Probable
  Street address
- Transactions[].Receiver.Address.City
  String
  Probable
  City
- Transactions[].Receiver.Address.State
  String
  Probable
  State
- Transactions[].Receiver.Address.ZIP
  String
  Probable
  ZIP
- Transactions[].Receiver.Address.County
  String
  Possible
  County
- Transactions[].Receiver.Address.Country
  String
  Possible
  ValueSet
  Country
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Receiver.EmailAddress
  String
  Probable
- Transactions[].Receiver.PhoneNumber.Office
  String
  Probable
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Receiver.PhoneNumber.Fax
  String
  Probable
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Submissions[]
  Array of Objects
  Reliable
  A collection of claims submissions from a provider for services provided to patients.
- Transactions[].Submissions[].BillingProvider
  Object
  Reliable
  Billing Provider
- Transactions[].Submissions[].BillingProvider.Identifiers[]
  Array of Objects
  Reliable
  List of IDs and ID Types that identify the concept
- Transactions[].Submissions[].BillingProvider.Identifiers[].ID
  String
  Reliable
  ID for the business
- Transactions[].Submissions[].BillingProvider.Identifiers[].IDType
  String
  Reliable
  The type of ID
- Transactions[].Submissions[].BillingProvider.Name
  String
  Reliable
- Transactions[].Submissions[].BillingProvider.Address
  Object
  Probable
  Address of the business
- Transactions[].Submissions[].BillingProvider.Address.StreetAddress
  String
  Probable
  Street address
- Transactions[].Submissions[].BillingProvider.Address.City
  String
  Probable
  City
- Transactions[].Submissions[].BillingProvider.Address.State
  String
  Probable
  State
- Transactions[].Submissions[].BillingProvider.Address.ZIP
  String
  Probable
  ZIP
- Transactions[].Submissions[].BillingProvider.Address.County
  String
  Possible
  County
- Transactions[].Submissions[].BillingProvider.Address.Country
  String
  Possible
  ValueSet
  Country
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].BillingProvider.EmailAddress
  String
  Probable
- Transactions[].Submissions[].BillingProvider.PhoneNumber.Office
  String
  Probable
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Submissions[].BillingProvider.PhoneNumber.Fax
  String
  Probable
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Submissions[].BillingProvider.Specialty.ID
  String
  Reliable
  Billing provider's specialty.
  Commonly the taxonomy ID
- Transactions[].Submissions[].BillingProvider.Specialty.Description
  String
  Reliable
  Billing provider's specialty description
- Transactions[].Submissions[].Subscribers[]
  Array of Objects
  Possible
  The subscriber is the individual who is contracted with the insurance plan
- Transactions[].Submissions[].Subscribers[].Identifiers[]
  Array of Objects
  Reliable
  List of IDs and ID Types that identify the concept
- Transactions[].Submissions[].Subscribers[].Identifiers[].ID
  String
  Reliable
  ID for the subscriber
- Transactions[].Submissions[].Subscribers[].Identifiers[].IDType
  String
  Reliable
  The type of ID
- Transactions[].Submissions[].Subscribers[].Demographics.FirstName
  String
  Possible
  First name of the Subscriber
- Transactions[].Submissions[].Subscribers[].Demographics.MiddleName
  String
  Possible
  Middle name of the Subscriber
- Transactions[].Submissions[].Subscribers[].Demographics.LastName
  String
  Possible
  Last name of the Subscriber
- Transactions[].Submissions[].Subscribers[].Demographics.Address
  Object
  Possible
  Address of the Subscriber
- Transactions[].Submissions[].Subscribers[].Demographics.Address.StreetAddress
  String
  Possible
  Street address
- Transactions[].Submissions[].Subscribers[].Demographics.Address.City
  String
  Possible
  City
- Transactions[].Submissions[].Subscribers[].Demographics.Address.State
  String
  Possible
  State
- Transactions[].Submissions[].Subscribers[].Demographics.Address.ZIP
  String
  Possible
  ZIP
- Transactions[].Submissions[].Subscribers[].Demographics.Address.County
  String
  Possible
  County
- Transactions[].Submissions[].Subscribers[].Demographics.Address.Country
  String
  Possible
  ValueSet
  Country
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Demographics.PhoneNumber.Home
  String
  Possible
  Home phone number.
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Submissions[].Subscribers[].Demographics.PhoneNumber.Office
  String
  Possible
  Office phone number.
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Submissions[].Subscribers[].Demographics.PhoneNumber.Mobile
  String
  Probable
  Mobile phone number.
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Submissions[].Subscribers[].Demographics.DOB
  String
  Reliable
  Subscriber's date of birth.
  In YYYY-MM-DD format
- Transactions[].Submissions[].Subscribers[].Demographics.Sex
  String
  Reliable
  ValueSet
  Subscriber's sex
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].OrganizationName
  String
  Reliable
  If the subscriber is not a person, this will contain the organization name
- Transactions[].Submissions[].Subscribers[].ResponsibilityLevel
  String
  Reliable
  ValueSet
  Payor responsibility level
  
  Supported Values
  
  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
  Probable
  Identifier of insurance plan
- Transactions[].Submissions[].Subscribers[].Insurance.Plan.IDType
  String
  Probable
  ID type of insurance plan
- Transactions[].Submissions[].Subscribers[].Insurance.Plan.Name
  String
  Probable
  Name of insurance plan
- Transactions[].Submissions[].Subscribers[].Insurance.Plan.Type
  String
  Possible
  Type of insurance plan
- Transactions[].Submissions[].Subscribers[].Insurance.MemberNumber
  String
  Possible
  Patient member number
- Transactions[].Submissions[].Subscribers[].Insurance.Company.ID
  String
  Probable
  ID of insurance company (payor)
- Transactions[].Submissions[].Subscribers[].Insurance.Company.IDType
  String
  Probable
  ID type of insurance company (payor)
- Transactions[].Submissions[].Subscribers[].Insurance.Company.Name
  String
  Probable
  Name of insurance company (payor)
- Transactions[].Submissions[].Subscribers[].Insurance.Company.Address
  Object
  Probable
  Insurance company's address
- Transactions[].Submissions[].Subscribers[].Insurance.Company.Address.StreetAddress
  String
  Probable
  Street address
- Transactions[].Submissions[].Subscribers[].Insurance.Company.Address.City
  String
  Probable
  City
- Transactions[].Submissions[].Subscribers[].Insurance.Company.Address.State
  String
  Probable
  State
- Transactions[].Submissions[].Subscribers[].Insurance.Company.Address.ZIP
  String
  Probable
  ZIP
- Transactions[].Submissions[].Subscribers[].Insurance.Company.Address.County
  String
  Possible
  County
- Transactions[].Submissions[].Subscribers[].Insurance.Company.Address.Country
  String
  Possible
  ValueSet
  Country
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Insurance.Company.PhoneNumber
  String
  Probable
  Insurance companys phone number.
  In E. 164 Format (i.e. +16085551234)
- Transactions[].Submissions[].Subscribers[].Insurance.GroupNumber
  String
  Probable
  Insurance policy group number
- Transactions[].Submissions[].Subscribers[].Insurance.GroupName
  String
  Probable
  Insurance policy group name
- Transactions[].Submissions[].Subscribers[].Insurance.EffectiveDate
  String
  Probable
  Effect date of this insurance policy.
  In YYYY-MM-DD format
- Transactions[].Submissions[].Subscribers[].Insurance.ExpirationDate
  String
  Probable
  Expiration date of this insurance policy.
  In YYYY-MM-DD format
- Transactions[].Submissions[].Subscribers[].Insurance.PolicyNumber
  String
  Probable
  Insurance policy number
- Transactions[].Submissions[].Subscribers[].Insurance.Priority
  String
  Possible
  ValueSet
  The insurance priority sequence.
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Insurance.AgreementType
  String
  Probable
  ValueSet
  Type of insurance agreement.
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Insurance.CoverageType
  String
  Probable
  ValueSet
  Type of insurance agreement.
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Patients[].Identifiers[]
  Array of Objects
  Reliable
  List of IDs and ID types that identify the patient
- Transactions[].Submissions[].Subscribers[].Patients[].Identifiers[].ID
  String
  Reliable
  ID for the patient
- Transactions[].Submissions[].Subscribers[].Patients[].Identifiers[].IDType
  String
  Reliable
  Type of ID.
  E.g. MRN, EPI
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.FirstName
  String
  Reliable
  Patient's first name
- Transactions[].Submissions[].Subscribers[].Patients[].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.
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.LastName
  String
  Reliable
  Patient's last name
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.DOB
  String
  Reliable
  Patient's date of birth.
  In ISO 8601 format
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.SSN
  String
  Probable
  Patient's social security number
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Sex
  String
  Reliable
  ValueSet
  Patient's sex
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Race
  String
  Possible
  ValueSet
  Patient's race
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.IsHispanic
  Boolean
  Possible
  ValueSet
  Indicates if the patient is of hispanic origin.
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Religion
  String
  Possible
  ValueSet
  Patient's religious affiliation
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.MaritalStatus
  String
  Possible
  ValueSet
  Patient's marital status
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.IsDeceased
  Boolean
  Possible
  Indicates if the patient is deceased
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.DeathDateTime
  DateTime
  Possible
  Date and Time the patient was proclaimed deceased.
  ISO 8601 Format
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.PhoneNumber.Home
  String
  Probable
  Patient's home phone number.
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.PhoneNumber.Office
  String
  Probable
  Patient's office phone number.
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.PhoneNumber.Mobile
  String
  Probable
  Patient's mobile phone number.
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.EmailAddresses[]
  Array of Strings
  Probable
  Patient's email address(es)
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Language
  String
  Possible
  ValueSet
  Patient's primary spoken language
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Citizenship[]
  Array of strings
  Possible
  ValueSet
  Patient's nation(s) of citizenship
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Address
  Object
  Probable
  Patient's home address
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Address.StreetAddress
  String
  Probable
  Street address
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Address.City
  String
  Probable
  City
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Address.State
  String
  Probable
  State
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Address.ZIP
  String
  Probable
  ZIP
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Address.County
  String
  Possible
  County
- Transactions[].Submissions[].Subscribers[].Patients[].Demographics.Address.Country
  String
  Possible
  ValueSet
  Country
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Patients[].Notes[]
  Array of strings
  Possible
  Patient-level notes
- Transactions[].Submissions[].Subscribers[].Patients[].RelationToSubscriber
  String
  Reliable
  ValueSet
  Relation to the subscriber
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[]
  Array of Object
  Reliable
  Array of claims for the given subscriber/patient.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].SubmissionNumber
  String
  Reliable
  This will generally be the claim number sent on the initial claim submission.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Type
  String
  Probable
  ValueSet
  Type of Claim (Institutional only)
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].TotalAmount
  String
  Probable
  Total amount of all lines on the claim.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].CopayAmount
  String
  Probable
  Amount the patient has paid or still owes.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].IsProviderSignatureOnFile
  Boolean
  Probable
  Whether or not the provider signature is on file for the claim.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].IsReleaseOfInformationOnFile
  Boolean
  Probable
  Whether or not the submitter has a signed ROI form for the patient.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].ProviderAcceptanceCode
  String
  Possible
  Code indicating whether the provider accepts assignment.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].BenefitsAssignmentCode
  Boolean
  Probable
  ValueSet
  Code indicates whether the patient has or has not assigned benefits to the provider.
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].AdditionalDates[]
  Array of Objects
  Probable
  Collection of additional dates related to the claim
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].AdditionalDates[].DateTime
  String
  Probable
  ISO 8601 Format
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].AdditionalDates[].Type
  String
  Probable
  Type 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
  Probable
  Reference numbers associated to the claim like Prior Auth Number, Member ID, and Provider IDs
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].ReferenceNumbers[].ID
  String
  Probable
  ID for the claim
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].ReferenceNumbers[].IDType
  String
  Probable
  The type of ID
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Diagnoses[].Code
  String
  Probable
  Diagnosis code.
  First index in array indicates primary diagnosis
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Diagnoses[].Codeset
  String
  Probable
  Code set used to identify the diagnosis code.
  e.x. ICD-10, ICD-9
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Diagnoses[].Description
  String
  Probable
  Diagnosis name
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Diagnoses[].Type
  String
  Probable
  Type of diagnosis.
  One of the following: Admitting, Working, or Final
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].DiagnosisRelatedGroup
  String
  Probable
  CMS Diagnosis Related Group for an inpatient admission
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].ID
  String
  Possible
  ID of the provider.
  This ID is often required for Inpatient Visits.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].IDType
  String
  Possible
  ID type of the ID for the provider
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].FirstName
  String
  Possible
  First name of the undefined
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].LastName
  String
  Possible
  Last name of the undefined
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Credentials[]
  Array of Strings
  Possible
  List of credentials for the undefined.
  e.g. MD, PhD
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Address
  Object
  Possible
  Provider's address
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Address.StreetAddress
  String
  Possible
  Street address
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Address.City
  String
  Possible
  City
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Address.State
  String
  Possible
  State
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Address.ZIP
  String
  Possible
  ZIP
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Address.County
  String
  Possible
  County
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Address.Country
  String
  Possible
  ValueSet
  Country
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].EmailAddresses[]
  Array of Strings
  Probable
  Provider's email address(es)
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].PhoneNumber.Office
  String
  Possible
  Provider's office phone number.
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location
  Object
  Possible
  Provider's location
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.Type
  String
  Possible
  Type of location.
  Examples: Clinic, Department, Home, Nursing Unit, Provider's Office, Phone
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.Facility
  String
  Possible
  Facility.
  Example: Community Hospital
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.FacilityIdentifiers[]
  Array of Objects
  Possible
  List of IDs specific to this facility
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.FacilityIdentifiers[].ID
  String
  Possible
  An ID specific to this facility
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.FacilityIdentifiers[].IDType
  String
  Possible
  The 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
  Possible
  Department
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.DepartmentIdentifiers[]
  Array of Objects
  Possible
  List of IDs specific to this department
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.DepartmentIdentifiers[].ID
  String
  Possible
  An ID specific to this department
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Location.DepartmentIdentifiers[].IDType
  String
  Possible
  The 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
  Possible
  Room.
  Example: 136
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Role
  String
  Probable
  The role this provider has in patient care.
  E.x. Attending, Referring, Operating
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Specialty.ID
  String
  Probable
  ID of specialty.
  Commonly the taxonomy ID
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Providers[].Specialty.Description
  String
  Probable
  Description/name of specialty
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[]
  Array of Objects
  Reliable
  Services associated with this claim
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Code
  String
  Probable
  Code for the service line
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Codeset
  String
  Probable
  Code set used to identify the service line
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Description
  String
  Probable
  Description of the service line
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Modifiers[]
  String
  Probable
  Array of service modifiers
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Amount
  String
  Probable
  Total dollar amount for this line item
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].StartDateTime
  String
  Probable
  When the service conveyed began
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].EndDateTime
  String
  Probable
  When the service conveyed ended
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].RevenueCode
  String
  Probable
  Institutional only.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Quantity.Value
  String
  Probable
  Service line quantity.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Quantity.Units
  String
  Probable
  Associated units to the quantity
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].IsEmergency
  Boolean
  Probable
  Whether or not this service was performed in an emergency setting.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].ReferenceNumbers[]
  Array of Objects
  Probable
  Reference numbers associated to the claim service line
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].ReferenceNumbers[].ID
  String
  Probable
  ID for the service line
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].ReferenceNumbers[].IDType
  String
  Probable
  The type of ID
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Diagnoses[].Code
  String
  Probable
  Diagnosis code.
  First index in array indicates primary diagnosis associated with this service line item.
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Diagnoses[].Codeset
  String
  Probable
  Code set used to identify the diagnosis code.
  e.x. ICD-10, ICD-9
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Diagnoses[].Description
  String
  Probable
  Diagnosis name
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Diagnoses[].Type
  String
  Probable
  Type of diagnosis.
  One of the following: Admitting, Working, or Final
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Drug
  Object
  Probable
  Drug information related to the service of an institutional claim
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Drug.PrescriptionID
  String
  Probable
  Pharmacy Prescription ID associated to the the drug
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Drug.NDC
  String
  Probable
  NDC ID
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Drug.Quantity.Value
  String
  Probable
  Drug Quantity
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Drug.Quantity.Units
  String
  Probable
  Associated Units to the quantity
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Services[].Notes
  String
  Probable
  Additional notes for this line
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.DateTime
  String
  Probable
  DateTime of admission.
  ISO 8601 Format
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.DischargeDateTime
  String
  Probable
  DateTime of discharge.
  ISO 8601 Format
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location
  Object
  Probable
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.Type
  String
  Probable
  Type of location.
  Examples: Clinic, Department, Home, Nursing Unit, Provider's Office, Phone
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.Facility
  String
  Probable
  Facility.
  Example: Community Hospital
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.FacilityIdentifiers[]
  Array of Objects
  Probable
  List of IDs specific to this facility
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.FacilityIdentifiers[].ID
  String
  Probable
  An ID specific to this facility
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.FacilityIdentifiers[].IDType
  String
  Probable
  The 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
  Probable
  Department
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.DepartmentIdentifiers[]
  Array of Objects
  Probable
  List of IDs specific to this department
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.DepartmentIdentifiers[].ID
  String
  Probable
  An ID specific to this department
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Location.DepartmentIdentifiers[].IDType
  String
  Probable
  The 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
  Probable
  Room.
  Example: 136
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation
  Object
  Probable
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.Type
  String
  Probable
  Type of location.
  Examples: Clinic, Department, Home, Nursing Unit, Provider's Office, Phone
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.Facility
  String
  Probable
  Facility.
  Example: Community Hospital
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.FacilityIdentifiers[]
  Array of Objects
  Probable
  List of IDs specific to this facility
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.FacilityIdentifiers[].ID
  String
  Probable
  An ID specific to this facility
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.FacilityIdentifiers[].IDType
  String
  Probable
  The 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
  Probable
  Department
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.DepartmentIdentifiers[]
  Array of Objects
  Probable
  List of IDs specific to this department
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.DepartmentIdentifiers[].ID
  String
  Probable
  An ID specific to this department
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.PreviousLocation.DepartmentIdentifiers[].IDType
  String
  Probable
  The 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
  Probable
  Room.
  Example: 136
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.Type
  String
  Probable
  Type of inpatient admission.
  Only populated for inpatient admissions. E.x. Elective, Emergency
- Transactions[].Submissions[].Subscribers[].Patients[].Claims[].Visit.VisitNumber
  String
  Possible
  Visit Number.
  Unique ID of a single visit

Sample MessageDownload JSON Schema

{
   "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
                                 }
                              }
                           ]
                        }
                     ]
                  }
               ]
            }
         ]
      }
   ]
}

PaymentBatch

DEV PREVIEW

A 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

Show Required Fields Only

Show Translation Fields

Meta
- Meta.DataModel
  String
  Reliable
  Required
  Claim
- Meta.EventType
  String
  Reliable
  Required
  PaymentBatch
- Meta.EventDateTime
  DateTime
  Reliable
  Displays the UTC date and time that an outgoing request is delivered or an incoming request is received.
  ISO 8601 Format
- Meta.Test
  Boolean
  Reliable
  Indicates whether the request is a test or not.
- Meta.Source
  String
  Reliable
  Contains the information for the system initiating the message, including the source ID and name.
  Included in messages from Redox
- Meta.Source.ID
  String
  Reliable
  Identifies 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
  Reliable
  Displays the name of the system initiating the message.
- Meta.Destinations[]
  Array of Objects
  Reliable
  Contains 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
  Reliable
  Identifies the endpoint that the request is directed to.
  UUID
- Meta.Destinations[].Name
  String
  Reliable
  Displays the name of the endpoint that the request is directed to.
- Meta.Logs[]
  Array of Objects
  Reliable
  Contains the log identifier(s) for the request.
- Meta.Logs[].ID
  String
  Reliable
  Identifies 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
  Reliable
  Identifies the request log attempt value, which is useful when retries are possible.
  UUID
- 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.
Transactions
- Transactions[].ID
  String
  Reliable
  ID used by submitter to reference this Claims
- Transactions[].IDType
  String
  Reliable
  Type of ID
- Transactions[].Type
  String
  Reliable
  ValueSet
  The type of Claims, Institutional or Professional
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].TotalPaymentAmount
  String
  Probable
  The 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
  Probable
  ValueSet
  A flag indicating whether the monetary amount in Transaction.TotalPaymentAmount is a credit or debit.
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].PaymentMethod
  String
  Probable
  ValueSet
  How the payment was/will be transferred.
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].PaymentDateTime
  String
  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. ISO 8601 Format
- Transactions[].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.
- Transactions[].Submitter
  Object
  Reliable
  Submitter of a Claims
- Transactions[].Submitter.Identifiers[]
  Array of Objects
  Reliable
  List of IDs and ID Types that identify the concept
- Transactions[].Submitter.Identifiers[].ID
  String
  Reliable
  ID for the submitter
- Transactions[].Submitter.Identifiers[].IDType
  String
  Reliable
  The type of ID
- Transactions[].Submitter.Name
  String
  Reliable
- Transactions[].Submitter.Address
  Object
  Probable
  Address of the Submitter
- Transactions[].Submitter.Address.StreetAddress
  String
  Probable
  Street address
- Transactions[].Submitter.Address.City
  String
  Probable
  City
- Transactions[].Submitter.Address.State
  String
  Probable
  State
- Transactions[].Submitter.Address.ZIP
  String
  Probable
  ZIP
- Transactions[].Submitter.Address.County
  String
  Possible
  County
- Transactions[].Submitter.Address.Country
  String
  Possible
  ValueSet
  Country
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Submitter.EmailAddress
  String
  Probable
- Transactions[].Submitter.PhoneNumber.Office
  String
  Probable
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Submitter.PhoneNumber.Fax
  String
  Probable
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Receiver
  Object
  Reliable
  Receiver of a Claims
- Transactions[].Receiver.Identifiers[]
  Array of Objects
  Reliable
  List of IDs and ID Types that identify the concept
- Transactions[].Receiver.Identifiers[].ID
  String
  Reliable
  ID for the receiver
- Transactions[].Receiver.Identifiers[].IDType
  String
  Reliable
  The type of ID
- Transactions[].Receiver.Name
  String
  Reliable
- Transactions[].Receiver.Address
  Object
  Probable
  Address of the Receiver
- Transactions[].Receiver.Address.StreetAddress
  String
  Probable
  Street address
- Transactions[].Receiver.Address.City
  String
  Probable
  City
- Transactions[].Receiver.Address.State
  String
  Probable
  State
- Transactions[].Receiver.Address.ZIP
  String
  Probable
  ZIP
- Transactions[].Receiver.Address.County
  String
  Possible
  County
- Transactions[].Receiver.Address.Country
  String
  Possible
  ValueSet
  Country
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Receiver.EmailAddress
  String
  Probable
- Transactions[].Receiver.PhoneNumber.Office
  String
  Probable
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Receiver.PhoneNumber.Fax
  String
  Probable
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Payments[]
  Array of Objects
  Probable
- Transactions[].Payments[].DateTime
  String
  Probable
  The DateTime this payment was processed.
  ISO 8601 Format
- Transactions[].Payments[].Patient.Identifiers[]
  Array of Objects
  Reliable
  List of IDs and ID types that identify the patient
- Transactions[].Payments[].Patient.Identifiers[].ID
  String
  Reliable
  ID for the patient
- Transactions[].Payments[].Patient.Identifiers[].IDType
  String
  Reliable
  Type of ID.
  E.g. MRN, EPI
- Transactions[].Payments[].Patient.Demographics.FirstName
  String
  Reliable
  Patient's first name
- Transactions[].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.
- Transactions[].Payments[].Patient.Demographics.LastName
  String
  Reliable
  Patient's last name
- Transactions[].Payments[].Patient.Demographics.DOB
  String
  Reliable
  Patient's date of birth.
  In ISO 8601 format
- Transactions[].Payments[].Patient.Demographics.SSN
  String
  Probable
  Patient's social security number
- Transactions[].Payments[].Patient.Demographics.Sex
  String
  Reliable
  ValueSet
  Patient's sex
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Payments[].Patient.Demographics.Race
  String
  Possible
  ValueSet
  Patient's race
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Payments[].Patient.Demographics.IsHispanic
  Boolean
  Possible
  ValueSet
  Indicates if the patient is of hispanic origin.
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Payments[].Patient.Demographics.Religion
  String
  Possible
  ValueSet
  Patient's religious affiliation
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Payments[].Patient.Demographics.MaritalStatus
  String
  Possible
  ValueSet
  Patient's marital status
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Payments[].Patient.Demographics.IsDeceased
  Boolean
  Possible
  Indicates if the patient is deceased
- Transactions[].Payments[].Patient.Demographics.DeathDateTime
  DateTime
  Possible
  Date and Time the patient was proclaimed deceased.
  ISO 8601 Format
- Transactions[].Payments[].Patient.Demographics.PhoneNumber.Home
  String
  Probable
  Patient's home phone number.
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Payments[].Patient.Demographics.PhoneNumber.Office
  String
  Probable
  Patient's office phone number.
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Payments[].Patient.Demographics.PhoneNumber.Mobile
  String
  Probable
  Patient's mobile phone number.
  In E. 164 Format. (e.g. +16085551234)
- Transactions[].Payments[].Patient.Demographics.EmailAddresses[]
  Array of Strings
  Probable
  Patient's email address(es)
- Transactions[].Payments[].Patient.Demographics.Language
  String
  Possible
  ValueSet
  Patient's primary spoken language
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Payments[].Patient.Demographics.Citizenship[]
  Array of strings
  Possible
  ValueSet
  Patient's nation(s) of citizenship
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Payments[].Patient.Demographics.Address
  Object
  Probable
  Patient's home address
- Transactions[].Payments[].Patient.Demographics.Address.StreetAddress
  String
  Probable
  Street address
- Transactions[].Payments[].Patient.Demographics.Address.City
  String
  Probable
  City
- Transactions[].Payments[].Patient.Demographics.Address.State
  String
  Probable
  State
- Transactions[].Payments[].Patient.Demographics.Address.ZIP
  String
  Probable
  ZIP
- Transactions[].Payments[].Patient.Demographics.Address.County
  String
  Possible
  County
- Transactions[].Payments[].Patient.Demographics.Address.Country
  String
  Possible
  ValueSet
  Country
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Payments[].Patient.Notes[]
  Array of strings
  Possible
  Patient-level notes
- Transactions[].Payments[].Claims[]
  Array of Objects
  Probable
- Transactions[].Payments[].Claims[].ControlNumber
  String
  Reliable
  The Payer's reference number
- Transactions[].Payments[].Claims[].SubmissionNumber
  String
  Reliable
  This will generally be the claim number sent on the initial claim submission.
- Transactions[].Payments[].Claims[].ReceivedDate
  String
  Probable
  Date the claim was submitted.
  ISO 8601 Format
- Transactions[].Payments[].Claims[].StartDateTime
  String
  Probable
  Date the statement period started.
  ISO 8601 Format
- Transactions[].Payments[].Claims[].EndDateTime
  String
  Probable
  Date the statement period ended.
  ISO 8601 Format
- Transactions[].Payments[].Claims[].Status
  String
  Reliable
  ValueSet
  Status of the claim
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Payments[].Claims[].ChargedAmount
  String
  Reliable
  Total monetary amount of the claim
- Transactions[].Payments[].Claims[].PaymentAmount
  String
  Probable
  Monetary amount of the claim paid
- Transactions[].Payments[].Claims[].PatientResponsibilityAmount
  String
  Reliable
  Monetary amount of the claim the patient is responsible for
- Transactions[].Payments[].Claims[].ReferenceNumbers[]
  Array of Objects
  Probable
  Reference numbers associated to the claim like Prior Auth Number, Member ID, and Provider IDs
- Transactions[].Payments[].Claims[].ReferenceNumbers[].ID
  String
  Probable
  ID for the claim
- Transactions[].Payments[].Claims[].ReferenceNumbers[].IDType
  String
  Probable
  The type of ID
- Transactions[].Payments[].Claims[].Adjustments[]
  Object
  Reliable
  Adjustments 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
  Probable
  Monetary 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
  Probable
  ValueSet
  Type of Adjustment
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Payments[].Claims[].Adjustments[].Reason
  String
  Probable
  ValueSet
  Adjustment reason
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Payments[].Claims[].Services[]
  String
  Probable
  This array will provide additional detail for claims processed at the line level.
- Transactions[].Payments[].Claims[].Services[].ChargedAmount
  String
  Probable
  The monetory amount charged
- Transactions[].Payments[].Claims[].Services[].PaymentAmount
  String
  Reliable
  The monetory amount paid
- Transactions[].Payments[].Claims[].Services[].ChargedUnits
  String
  Probable
  The number of units of service charged for
- Transactions[].Payments[].Claims[].Services[].PaymentUnits
  String
  Probable
  The number of units of service paid for
- Transactions[].Payments[].Claims[].Services[].AllowedAmount
  String
  Reliable
  Maximum monetary amount of payment
- Transactions[].Payments[].Claims[].Services[].SubmittedService
  Object
  Probable
  Submitted service information
- Transactions[].Payments[].Claims[].Services[].SubmittedService.Code
  String
  Probable
  Code for the submitted service
- Transactions[].Payments[].Claims[].Services[].SubmittedService.Codeset
  String
  Probable
  Code set used to identify the submitted service
- Transactions[].Payments[].Claims[].Services[].SubmittedService.Description
  String
  Probable
  Description of the submitted service
- Transactions[].Payments[].Claims[].Services[].SubmittedService.Modifiers[]
  String
  Probable
  Array of modifiers
- Transactions[].Payments[].Claims[].Services[].AdjudicatedService
  Object
  Probable
  Adjudicated service information
- Transactions[].Payments[].Claims[].Services[].AdjudicatedService.Code
  String
  Probable
  Code for the adjudicated service
- Transactions[].Payments[].Claims[].Services[].AdjudicatedService.Codeset
  String
  Probable
  Code set used to identify the adjudicated service
- Transactions[].Payments[].Claims[].Services[].AdjudicatedService.Description
  String
  Probable
  Description of the adjudicated service
- Transactions[].Payments[].Claims[].Services[].AdjudicatedService.Modifiers[]
  String
  Probable
  Array of modifiers
- Transactions[].Payments[].Claims[].Services[].Adjustments[]
  Object
  Reliable
  Adjustments explain why a claim was paid differently than it was billed.
- Transactions[].Payments[].Claims[].Services[].Adjustments[].Amount
  String
  Probable
  Monetary 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
  Probable
  ValueSet
  Type of Adjustment
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Payments[].Claims[].Services[].Adjustments[].Reason
  String
  Probable
  ValueSet
  Adjustment reason
  
  Supported Values
  
  Additional values may be added by Redox in the future.
- Transactions[].Payments[].Claims[].Services[].StartDateTime
  String
  Probable
  Date the claim was submitted.
  ISO 8601 Format
- Transactions[].Payments[].Claims[].Services[].EndDateTime
  String
  Probable
  Date the statement period started.
  ISO 8601 Format
- Transactions[].Payments[].Claims[].Services[].ReferenceNumbers[]
  Array of Objects
  Probable
  Reference numbers associated to the claim service line
- Transactions[].Payments[].Claims[].Services[].ReferenceNumbers[].ID
  String
  Probable
  ID for the service line
- Transactions[].Payments[].Claims[].Services[].ReferenceNumbers[].IDType
  String
  Probable
  The type of ID

Sample MessageDownload JSON Schema

{
   "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"
                              }
                           ]
                        }
                     ]
                  }
               ]
            }
         ]
      }
   ]
}

Claim

SubmissionBatchlink

Fields

Meta

Transactions

PaymentBatchlink

Fields

Meta

Transactions

SubmissionBatch

PaymentBatch