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Whether this patient has authorized insurance payments to be made to you, not them. If false, patient may receive reimbursement. Box 13 on the CMS-1500 claim form or Form Locator 53 on a UB-04 claim form.

Defines if the Encounter is to be billed by Candid to the responsible_party. Examples for when this should be set to NOT_BILLABLE include if the Encounter has not occurred yet or if there is no intention of ever billing the responsible_party.

The billing provider is the provider or business entity submitting the claim. Billing provider may be, but is not necessarily, the same person/NPI as the rendering provider. From a payer’s perspective, this represents the person or entity being reimbursed. When a contract exists with the target payer, the billing provider should be the entity contracted with the payer. In some circumstances, this will be an individual provider. In that case, submit that provider’s NPI and the tax ID (TIN) that the provider gave to the payer during contracting. In other cases, the billing entity will be a medical group. If so, submit the group NPI and the group’s tax ID. Box 33 on the CMS-1500 claim form or Form Locator 1 on a UB-04 claim form.

A client-specified unique ID to associate with this encounter; for example, your internal encounter ID or a Dr. Chrono encounter ID. This field should not contain PHI.

Whether this patient has authorized the release of medical information for billing purpose. Box 12 on the CMS-1500 claim form or Form Locator 52 on a UB-04 claim form.

Whether you have accepted the patient’s authorization for insurance payments to be made to you, not them. Box 27 on the CMS-1500 claim form. There is no exact equivalent of this field on a UB-04 claim, however contributes to the concept of Form Locator 53.

The rendering provider is the practitioner — physician, nurse practitioner, etc. — performing the service. For telehealth services, the rendering provider performs the visit, asynchronous communication, or other service. The rendering provider address should generally be the same as the service facility address.

Encounter Service facility is typically the location a medical service was rendered, such as a provider office or hospital. For telehealth, service facility can represent the provider’s location when the service was delivered (e.g., home), or the location where an in-person visit would have taken place, whichever is easier to identify. If the provider is in-network, service facility may be defined in payer contracts. Box 32 on the CMS-1500 claim form. There is no equivalent on the paper UB-04 claim form, but this field is equivalent to Loop 2310E Service Facility Location details on an 837i form, and is used when this is different to the entity identified as the Billing Provider. Note that for an in-network claim to be successfully adjudicated, the service facility address listed

The party who originally submitted the Claim. For Claims originating in Candid, this will be EncounterSubmissionOriginType.CANDID. For Encounters created with an external_claim_submission object, this will be EncounterSubmissionOriginType.EXTERNAL.

Key-value pairs that must adhere to a schema created via the Custom Schema API. Multiple schema instances cannot be created for the same schema on an encounter.

837p Loop2300 DTP*439, CMS1500 Box 15

Defines additional information on the claim needed by the payer. Box 19 on the CMS-1500 claim form or Form Locator 80 on a UB-04 claim form.

837p Loop2300 DTP*435, CMS-1500 Box 18 or UB-04 Form Locator 12. Required on all ambulance claims when the patient was known to be admitted to the hospital. OR Required on all claims involving inpatient medical visits.

Human-readable description of the appointment type (ex: “Acupuncture - Headaches”).

Spot to store misc, human-readable, notes about this encounter to be used in the billing process.

Refers to Loop 2300 - Segment PWK on the 837P and 837i form. No more than 10 entries are permitted.

Date formatted as YYYY-MM-DD; eg: 2019-08-24. This date must be the local date in the timezone where the service occurred. Box 24a on the CMS-1500 claim form or Form Locator 45 on the UB-04 claim form. If service occurred over a range of dates, this should be the start date. date_of_service must be defined on either the encounter or the service lines but not both. If there are greater than zero service lines, it is recommended to specify date_of_service on the service_line instead of on the encounter to prepare for future API versions.

Code indicating the reason why a claim submission was delayed. Corresponds to CLM-20 in the 837 specification (both professional and institutional).

837p Loop2300 DTP*096, CMS-1500 Box 18 Required for inpatient claims when the patient was discharged from the facility and the discharge date is known. Not used on an institutional claim.

Date formatted as YYYY-MM-DD; eg: 2019-08-25. This date must be the local date in the timezone where the service occurred. If omitted, the Encounter is assumed to be for a single day. Must not be temporally before the date_of_service field. If there are greater than zero service lines, it is recommended to specify end_date_of_service on the service_line instead of on the encounter to prepare for future API versions.

Refers to Box 24H on the CMS1500 form and Loop 2300 CRC - EPSDT Referral on the 837P and 837i form

837p Loop2300 DTP*484, CMS-1500 Box 14 Required when, in the judgment of the provider, the services on this claim are related to the patient’s pregnancy. This field is populated separately via occurrence codes for UB-04 claim forms.

The party (payer, patient, etc.) responsible for the remainder of the balance on the claim.

837p Loop2300 DTP*431, CMS-1500 Box 14 Required for the initial medical service or visit performed in response to a medical emergency when the date is available and is different than the date of service. OR This date is the onset of acute symptoms for the current illness or condition. For UB-04 claims, this is populated separately via occurrence codes.

A patient control number (PCN) is a unique identifier assigned to a patient within a healthcare system or facility. It’s used to track and manage a patient’s medical records, treatments, and other healthcare-related information.

Box 24B on the CMS-1500 claim form. 837p Loop2300, CLM-05-1. 02 for telemedicine, 11 for in-person. Full list here.

Box 24B on the CMS-1500 claim form. 837p Loop2300, CLM-05-1. 02 for telemedicine, 11 for in-person. Full list here.

Box 23 on the CMS-1500 claim form or Form Locator 63 on a UB-04 claim form.

Refers to REF*9F on the 837p. Value cannot be greater than 50 characters.

837p Loop2300 REF*4N Required when mandated by government law or regulation to obtain authorization for specific service(s) but, for the reasons listed in one of the enum values of ServiceAuthorizationExceptionCode, the service was performed without obtaining the authorization.

Subscriber_primary is required when responsible_party is INSURANCE_PAY (i.e. when the claim should be billed to insurance). These are not required fields when responsible_party is SELF_PAY (i.e. when the claim should be billed to the patient). However, if you collect this for patients, even self-pay, we recommend including it when sending encounters to Candid. Note: Cash Pay is no longer a valid payer_id in v4, please use responsible party to define self-pay claims.

Whether or not this was a synchronous or asynchronous encounter. Asynchronous encounters occur when providers and patients communicate online using forms, instant messaging, or other pre-recorded digital mediums. Synchronous encounters occur in live, real-time settings where the patient interacts directly with the provider, such as over video or a phone call.

837i-REF1000 — an optional state indicating where an accident related to the encounter occurred.

837i Loop 2300 DTP-03 Extension of the admission date with hour (0-23) details. Required for institutional submission.

837i Loop 2300 CLI1-02 Code used to indicate the conditions under which an admission occurs. Equivalent to Form Locator 15 Point of Origin on a UB-04 claim, not used on CMS-1500 claim forms.

837i Loop 2300 CL1-01 Code used to indicate the priority of an admission or visit. Equivalent to Form Locator 14 Priority of Admission on a UB-04 claim, not used on CMS-1500 claim forms.

837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has overall responsibility for the patient in institutional claims processing.

837i Loop 2300 DTP-03 Extension of the discharge date with hour (0-23) details.

837i CL1-03 or Form Locator 17 on a UB-04 claim form. This is a required field on UB-04 claims. Code indicating patient status as of the “statement covers through date”.

837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has primary responsibility for surgical procedures in institutional claims processing.

837i NM1 2500 variant for Loop ID-2310. Used to indicate the individual whom has secondary responsibility for surgical procedures in institutional claims processing. Only used when operating_provider is also set.

Describes the currently expected target form for this encounter. This effects what validations and queues the form is processed under. When this value is not set, it should be assumed to be TARGET_PROFESSIONAL.

Four digit code used in institutional forms to indicate the type of bill (e.g., hospital inpatient, hospital outpatient). First digit is a leading 0, followed by the type_of_facility, type_of_care, then frequency_code. Professional forms are not required to submit this attribute. You may send the 4 digit code via raw_code, or each individual digit separately via composite_codes.