EncountersV4
Get encounter
GET
This endpoint returns an object
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.
Allowed values: BILLABLENOT_BILLABLE
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. 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.
Allowed values: CANDIDCUSTOMERCODERNONE
Allowed values: INSURANCE_PAYSELF_PAYUNKNOWN
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.
Allowed values: CANDIDEXTERNAL
837p Loop2300 DTP*435, CMS-1500 Box 18 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.
Allowed values: CANDIDCUSTOMERTCNPJF
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.
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.
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.
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.
Box 24B on the CMS-1500 claim form. Line-level place of service is not currently supported. 02 for telemedicine, 11 for in-person. Full list here.
Box 24B on the CMS-1500 claim form. Line-level place of service is not currently supported. 02 for telemedicine, 11 for in-person. Full list here.
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.
Allowed values: SynchronousAsynchronous
GET
200Retrieved