Defines additional information on the claim needed by the payer. Box 19 on the CMS-1500 claim form.
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.
Human-readable description of the appointment type (ex: “Acupuncture - Headaches”).
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.
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.
Holds a collection of clinical observations made by healthcare providers during patient encounters.
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. If service lines have distinct date_of_service values, updating the encounter’s date_of_service will fail. If all service line date_of_service values are the same, updating the encounter’s date_of_service will update all service line date_of_service values.
837i Loop2300, CLM-1300 Box 20 Code indicating the reason why a request was delayed
Ideally, this field should contain no more than 12 diagnoses. However, more diagnoses may be submitted at this time, and coders will later prioritize the 12 that will be submitted to the payor.
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. If service lines have distinct end_date_of_service values, updating the encounter’s end_date_of_service will fail. If all service line end_date_of_service values are the same, updating the encounter’s end_date_of_service will update all service line date_of_service values.
Existing medications that should be on the encounter. Note all current existing medications on encounter will be overridden with this list.
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.
Personal and contact info for the guarantor of the patient responsibility.
The second iteration of Loop ID-2310. Use code “P3 - Primary Care Provider” in this loop to indicate the initial referral from the primary care provider or whatever provider wrote the initial referral for this patient’s episode of care being billed/reported in this transaction.
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.de
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.
Contains the identification information of the individual receiving medical services.
Specifies the address to which payments for the claim should be sent.
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.
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.
Refers to REF*9F on the 837p. Value cannot be greater than 50 characters.
The final provider who referred the services that were rendered. All physicians who order services or refer Medicare beneficiaries must report this data.
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.
Defines the party to be billed with the initial balance owed on the claim. Use SELF_PAY if you intend to bill self pay/cash pay.
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. Note that for an in-network claim to be successfully adjudicated, the service facility address listed on claims must match what was provided to the payer during the credentialing process.
Contains details of the primary insurance subscriber.
Contains details of the secondary insurance subscriber.
Required when the rendering provider is supervised by a physician. If not required by this implementation guide, do not send.
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.
Names of tags that should be on the encounter. Note all tags on encounter will be overridden with this list.
If a vitals entity already exists for the encounter, then all values will be updated to the provided values. Otherwise, a new vitals object will be created for the encounter.
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. Updating schema instances utilizes PUT semantics, so the schema instances on the encounter will be set to whatever inputs are provided. If null is provided as an input, then the encounter’s schema instances will be cleared.
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.
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.
Holds a collection of clinical observations made by healthcare providers during patient encounters.
Ideally, this field should contain no more than 12 diagnoses. However, more diagnoses may be submitted at this time, and coders will later prioritize the 12 that will be submitted to the payor.
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.
The party who is responsible for taking the next action on an Encounter, as defined by ownership of open Tasks.
Contains the identification information of the individual receiving medical services.
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.
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.
Defines the party to be billed with the initial balance owed on the claim.
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. Note that for an in-network claim to be successfully adjudicated, the service facility address listed on claims must match what was provided to the payer during the credentialing process.
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.
URL that links directly to the claim created in Candid.
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.
Defines additional information on the claim needed by the payer. Box 19 on the CMS-1500 claim form.
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.
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.
The entity that performed the coding of medical services for the claim.
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. 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.
837i Loop2300, CLM-1300 Box 20 Code indicating the reason why a request was delayed
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. 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.
Personal and contact info for the guarantor of the patient responsibility.
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.
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.
Specifies the address to which payments for the claim should be sent.
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.
Refers to REF*9F on the 837p. Value cannot be greater than 50 characters.
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.
Contains details of the secondary insurance subscriber.
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.