Create insurance adjudication

Beta

POST

/api/insurance-adjudications/v1

POST

/api/insurance-adjudications/v1

1 import datetime
2 import uuid
3 
4 from candid import CandidApiClient
5 from candid.resources.commons import ClaimAdjustmentGroupCodes
6 from candid.resources.era_commons import ClaimStatusCodeCreate
7 from candid.resources.insurance_adjudications.resources.v_1 import (
8     ClaimAdjudicationCreate,
9     InsuranceAdjudicationCreate,
10     ServiceLineAdjudicationCreate,
11 )
12 from candid.resources.payers.resources.v_3 import PayerIdentifier_PayerInfo
13 from candid.resources.remits.resources.v_1 import Payee, PayeeIdentifier_Npi
14 from candid.resources.x_12.resources.v_1 import (
15     Carc,
16     ClaimAdjustmentReasonCode,
17     Rarc,
18     RemittanceAdviceRemarkCode,
19 )
20 
21 client = CandidApiClient(
22     client_id="YOUR_CLIENT_ID",
23     client_secret="YOUR_CLIENT_SECRET",
24 )
25 client.insurance_adjudications.v_1.create(
26     request=InsuranceAdjudicationCreate(
27         payer_identifier=PayerIdentifier_PayerInfo(
28             payer_id="payer_id",
29             payer_name="payer_name",
30         ),
31         payee=Payee(
32             payee_name="payee_name",
33             payee_identifier=PayeeIdentifier_Npi(value="payee_identifier"),
34         ),
35         check_date=datetime.date.fromisoformat(
36             "2023-01-15",
37         ),
38         claims={
39             uuid.UUID(
40                 "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
41             ): [
42                 ClaimAdjudicationCreate(
43                     claim_status_code=ClaimStatusCodeCreate.PROCESSED_AS_PRIMARY,
44                     service_lines={
45                         uuid.UUID(
46                             "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
47                         ): [
48                             ServiceLineAdjudicationCreate(
49                                 carcs=[
50                                     ClaimAdjustmentReasonCode(
51                                         group_code=ClaimAdjustmentGroupCodes.CO,
52                                         reason_code=Carc.CARC_1,
53                                         amount_cents=1,
54                                     ),
55                                     ClaimAdjustmentReasonCode(
56                                         group_code=ClaimAdjustmentGroupCodes.CO,
57                                         reason_code=Carc.CARC_1,
58                                         amount_cents=1,
59                                     ),
60                                 ],
61                                 rarcs=[
62                                     RemittanceAdviceRemarkCode(
63                                         reason_code=Rarc.M_1,
64                                     ),
65                                     RemittanceAdviceRemarkCode(
66                                         reason_code=Rarc.M_1,
67                                     ),
68                                 ],
69                             ),
70                             ServiceLineAdjudicationCreate(
71                                 carcs=[
72                                     ClaimAdjustmentReasonCode(
73                                         group_code=ClaimAdjustmentGroupCodes.CO,
74                                         reason_code=Carc.CARC_1,
75                                         amount_cents=1,
76                                     ),
77                                     ClaimAdjustmentReasonCode(
78                                         group_code=ClaimAdjustmentGroupCodes.CO,
79                                         reason_code=Carc.CARC_1,
80                                         amount_cents=1,
81                                     ),
82                                 ],
83                                 rarcs=[
84                                     RemittanceAdviceRemarkCode(
85                                         reason_code=Rarc.M_1,
86                                     ),
87                                     RemittanceAdviceRemarkCode(
88                                         reason_code=Rarc.M_1,
89                                     ),
90                                 ],
91                             ),
92                         ]
93                     },
94                     carcs=[
95                         ClaimAdjustmentReasonCode(
96                             group_code=ClaimAdjustmentGroupCodes.CO,
97                             reason_code=Carc.CARC_1,
98                             amount_cents=1,
99                         ),
100                         ClaimAdjustmentReasonCode(
101                             group_code=ClaimAdjustmentGroupCodes.CO,
102                             reason_code=Carc.CARC_1,
103                             amount_cents=1,
104                         ),
105                     ],
106                 ),
107                 ClaimAdjudicationCreate(
108                     claim_status_code=ClaimStatusCodeCreate.PROCESSED_AS_PRIMARY,
109                     service_lines={
110                         uuid.UUID(
111                             "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
112                         ): [
113                             ServiceLineAdjudicationCreate(
114                                 carcs=[
115                                     ClaimAdjustmentReasonCode(
116                                         group_code=ClaimAdjustmentGroupCodes.CO,
117                                         reason_code=Carc.CARC_1,
118                                         amount_cents=1,
119                                     ),
120                                     ClaimAdjustmentReasonCode(
121                                         group_code=ClaimAdjustmentGroupCodes.CO,
122                                         reason_code=Carc.CARC_1,
123                                         amount_cents=1,
124                                     ),
125                                 ],
126                                 rarcs=[
127                                     RemittanceAdviceRemarkCode(
128                                         reason_code=Rarc.M_1,
129                                     ),
130                                     RemittanceAdviceRemarkCode(
131                                         reason_code=Rarc.M_1,
132                                     ),
133                                 ],
134                             ),
135                             ServiceLineAdjudicationCreate(
136                                 carcs=[
137                                     ClaimAdjustmentReasonCode(
138                                         group_code=ClaimAdjustmentGroupCodes.CO,
139                                         reason_code=Carc.CARC_1,
140                                         amount_cents=1,
141                                     ),
142                                     ClaimAdjustmentReasonCode(
143                                         group_code=ClaimAdjustmentGroupCodes.CO,
144                                         reason_code=Carc.CARC_1,
145                                         amount_cents=1,
146                                     ),
147                                 ],
148                                 rarcs=[
149                                     RemittanceAdviceRemarkCode(
150                                         reason_code=Rarc.M_1,
151                                     ),
152                                     RemittanceAdviceRemarkCode(
153                                         reason_code=Rarc.M_1,
154                                     ),
155                                 ],
156                             ),
157                         ]
158                     },
159                     carcs=[
160                         ClaimAdjustmentReasonCode(
161                             group_code=ClaimAdjustmentGroupCodes.CO,
162                             reason_code=Carc.CARC_1,
163                             amount_cents=1,
164                         ),
165                         ClaimAdjustmentReasonCode(
166                             group_code=ClaimAdjustmentGroupCodes.CO,
167                             reason_code=Carc.CARC_1,
168                             amount_cents=1,
169                         ),
170                     ],
171                 ),
172             ]
173         },
174     ),
175 )

Try it

1 {
2   "insurance_adjudication_id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
3   "payer_uuid": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
4   "check_date": "2023-01-15",
5   "claims": {
6     "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32": [
7       {
8         "claim_id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
9         "service_lines": {
10           "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32": [
11             {
12               "service_line_adjudication_id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
13               "carcs": [
14                 {
15                   "group_code": "CO",
16                   "reason_code": "1",
17                   "amount_cents": 1
18                 },
19                 {
20                   "group_code": "CO",
21                   "reason_code": "1",
22                   "amount_cents": 1
23                 }
24               ],
25               "rarcs": [
26                 {
27                   "reason_code": "M1"
28                 },
29                 {
30                   "reason_code": "M1"
31                 }
32               ],
33               "denial_reason": "Authorization Required",
34               "insurance_allowed_amount_cents": 1,
35               "insurance_paid_amount_cents": 1,
36               "deductible_amount_cents": 1,
37               "coinsurance_amount_cents": 1,
38               "copay_amount_cents": 1
39             },
40             {
41               "service_line_adjudication_id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
42               "carcs": [
43                 {
44                   "group_code": "CO",
45                   "reason_code": "1",
46                   "amount_cents": 1
47                 },
48                 {
49                   "group_code": "CO",
50                   "reason_code": "1",
51                   "amount_cents": 1
52                 }
53               ],
54               "rarcs": [
55                 {
56                   "reason_code": "M1"
57                 },
58                 {
59                   "reason_code": "M1"
60                 }
61               ],
62               "denial_reason": "Authorization Required",
63               "insurance_allowed_amount_cents": 1,
64               "insurance_paid_amount_cents": 1,
65               "deductible_amount_cents": 1,
66               "coinsurance_amount_cents": 1,
67               "copay_amount_cents": 1
68             }
69           ]
70         },
71         "carcs": [
72           {
73             "group_code": "CO",
74             "reason_code": "1",
75             "amount_cents": 1
76           },
77           {
78             "group_code": "CO",
79             "reason_code": "1",
80             "amount_cents": 1
81           }
82         ],
83         "insurance_allowed_amount_cents": 1,
84         "insurance_paid_amount_cents": 1,
85         "charge_amount_cents": 1,
86         "payer_claim_number": "payer_claim_number"
87       },
88       {
89         "claim_id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
90         "service_lines": {
91           "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32": [
92             {
93               "service_line_adjudication_id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
94               "carcs": [
95                 {
96                   "group_code": "CO",
97                   "reason_code": "1",
98                   "amount_cents": 1
99                 },
100                 {
101                   "group_code": "CO",
102                   "reason_code": "1",
103                   "amount_cents": 1
104                 }
105               ],
106               "rarcs": [
107                 {
108                   "reason_code": "M1"
109                 },
110                 {
111                   "reason_code": "M1"
112                 }
113               ],
114               "denial_reason": "Authorization Required",
115               "insurance_allowed_amount_cents": 1,
116               "insurance_paid_amount_cents": 1,
117               "deductible_amount_cents": 1,
118               "coinsurance_amount_cents": 1,
119               "copay_amount_cents": 1
120             },
121             {
122               "service_line_adjudication_id": "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
123               "carcs": [
124                 {
125                   "group_code": "CO",
126                   "reason_code": "1",
127                   "amount_cents": 1
128                 },
129                 {
130                   "group_code": "CO",
131                   "reason_code": "1",
132                   "amount_cents": 1
133                 }
134               ],
135               "rarcs": [
136                 {
137                   "reason_code": "M1"
138                 },
139                 {
140                   "reason_code": "M1"
141                 }
142               ],
143               "denial_reason": "Authorization Required",
144               "insurance_allowed_amount_cents": 1,
145               "insurance_paid_amount_cents": 1,
146               "deductible_amount_cents": 1,
147               "coinsurance_amount_cents": 1,
148               "copay_amount_cents": 1
149             }
150           ]
151         },
152         "carcs": [
153           {
154             "group_code": "CO",
155             "reason_code": "1",
156             "amount_cents": 1
157           },
158           {
159             "group_code": "CO",
160             "reason_code": "1",
161             "amount_cents": 1
162           }
163         ],
164         "insurance_allowed_amount_cents": 1,
165         "insurance_paid_amount_cents": 1,
166         "charge_amount_cents": 1,
167         "payer_claim_number": "payer_claim_number"
168       }
169     ]
170   },
171   "post_date": "2023-01-15",
172   "check_number": "check_number",
173   "note": "note"
174 }

Creates a new insurance adjudication record and returns the newly created InsuranceAdjudication object.

Authentication

AuthorizationBearer

OAuth authentication of the form <token>.

Request

This endpoint expects an object.

payer_identifierobjectRequired

payeeobjectRequired

check_datedateRequired

claimsmap from UUIDs to lists of objectsRequired

post_datedateOptional

check_numberstringOptional

check_amount_centsintegerOptional

notestringOptional

remit_draft_idUUIDOptional

Response

This endpoint returns an object.

insurance_adjudication_idUUID

payer_uuidUUID

check_datedate

claimsmap from UUIDs to lists of objects

post_datedate or null

check_numberstring or null

notestring or null

Authentication

Request

Response

Errors