Common API Reference
This page contains information about return values and errors common to all of the V3 APis
Host Names
In the HTTP requests documented below, use the host name:
- sandbox.services.apexedi.com for testing
Valid credentials are required for both production and testing. The https protocol is required for both production and testing.
When submitting test Claims or Eligibility requests on the sandbox system, use the following payer IDs:
Medical: TST01
Dental: TST02
Return Values and Errors
The HTTP status code indicates the success or failure of the call. On successful calls, the body of the response is encoded as a JSON object. On failed calls, the body of the response generally contains additional information. In some cases, it is simply an error message. In other cases, particularly when a claim or request has errors, the response contains structured error information encoded as JSON.
| Common Error Responses |
|---|
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Invalid or Missing Vendor Credentials
|
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Client Has Not Accepted Business Associate Agreement The client must accept a Business Associate Agreement (BAA) with Apex EDI before submitting personal health information (PHI) to Apex EDI. If the client has not accepted a BAA, then attempts by a vendor to call the API on behalf of the client will fail with a 401 error. This condition can be detected in software by the vendor by parsing as an integer the portion of the text in the body of the response before the first colon (:). If this integer is 201, then the client has not yet accepted a BAA. If there is no colon in the body of the response, the portion of the message before the first color is not an integer, or the value of the integer is not 201, then the cause of the authorization error is something other than a failure on the part of the client to accept a BAA.
|
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Calling API With Incorrect REST Verb - GET when POST is required
|
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An Apex Internal Service is Unresponsive
|
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Invalid vendorSiteId Used
|
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Missing Parameter, e.g., vendorSiteId
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Parameter Has No Content for VendorSiteId
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API Calls
GetPayers
/api/v3/payers/get_list?vendorSiteId=<vendorSiteId>&type=<payertype>
where payertype = dental or medical, and vendorSiteId is the assigned Vendor Site ID
curl -X POST https://sandbox.services.apexedi.com/api/v3/payers/get_list?vendorSiteId=XXSiteId&type=medical
--header "Authorization: Basic <vendorkey:vendorPassword as base64 encoded string>"
--header "Content-Type: application/json"
GetTestPayers
/api/v3/payers/get_list_of_test?vendorSiteId=<vendorSiteId>&type=<payertype>
where test payertype = dental or medical, and vendorSiteId is the assigned Vendor Site ID
Curl Example
curl -X POST https://sandbox.services.apexedi.com/api/v3/payers/get_list_of_test?vendorSiteId=XXSiteId&type=dental
curl -X POST https://sandbox.services.apexedi.com/api/v3/payers/get_list_of_test?vendorSiteId=XXSiteId&type=medical
--header "Authorization: Basic <vendorkey:vendorPassword as base64 encoded string>"
--header "Content-Type: application/json"
Responses
Successful Sample List Format of Dental Payers (Live or Test) Returned:
NOTE: The 'ApexPayerId' will be phased out at a future date, the preferred Payer ID is 'PayerId'.
- HttpStatusCode: 200 (OK)
- Body:
[ { "Type": "Dental", "Name": "American Family Care (Molina)", "ApexPayerId": "APX10008", "PayerId": "UTMOL", "NationalPayerId": "", "EraAvailability": "RequiresEnrollment", "OffersEligibility": true, "ClaimEnrollmentRequired": false }, { "Type": "Dental", "Name": "DMBA (Deseret Mutual Benefits Administrators)", "ApexPayerId": "APX10010", "PayerId": "DMRAT", "NationalPayerId": "", "EraAvailability": "RequiresEnrollment", "OffersEligibility": true, "ClaimEnrollmentRequired": true }, { "Type": "Dental", "Name": "IHC Direct Med", "ApexPayerId": "APX10011", "PayerId": "UHIHC", "NationalPayerId": "", "EraAvailability": "RequiresEnrollment", "OffersEligibility": true, "ClaimEnrollmentRequired": false }, ]
Successful Sample List Formatt of Medical Payers (Live or Test) Returned:
- HttpStatusCode: 200 (OK)
- Body:
[ { "Type": "Medical", "Name": "American Family Care (Molina)", "ApexPayerId": "APX10008", "PayerId": "UTMOL", "NationalPayerId": "", "EraAvailability": "RequiresEnrollment", "OffersEligibility": true, "ClaimEnrollmentRequired": false }, { "Type": "Medical", "Name": "DMBA (Deseret Mutual Benefits Administrators)", "ApexPayerId": "APX10010", "PayerId": "DMRAT", "NationalPayerId": "", "EraAvailability": "RequiresEnrollment", "OffersEligibility": true, "ClaimEnrollmentRequired": true }, { "Type": "Medical", "Name": "IHC Direct Med", "ApexPayerId": "APX10011", "PayerId": "UHIHC", "NationalPayerId": "", "EraAvailability": "RequiresEnrollment", "OffersEligibility": true, "ClaimEnrollmentRequired": false }, ]
No Payer Parameter Supplied: (Payer Type parameter was missing, must supply 'medical' or 'dental')
- HttpStatusCode: 404 (Not Found)
- Body:
{ "Message": "No HTTP resource was found that matches the request URI 'http://sandbox.services.apexedi.com/api/v3/payers/get_list'.", "MessageDetail": "No action was found on the controller 'Payers' that matches the request." }
SubmitClaims
/api/v3/claims/submit?vendorSiteId=<vendorSiteId>
/api/v3/claims/submitDental?vendorSiteId=<vendorSiteId>
where vendorSiteId is the assigned Vendor Site ID
If you are submitting a dental claim use "submitDental" path with the dental JSON object.
The body of the HTTP request is a JSON object with the required fields DocumentType and Claims. DocumentType must be of type MedicalClaim or DentalClaim. Claims is a list of one or more claims in JSON in JSON format.
If the request is not well-formed, then the HTTP status code will be 400, and the body of the response will contain information about the errors. If the request is well-formed, then the status will 200, and response will indicate which, if any, of the claims was accepted for transmission. It will also contain any validation errors that were detected.
When submitting test claims on the sandbox system, use the following payer IDs:
Medical: TST01
Dental: TST02
Curl Example
curl -X POST https://sandbox.services.apexedi.com/api/V3/claims/submit?vendorSiteId=XXSiteId ^
--header "Authorization: Basic <vendorkey:vendorPassword as base64 encoded string>" ^
--header "Content-Type: application/json" ^
--data <Claim data as json>
Example Medical JSON claim data (required fields only)
{
"DocumentType":"MedicalClaim",
"Claims":[
{
"Apex_PayerId":"TST01",
"Apex_VendorClaimId":"636336444143562077",
"F00_PayerName":"ACME HEALTH INSURANCE CO.",
"F01A_InsuredId":"904XT2654",
"F02_PatientNameLast":"SMITH",
"F02_PatientNameFirst":"JOHN",
"F03_PatientDob":"1961-04-20",
"F03_PatientSex":"M",
"F04_InsuredNameLast":"SMITH",
"F04_InsuredNameFirst":"JOHN",
"F05_PatientCity":"BROOKLYN",
"F05_PatientState": "NY",
"F05_PatientZip":"11223",
"F06_PatientRelationshipToInsured":"Self",
"F07_InsuredAddress1":"15892 ELM AVE",
"F07_InsuredCity": "BROOKLYN",
"F07_InsuredState": "NY",
"F07_InsuredZip":"11223",
"F11A_InsuredDob":"1961-04-20",
"F11A_InsuredSex":"M",
"F12_PatientAuthorization":"Yes",
"F21_IcdIndicator":"10",
"F21_DiagnosisCodes":["H906", "A043"],
"F24_ClaimLines":[
{
"F24A_DateOfServiceFrom":"2016-11-12",
"F24B_PlaceOfServiceCode":"11",
"F24D_HcpcsProcedureCode":"G8427",
"F24E_DiagnosisPointers":["A", "B"],
"F24F_Charges":32.0,
"----Comment: X12_ProvderControlNumber Is Optional": "This is the LineItemControlNumber (REF*6R)---"
"X12_ProviderControlNumber": "EDI.RGA000.15",
}],
"F25_FederalTaxIdEin":"123456789",
"F25_FederalTaxIdSsn":"Ssn if null Ein",
"F28_TotalCharge":32.0
"F31_PhysicianOrSupplierSignatureIsOnFile":true,
"F33_BillingProviderNameLast":"ACME HEARING CLINIC",
"F33_BillingProviderAddress1":"1734 9TH AVE SE #4",
"F33_BillingProviderCity":"EDGEWOOD",
"F33_BillingProviderState":"ST"
}]
}
Example Medical JSON claim data (extended example)
{
"DocumentType":"MedicalClaim",
"Claims":[
{
"Apex_PayerId":"TST01",
"Apex_VendorClaimId":"636336444143562077",
"F00_PayerName":"ACME HEALTH INSURANCE CO.",
"F00_PayerAddress1":"PO BOX 8943",
"F00_PayerAddress2":null,
"F00_PayerCity":"BROOKLYN",
"F00_PayerState":"NY",
"F00_PayerZip":"11223",
"F01_ClaimType":"Group",
"F01A_InsuredId":"904XT2654",
"F02_PatientNameLast":"SMITH",
"F02_PatientNameFirst":"JOHN",
"F02_PatientNameMiddle":null,
"F02_PatientSuffix":null,
"F03_PatientDob":"1961-04-20",
"F03_PatientSex":"M",
"F04_InsuredNameLast":"SMITH",
"F04_InsuredNameFirst":"JOHN",
"F04_InsuredNameMiddle":null,
"F04_InsuredSuffix":null,
"F05_PatientAddress1":"10545 404TH AVE",
"F05_PatientAddress2":null,
"F05_PatientCity":"BROOKLYN",
"F05_PatientState":"NY",
"F05_PatientZip":"11223",
"F05_PatientPhone":null,
"F06_PatientRelationshipToInsured":"Self",
"F07_InsuredAddress1":"15892 ELM AVE",
"F07_InsuredAddress2":null,
"F07_InsuredCity":"BROOKLYN",
"F07_InsuredState":"NY",
"F07_InsuredZip":"11223",
"F07_InsuredPhone":null,
"F09_OtherInsuredNameLast":"SMITH",
"F09_OtherInsuredNameFirst":"JOHN",
"F09_OtherInsuredNameMiddle":null,
"F09_OtherInsuredSuffix":null,
"F09A_OtherInsuredGroupNum":null,
"F09B_OtherInsuredDOB":null,
"F09B_OtherInsuredSex":null,
"F09C_OtherEmployerName":null,
"F09_PatientRelationshipToInsured":null,
"F09D_OtherPlanName":null,
"F10A_PatientCondEmployment":false,
"F10B_PatientCondAutoAccident":false,
"F10B_PatientCondAutoAccidentState":null,
"F10C_PatientCondOtherAccident":false,
"F11_InsuredsPolicyGroupOrFecaNumber":"65636",
"F11A_InsuredDob":"1961-04-20",
"F11A_InsuredSex":"M",
"F11C_PlanName":null,
"F11D_OtherPlan":false,
"F12_PatientAuthorization":"Yes",
"F12_PatientAuthorizationDate":"2016-09-20",
"F13_InsuredAuthorization":"Y",
"F14_DateOfCurrentIllnessOrSymptom":null,
"F14_LastMenstrualPeriodDate":null,
"F15_InitialTreatmentDate":null,
"F15_LastSeenDate":null,
"F15_AcuteManifestionDate":null,
"F15_AccidentDate":null,
"F15_LastXRayDate":null,
"F15_HearingAndVisionPrescriptionDate":null,
"F15_AssumedCareStartDate":null,
"F15_AssumedCareEndDate":null,
"F15_PropertyCasualtyFirstContactDate":null,
"F16_LastWorkedDate":null,
"F16_AuthorizedReturnToWorkDate":null,
"F17_ReferringProviderNameLast":null,
"F17_ReferringProviderNameFirst":null,
"F17_ReferringProviderNameMiddle":null,
"F17_ReferringProviderSuffix":null,
"F17_SupervisingProviderNameLast":null,
"F17_SupervisingProviderNameFirst":null,
"F17_SupervisingProviderNameMiddle":null,
"F17_SupervisingProviderSuffix":null,
"F17_OrderingProviderNameLast":null,
"F17_OrderingProviderNameFirst":null,
"F17_OrderingProviderNameMiddle":null,
"F17_OrderingProviderSuffix":null,
"F17A_ReferringProviderIdNumber":null,
"F17A_SupervisingProviderIdNumber":null,
"F17A_OrderingProviderIdNumber":null,
"F17B_ReferringProviderNpi":null,
"F17B_SupervisingProviderNpi":null,
"F17B_OrderingProviderNpi":null,
"F18_HospitalizationDateFrom":null,
"F18_HospitalizationDateTo":null,
"F19_ClaimSupplementalInfoNoteText":null,
"F21_IcdIndicator":"10",
"F21_DiagnosisCodes":["H906",
"A043"],
"F22_MedicaidResubmissionCode":null,
"F22_OriginalReferenceNumber":null,
"F23_PriorAuthorizationNumber":null,
"F23_ReferralNumber":null,
"F23_ClinicalLaboratoryImprovementAmendmentNumber":null,
"F23_MammographyCertificationNumber":null,
"F24_ClaimLines":[
{
"F24A_DateOfServiceFrom":"2016-11-12",
"F24A_DateOfServiceTo":"2016-11-12",
"F24B_PlaceOfServiceCode":"11",
"F24C_Emg":false,
"F24D_HcpcsProcedureCode":"G8427",
"F24D_Modifiers":null,
"X12_Description":null,
"F24E_DiagnosisPointers":["A",
"B"],
"F24F_Charges":0.0,
"F24G_DaysOrUnits":1.0,
"F24H_EarlyPeriodicScreeningDiagnosisAndTreatment":false,
"F24H_FamilyPlannning":false,
"F24J_Shaded_RendProviderTaxonomyCode":null,
"F24J_Shaded_RendProviderStateLicenseNumber":null,
"F24J_Shaded_RendProviderUpinNumber":null,
"F24J_Shaded_RendProviderCommercialNumber":null,
"F24J_Shaded_RendProviderLocationNumber":null,
"F24J_RenderingNpi":null,
"X12_Anesthesia":false,
"X12_ContractMonetaryAmount":null,
"X12_ContractTypeCode":null,
"X12_AdjudicationOrPaymentDate":null,
"X12_LineContractualObligationAdjustments":null,
"X12_LineCorrectionAndReversalAdjustments":null,
"X12_LineOtherAdjustments":null,
"X12_LinePayorInitiatedReductions":null,
"X12_LinePatientResponsibilityAdjustments":null,
"X12_MeasurementId":null,
"X12_MeasurementQualifier":null,
"X12_MeasurementValue":0.0,
"X12_NdcCode":null,
"X12_NdcQuantity":0.0,
"X12_DrugQuantityInternationalUnits":null,
"X12_DrugQuantityGrams":null,
"X12_DrugQuantityMilligrams":null,
"X12_DrugQuantityMilliliters":null,
"X12_DrugQuantityUnits":null,
"X12_NdcPharmacyPrescriptionNumber":null,
"X12_NdcLinkSequenceNumber":null,
"X12_PrimaryPayerPaidAmount":null,
"----Comment: X12_ProvderControlNumber": "This is the LineItemControlNumber (REF*6R)---"
"X12_ProviderControlNumber":null,
"F24_Shaded_LineNoteText":null
}],
"F25_FederalTaxIdEin":"123456789",
"F25_FederalTaxIdSsn":"Ssn if null Ein",
"F26_PatientAcctNumber":null,
"F27_AcceptAssignment":"Assigned",
"F28_TotalCharge":0.0,
"F29_PatientAmountPaid":null,
"F29_PayerAmountPaid":null,
"F31_PhysicianOrSupplierSignatureIsOnFile":false,
"F32_FacilityName":"ACME HEARING CLINIC",
"F32_FacilityAddress1":"1734 9TH AVE SE #4",
"F32_FacilityAddress2":null,
"F32_FacilityCity":"BROOKLYN
"F32_FacilityState":"NY",
"F32_FacilityZip":"11223",
"F32A_FacilityNpi":"1111122222",
"F32B_FacilityIdStateLicenseNumber":null,
"F32B_FacilityIdProviderCommercialLicenseNumber":null,
"F32B_FacilityIdLocationNumber":null,
"F33_BillingProviderNameLast":"JONES",
"F33_BillingProviderNameFirst":"JANE",
"F33_BillingProviderNameMiddle":null,
"F33_BillingProviderSuffix":"AU.D.",
"F33_BillingProviderAddress1":"1734 9TH AVE SE #4",
"F33_BillingProviderAddress2":null,
"F33_BillingProviderCity":"DULLES",
"F33_BillingProviderState":"VA",
"F33_BillingProviderZip":"20189",
"F33_BillingProviderPhoneNumber":"9998887777",
"F33A_BillingProviderNpi":"1111122222",
"F33B_BillingProviderTaxonomyCode":null,
"F33B_BillingProviderSsn":null,
"X12_PlaceOfServiceCode":null,
"X12_RendProviderNameLast":null,
"X12_RendProviderNameFirst":null,
"X12_RendProviderNameMiddle":null,
"X12_RendProviderSuffix":null,
"X12_RendProviderTaxonomyCode":null,
"X12_RendProviderStateLicenseNumber":null,
"X12_RendProviderUpinNumber":null,
"X12_RendProviderCommercialNumber":null,
"X12_RendProviderLocationNumber":null,
"X12_RenderingNPI":null,
"X12_AcuteManifestationCode":null,
"X12_ClaimAdjudicationDate":null,
"X12_ClaimPrimaryPayerPaidAmount":null,
"X12_ClaimContractualObligationAdjustments":null,
"X12_ClaimCorrectionAndReversalAdjustments":null,
"X12_ClaimOtherAdjustments":null,
"X12_ClaimPayorInitiatedReductions":null,
"X12_ClaimPatientResponsibilityAdjustments":null,
"X12_MedicalRecordNumber":null,
"X12_SpectacleLenses":null,
"X12_ContactLenses":null,
"X12_SpectacleFrames":null,
"X12_DisabilityDateFrom":null,
"X12_DisabilityDateTo":null,
"X12_ClaimContractMonetaryAmount":null,
"X12_ClaimContractTypeCode":null,
"X12_ClaimContractCode":null,
"X12_DelayReasonCode":null,
"X12_OtherPayerName":null
}]
}
Example Dental JSON claim data (required fields only)
{
"DocumentType": "DentalClaim",
"Claims": [
{
"Apex_VendorClaimId": "D123456789",
"Apex_PayerId": "TST02",
"F01_TypeOfTransaction": "ActualServices",
"F03_PayerName": "DELTA DENTAL",
"F04_OtherCoverage": false,
"F12_InsuredLastName": "GAN",
"F12_InsuredFirstName": "NAM",
"F15_InsuredID": "123456789",
"F32_TotalFee": "12345",
"F36_PatientSignature": "SIGNATURE ON FILE",
"F38_PlaceOfTreatment": "11",
"F40_OrthoTreatment": false,
"F43_Prosthesis": false,
"X12_TINorSSNQualifier": "EI",
"F53_TreatingDentistSignature": "Z",
"X12_ServiceDate": "2021-10-08",
"F18_PatientRelationship": "Self",
"F12_InsuredLastName": "GON",
"F12_InsuredFirstName": "MELL",
"F12_InsuredAddress": "125 street",
"F12_InsuredCity":"Small Town",
"F12_InsuredST":"UT",
"F12_InsuredZip":"12345",
"F13_InsuredDOB":"1990-01-01",
"F14_InsuredSex":"M",
"F15_InsuredID": "123456789",
"X12_SubscriberEntityTypeQualifier": "1",
"F18_PatientRelationship": "Self",
"X12_ServiceDate": "2021-10-08",
"LineItems": [
{
"F29_ProcedureCode": "D12345",
"F24_DateOfServiceFrom": "2021-10-08",
"F31_LineFee": "100"
}
],
"F32_TotalFee": "12345",
"F36_PatientSignature": "SIGNATURE ON FILE",
"F40_OrthoTreatment": false,
"F43_Prosthesis": false,
"F48_BillingDentistLastName": "Z",
"F48_BillingDentistAddress": "123",
"F48_BillingDentistCity": "123",
"F48_BillingDentistST": "TR",
"F48_BillingDentistZip": "84003",
"F48_BillingDentistNPI": "1234597893",
"F51_BillingDentistTaxID": "32145987",
"X12_TINorSSNQualifier": "EI",
"F53_TreatingDentistSignature": "Z",
}
]
}
Example Dental JSON claim data (extended example)
{
"DocumentType": "DentalClaim",
"Claims": [
{
"Apex_VendorClaimID": "D123456789",
"Apex_PayerId": "TST02",
"F01_TypeOfTransaction": "ActualServices",
"F02_PriorAuthNum": null,
"F03_PayerName": "My Payer Name",
"F03_PayerAddress1": "PO BOX 123",
"F03_PayerAddress2": null,
"F03_PayerCity": "City",
"F03_PayerState": "ST",
"F03_PayerZip": "12345",
"F04_OtherCoverage": false,
"F05_OtherInsuredLastName": null,
"F05_OtherInsuredFirstName": null,
"F05_OtherInsuredMI": null,
"F05_OtherInsuredSuffix": null,
"F06_OtherInsuredDOB": null,
"F07_OtherInsuredSex": null,
"F08_OtherInsuredPolicy": null,
"F09_OtherInsuredGrpNumber": null,
"F10_OtherPatientRelationship": "2",
"F11_OtherPayerName": null,
"F11_OtherPayerAddress": null,
"F11_OtherPayerCity": null,
"F11_OtherPayerST": null,
"F11_OtherPayerZip": null,
"F12_InsuredLastName": "GON",
"F12_InsuredFirstName": "MELL",
"F12_InsuredMI": "GETH",
"F12_InsuredSuffix": null,
"F12_InsuredAddress": "123 st",
"F12_InsuredCity": "Small Town",
"F12_InsuredST": "UT",
"F12_InsuredZip": "12345",
"F13_InsuredDOB": "1990-01-10",
"F14_InsuredSex": "M",
"F15_InsuredID": "123456789",
"F16_InsuredGroupNumber": "11111",
"F17_InsuredEmployerName": null,
"F18_PatientRelationship": "Self",
"F20_PatientLastName": "GON",
"F20_PatientFirstName": "MELL",
"F20_PatientMI": "GETH",
"F20_PatientSuffix": null,
"F20_PatientAddress": "123 st",
"F20_PatientCity": "Small Town",
"F20_PatientST": "UT",
"F20_PatientZip": "12345",
"F20_PatientDOB": "1990-01-10",
"F22_PatientSex": "M",
"F23_PatientID": "123456",
"F32_TotalFee": "12345",
"F33_MissingTeeth": [],
"F34_DiagnosiseCodeQualifier": null,
"F34a_DiagnosisCode": null,
"F35_Remarks": null,
"F36_PatientSignature": "SIGNATURE ON FILE",
"F36_PatientSignatureDate": "2022-10-08",
"F37_InsuredSignature": "SIGNATURE ON FILE",
"F37_InsuredSignatureDate": "2022-10-08",
"F38_PlaceOfTreatment": "11",
"F40_OrthoTreatment": false,
"F41_DateAppliancePlaced": null,
"F42_MonthsTreatment": null,
"F43_Prosthesis": false,
"F44_ProsthesisDateOfPriorPlacement": null,
"F45_TreatmentResultingFrom": null,
"F46_AccidentDate": null,
"F47_AutoAccidentState": null,
"F48_BillingDentistLastName": "Z",
"F48_BillingDentistFirstName": "Z",
"F48_BillingDentistMI": "Z",
"F48_BillingDentistSuffix": "Z",
"F48_BillingDentistAddress": "123",
"F48_BillingDentistCity": "123",
"F48_BillingDentistST": "TR",
"F48_BillingDentistZip": null,
"F48_BillingDentistNPI": "12345978",
"F50_BillingDentistLicense": null,
"F51_BillingDentistTaxID": "32145987",
"X12_TINorSSNQualifier": "EI",
"F52_BillingDentistPhone": "98151987",
"F52a_BillingDentistID": null,
"F53_TreatingDentistSignature": "Z",
"F53_TreatingDentistSignatureDate": null,
"X12_RenderingProvLastName": null,
"X12_RenderingProvFirstName": null,
"X12_RenderingProvMI": null,
"X12_RenderingProvSuffix": null,
"F53_TreatingDentistNPI": "1651984",
"F55_TreatingDentistLicense": "15984",
"X12_TreatmantLocationName": null,
"F56_TreatmentAddress": null,
"F56_TreatmentCity": null,
"F56_TreatmentST": null,
"F56_TreatmentZip": null,
"X12_TreatmantLocationNPI": null,
"F56a_DentistSpecialtyCode": "1984981x",
"F58_TreatingDentistAddlID": null,
"X12_Paytoaddress": null,
"X12_PaytoCity": null,
"X12_PaytoST": null,
"X12_PaytoZip": null,
"X12_AttachmentReportType": null,
"X12_AttachmentControlNumber": null,
"X12_AttachmentTransmissionCode": null,
"X12_PatientAmountPaid": null,
"X12_PredeterminationID": null,
"X12_ClaimFrequencyCode": null,
"X12_PayerControlNumber": null,
"X12_SubscriberIdentificationCodeQualifier": "1",
"X12_SubscriberEntityTypeQualifier": "1",
"X12_ServiceDate": "2021-10-08",
"LineItems": [
{
"F24_DateOfServiceFrom": "2021-10-08",
"F24_DateOfServiceTo": null,
"F25_AreaOfOralCavity": null,
"F26_ToothSystem": null,
"Teeth": [
{
"F27_Tooth": null,
"F28_ToothSurface": [
null,
null,
null,
null,
null
]
}
],
"F29_ProcedureCode": "D1235",
"F29a_DiagnosisPointer": null,
"F29b_Quantity": null,
"F30_Description": null,
"F31_LineFee": "1568",
"F31a_OtherFee": null,
"X12_LineControlNumber": null,
"X12_LineTreatingDentistLastname": null,
"X12_LineTreatingDentistFirstname": null,
"X12_LineTreatingDentistMI": null,
"X12_LineTreatingDentistSuffix": null,
"X12_LineTreatingDentistNPI": null,
"X12_LineTreatingDentistSpecialtyCode": null,
"X12_PrimaryPaidAmount": null,
"X12_UnitsPaid": null,
"X12_AdjudicationDate": null,
"X12_PlaceOfServiceCode": null,
"Adjustments": null
},
{
"F24_DateOfServiceFrom": "2021-10-08",
"F24_DateOfServiceTo": null,
"F25_AreaOfOralCavity": ["00","01"],l
"F26_ToothSystem": null,
"Teeth": [
{
"F27_Tooth": null,
"F28_ToothSurface": [
null,
null,
null,
null,
null
]
}
],
"F29_ProcedureCode": "D18",
"F29a_DiagnosisPointer": null,
"F29b_Quantity": null,
"F30_Description": null,
"F31_LineFee": "48",
"F31a_OtherFee": null,
"X12_LineControlNumber": null,
"X12_LineTreatingDentistLastname": null,
"X12_LineTreatingDentistFirstname": null,
"X12_LineTreatingDentistMI": null,
"X12_LineTreatingDentistSuffix": null,
"X12_LineTreatingDentistNPI": null,
"X12_LineTreatingDentistSpecialtyCode": null,
"X12_PrimaryPaidAmount": null,
"X12_UnitsPaid": null,
"X12_AdjudicationDate": null,
"X12_PlaceOfServiceCode": null,
"Adjustments": [
{
"X12_AdjustmentGroupCode": "15D",
"X12_AdjustmentReasonCode": "asdf",
"X12_AdjustmentAmount": "1684"
}
]
}
]
}
]
}
Responses
Successful submission, claim accepted.
There is one entry for each submitted claim. In this case, only one claim was submitted. If multiple claims are submitted, some may be accepted and others not accepted.
- HttpStatusCode: 200 (OK)
- Body:
{ "ClaimResults": [ { "VendorClaimId": "636336610085492300", "Status": "Accepted", "Errors": [], "RequestId": "f5500469a78847da90e2818239a6290e" } ], "DocumentLevelErrors": [] }
Successful submission, claim rejected.
There is one entry for each submitted claim. In this case, only one claim was submitted, and it was rejected. If multiple claims are submitted, some may be accepted and others not accepted. Validation errors are included for particular invalid fields.
- HttpStatusCode: 200 (OK)
- Body:
{ "ClaimResults": [ { "VendorClaimId": "636331353325402950", "Status": "NotAccepted", "Errors": [ { "Type": "Validation", "Code": "Validation", "Location": null, "SupplementalInformation": "Insured/Subscriber Date of Birth is missing or invalid." }, { "Type": "Validation", "Code": "Validation", "Location": null, "SupplementalInformation": "Diagnosis Code 1 is invalid." }, { "Type": "Validation", "Code": "Validation", "Location": null, "SupplementalInformation": "Diagnosis Code 1 is not valid for the given Date of Service." }, { "Type": "Validation", "Code": "Validation", "Location": null, "SupplementalInformation": "Diagnosis Code 2 is invalid." }, { "Type": "Validation", "Code": "Validation", "Location": null, "SupplementalInformation": "Diagnosis Code 2 is not valid for the given Date of Service." }, { "Type": "Validation", "Code": "Validation", "Location": null, "SupplementalInformation": "the 'FROM' and/or 'TO' Date of Service is invalid. Verify the 'TO' Date of Service is after the 'FROM' Date of Service. Please correct and resubmit the claim." }, { "Type": "Validation", "Code": "Validation", "Location": null, "SupplementalInformation": "the Procedure Code is not valid for the given Date of Service." }, { "Type": "Validation", "Code": "Validation", "Location": null, "SupplementalInformation": "Insured/Subscriber Date of Birth is missing or invalid." }, { "Type": "Validation", "Code": "Validation", "Location": null, "SupplementalInformation": "Diagnosis Code 1 is invalid." }, { "Type": "Validation", "Code": "Validation", "Location": null, "SupplementalInformation": "Diagnosis Code 1 is not valid for the given Date of Service." }, { "Type": "Validation", "Code": "Validation", "Location": null, "SupplementalInformation": "Diagnosis Code 2 is invalid." }, { "Type": "Validation", "Code": "Validation", "Location": null, "SupplementalInformation": "Diagnosis Code 2 is not valid for the given Date of Service." }, { "Type": "Validation", "Code": "Validation", "Location": null, "SupplementalInformation": "the 'FROM' and/or 'TO' Date of Service is invalid. Verify the 'TO' Date of Service is after the 'FROM' Date of Service. Please correct and resubmit the claim." }, { "Type": "Validation", "Code": "Validation", "Location": null, "SupplementalInformation": "the Procedure Code is not valid for the given Date of Service." } ], "RequestId": "cf8bc4e25b794d0f83592d6ab688ba0e" } ], "DocumentLevelErrors": [] }
Bad Request. The input is not in the correct format, required fields are missing, or the list of claims is empty.
- HttpStatusCode: 400 (Bad Request)
- Body:
{ "Message": "Entire claim submission requires correction and resubmission", "ModelState": { "Claims": [ "At least one claim is required" ] }
Bad Request. Some fields are not formatted properly.
- HttpStatusCode: 400 (Bad Request)
- Body:
{ "Message": "The request is invalid.", "ModelState": { "Claims[0].F03_PatientDob": [ "F03_PatientDob 19510220 is not a valid date in the format yyyy-mm-dd" ], "Claims[0].F11A_InsuredDob": [ "F11A_InsuredDob 19510220 is not a valid date in the format yyyy-mm-dd" ], "Claims[0].F12_PatientAuthorizationDate": [ "F12_PatientAuthorizationDate 20160920 is not a valid date in the format yyyy-mm-dd" ], "Claims[0].F24_ClaimLines[0].F24A_DateOfServiceFrom": [ "F24A_DateOfServiceFrom 20161112 is not a valid date in the format yyyy-mm-dd" ], "Claims[0].F24_ClaimLines[0].F24A_DateOfServiceTo": [ "F24A_DateOfServiceTo 20161112 is not a valid date in the format yyyy-mm-dd" ] } }
Claims Submission Failure. One or more claim fields missing.
- HttpStatusCode: 400 (Bad Request)
- Body:
{ "Message": "The request is invalid.", "ModelState": { "Claims[0].X12_RendProviderNameLast": [ "The X12_RendProviderNameLast field is required." ] } }
Import Service returns a NULL result
- HttpStatusCode: 204 (NoContent)
- Body:
{ "Message":"ImportServices could not import claims, ImportResult == NULL" }
Client Account Is In Bad State
- HttpStatusCode: 200 (OK)
- Body:
{ "ClaimResults": [], "DocumentLevelErrors": [ { "Type": "System", "Code": "InvalidSourceDocument", "Location": "line number ", "SupplementalInformation": "Unknown client 'XYZ' for source file 'C:\\\\ApexServices\\\\Importing\\\\WorkArea\\\\FVIODNXDMPIJBCGSA5RDDZPD\\\\M0829170942.XYZ'" } ] }
GetClaimStatusByDate
/api/V3/claims/status/get_by_date?vendorSiteId=<vendorSiteId>&startDate=<YYYY-MM-DD>&endDate=<YYYY-MM-DD>
Only the current status of a given claim is returned. The payer response related document ID should be used to get the payer response document for that current status via the GetPayerResponseDocument API
Curl Example
curl -X POST "https://sandbox.services.apexedi.com/api/v3/claims/status/get_by_date?vendorSiteId=XXSiteId&startDate=2017-04-12&endDate=2017-05-12"
--header "Authorization: Basic <vendorkey:vendorPassword as base64 encoded string>"
--header "Content-Type: application/json"
Responses
Successful List of Statuses returned
- HttpStatusCode: 200 (OK)
- Body:
[ { "VendorId": 333, "VendorSiteId": "444_XYZ", "ClaimNumber": "M28587618", "CurrentState": "Complete", "StateChangeDate": "2017-03-08", "PayerAction": "ProcessedAsPrimary", "PayerActionDate": "2017-02-13", "PayerControlNumber": "7284901234 0984823419", "CreateDate": "2017-02-13", "LastUpdateDate": "2017-03-08", "RelatedDocumentType": "RemittanceAdvice", "RelatedDocumentId": "RJL39LKFKLEPRJLXLKERUOWEKMAKSDJFOEIRASEKRU9824LKJLKAJ9", "TotalClaimAmount": 1735.00, "PayerAmount": 0.00, "Adjustments": 1735.00, "PatientAmount": 1735.00, "PayerName": null, "PaymentMethod": null, "PaymentReferenceNumber": "YK93459691", "PaymentEffectiveDate": "0001-01-01", "VendorClaimId": "288537" }, { "VendorId": 333, "VendorSiteId": "444_XYZ", "ClaimNumber": "M28719741", "CurrentState": "Complete", "StateChangeDate": "2017-04-12", "PayerAction": "ProcessedAsPrimary", "PayerActionDate": "2017-02-21", "PayerControlNumber": "OFC4342348700", "CreateDate": "2017-02-21", "LastUpdateDate": "2017-04-12", "RelatedDocumentType": "RemittanceAdvice", "RelatedDocumentId": "AHL2C6IOEWL2MJ6UT5JXOO3WXRBQD336DGUHEHKJJC5GTR2XRSYUU5", "TotalClaimAmount": 1735.00, "PayerAmount": 0.00, "Adjustments": 1735.00, "PatientAmount": 0.00, "PayerName": null, "PaymentMethod": null, "PaymentReferenceNumber": "080522Z000823", "PaymentEffectiveDate": "0001-01-01", "VendorClaimId": "288868" } ]
Errors
Invalid Date
- HttpStatusCode: 400 Bad Request
- Body:
{
"Message": "The request is invalid.",
"MessageDetail": "The parameters dictionary contains a null entry for parameter 'startDate' [or 'endDate'] of non-nullable type 'System.DateTime' for method 'System.Web.Http.IHttpActionResult Get(System.String, System.DateTime, System.DateTime)' in 'OneTouchWebServiceV3.Controllers.ClaimsController'. An optional parameter must be a reference type, a nullable type, or be declared as an optional parameter."
}
Invalid VendorSiteID Used
- HttpStatusCode: 400 (Bad Request)
- Body:
{
"Message": "Invalid VendorSiteId"
}
Missing or Blank VendorSiteID
- HttpStatusCode: 404 (Not Found)
- Body:
{
"Message":"No HTTP resource was found that matches the request URI 'http://sandbox.services.apexedi.com/api/V3/claims/status/get_by_date'."
}
GetPayerResponseDocuments
/api/v3/claims/responses/get_by_doc_id?vendorSiteId=<vendorSiteId>
Curl Example
curl -X POST https://sandbox.services.apexedi.com/api/v3/claims/responses/get_by_doc_id?vendorSiteId=XXSiteId ^
--header "Authorization: Basic <vendorkey:vendorPassword as base64 encoded string> " ^
--header "Content-Type: application/json" ^
--data "[\"AFPO53XLSSMNA3VV7YFMZ5NEGAOJQZLEOWEW3RYQNOFGUTD5AXI5\",\"AGAXJYIN4WXXE47IVWOSKG2MSBMNNHUGBNR3GX6FBBGPNTVGQ5\",\"AFNLV3FNBUL43DFVWDXJHXCAN2FQXY3EQ5AHCYPDE6FW5GWM5\"]"
Responses
Successful List of Payer Response Returned:
- HttpStatusCode: 200 (OK)
- Body:
{ "RemittanceAdvices": [ { "PaymentDetails": { "HandlingCode": "Notification", "TotalActualProviderPayment": 0.0, "TransactionType": "Credit", "PaymentMethod": "None", "PaymentFormat": "Unknown", "TransactionEffectiveDate": "2017-03-07", "ProductionDate": "2017-03-07", "PaymentReferenceNumber": "QK57791333", "SenderAbaTransitRoutingNumber": null, "SenderCanadianBankNumber": null, "SenderAccountNumber": null, "SenderSoftwareVersion": "1083", "PayerId": null, "PayerSupplementalId": null, "PayerTaxId": "1411289245", "PayerSupplementalTaxId": "PE0047856", "ReceiverId": "B00099999800", "ReceiverAbaTransitRoutingNumber": null, "ReceiverCanadianBankNumber": null, "ReceiverBankIdNumber": null, "ReceiverDepositAccountNumber": null, "ReceiverSavingsAccountNumber": null, "Currency": null }, "Payer": { "Name": "ACCEPTABLE HEALTHCARE INSURANCE COMPANY", "BusinessContact": null, "TechnicalContacts": [ { "Name": "", "Methods": [ { "EmailAddress": null, "PhoneNumber": null, "PhoneNumberExtension": null, "FaxNumber": null } ] } ], "WebSite": null, "PhysicalAddress": { "SendToAttentionOf": null, "Address1": "P O BOX 999888", "Address2": null, "City": "ATLANTA", "State": "GA", "ZipCode": "303999888", "CountryCode": null, "CountrySubCode": null }, "PayerId": "87878", "CmsPlanId": null, "PayerIdentificationNumber": "87878", "SubmitterIdentificationNumber": null, "HealthIndustryNumber": null, "TaxpayerIdentificationNumber": null, "PharmacyProcessorNumber": null, "NaicCode": null, "BcbsPlanCode": null }, "Payee": { "Name": "TIP-TOP DIAGNOSTICS LLC", "NationalProviderId": null, "TaxIdNumber": "343434343", "CmsPlanId": null, "StateLicenseNumber": null, "PharmacyNumber": null, "PayeeId": "5959595959", "OtherPayeeId": null, "DeliveryMethod": "Unknown", "PhysicalAddress": { "SendToAttentionOf": null, "Address1": "23558 PLEASING LANE STE 504A", "Address2": null, "City": "FLORENCE", "State": "OH", "ZipCode": "431408685", "CountryCode": null, "CountrySubCode": null }, "DeliveryUrl": null }, "SubsidiaryProviderId": "5959595959", "ProviderFiscalYearEnd": null, "ClaimPayments": [ { "PatientControlNumber": "EDI.JONES000", "PayerControlNumber": "5846876875 0068512147", "ClaimType": "PointOfService", "PayerStatus": "ProcessedAsPrimary", "TotalClaimCharges": 250.0, "PaymentAmount": 0.0, "PatientResponsibility": 0.0, "PlaceOfService": "Office", "ClaimFrequency": "AdmitThroughDischarge", "DischargeFraction": null, "ClaimLevelAdjustments": null, "Patient": { "SocialSecurityNumber": null, "StandardUniqueHealthIdentifier": null, "MemberIdentificationNumber": null, "HealthInsuranceClaimNumber": null, "MedicaidIdentificationNumber": null, "Address": null, "EntityType": "Individual", "CommonName": "JONES", "FirstName": "SALLY", "MiddleName": null, "Suffix": null }, "Subscriber": { "TaxIdentificationNumber": null, "StandardUniqueHealthIdentifier": null, "MemberIdentificationNumber": "161616161616", "GroupPolicyNumber": null, "GroupName": null, "EntityType": "Individual", "CommonName": "JONES", "FirstName": "SALLY", "MiddleName": null, "Suffix": null }, "OtherSubscriber": null, "CorrectedEntity": { "CorrectedUniqueId": "515151515", "OtherInsuredGroupNumber": null, "EntityType": "Individual", "CommonName": null, "FirstName": null, "MiddleName": "A", "Suffix": null }, "RenderingProvider": null, "CrossoverPayer": null, "CorrectedPriorityPayer": null, "OutpatientAdjudicationInformation": null, "InpatientAdjudicationInformation": null, "ServicePayments": [ { "AdjudicatedProcedure1": { "Type": "Unknown", "ProcedureCode": "G0479", "Description": null, "Modifiers": [] }, "AdjudicatedProcedure2": null, "LineItemChargeAmount": 250.0, "LineItemProviderPaymentAmount": 0.0, "ServiceDates": { "Start": "2017-01-05", "End": null }, "NubcRevenueCode": null, "PaidUnitsOfServiceCount": 1.0, "OriginalUnitsOfServiceCount": null, "Adjustments": [ { "GroupCode": "PayorInitiatedReductions", "Adjustments": [ { "Reason": "226", "Amount": 250.0, "Quantity": null } ] } ], "AmbulatoryPatientGroupNumber": null, "AmbulatoryPatientClassification": null, "AuthorizationNumber": null, "AttachmentCode": null, "PriorAuthorizationNumber": null, "PredeterminationOfBenefitsId": null, "LocationNumber": null, "RateCode": null, "LineItemControlNumber": "EDI.JONES000.367", "RenderingProviderIds": null, "HealthCarePolicyNumbers": null, "AllowedActualAmount": null, "LateFilingReductionAmount": null, "TaxAmount": null, "TotalClaimBeforeTaxesAmount": null, "FederallyMandatedPayments": null, "Remarks": [ { "PaymentRemark": "N706", "PrescriptionDrugCode": null } ] } ], "GroupOrPolicyNumber": "747474", "MemberIdentificationNumber": null, "EmployeeIdentificationNumber": null, "RepricedClaimReferenceNumber": null, "AdjustedRepricedClaimReferenceNumber": null, "AuthorizationNumber": null, "ClassOfContractCode": "CHOYC+", "MedicalReferenceId": null, "OriginalReferenceNumber": null, "PriorAuthorizationNumber": null, "PredeterminationOfBenefitsId": null, "InsurancePolicyNumber": null, "SocialSecurityNumber": null, "StatementDate": { "Start": "2017-01-05", "End": "2017-01-05" }, "CoverageExpirationDate": null, "ClaimReceivedDate": "2017-01-10", "PrimaryPayerContact": { "Name": "HIGH POINT SERVICE CENTER", "Methods": [ { "EmailAddress": null, "PhoneNumber": "8778778778", "PhoneNumberExtension": null, "FaxNumber": null } ] }, "SecondaryPayerContact": null, "CovergeAmount": null, "PromptPayDiscountAmount": null, "PerDayLimitAmount": null, "PatientAmountPaid": null, "InterestAmount": null, "NegativeLedgerAmount": null, "TaxAmount": null, "TotalClaimBeforeTaxesAmount": null, "FederallyMandatedPayments": null, "CoveredQuantityActual": null, "NonCoveredQuantityEstimated": null, "CoinsuredQuantityActual": null, "LifetimeReservedQuantityActual": null, "LifetimeReservedQuantityEstimated": null, "NotReplacedBloodUnits": null, "OutlierDays": null, "PrescriptionQuantity": null, "Visits": null }, { "PatientControlNumber": "EDI.JOHSUE000", "PayerControlNumber": "6385088433 0263858372", "ClaimType": "PointOfService", "PayerStatus": "ProcessedAsPrimary", "TotalClaimCharges": 1735.0, "PaymentAmount": 0.0, "PatientResponsibility": 1735.0, "PlaceOfService": "Office", "ClaimFrequency": "AdmitThroughDischarge", "DischargeFraction": null, "ClaimLevelAdjustments": null, "Patient": { "SocialSecurityNumber": null, "StandardUniqueHealthIdentifier": null, "MemberIdentificationNumber": null, "HealthInsuranceClaimNumber": null, "MedicaidIdentificationNumber": null, "Address": null, "EntityType": "Individual", "CommonName": "JOHNSON", "FirstName": "SUE", "MiddleName": null, "Suffix": null }, "Subscriber": { "TaxIdentificationNumber": null, "StandardUniqueHealthIdentifier": null, "MemberIdentificationNumber": "939393939", "GroupPolicyNumber": null, "GroupName": null, "EntityType": "Individual", "CommonName": "JOHNSON", "FirstName": "SUE", "MiddleName": null, "Suffix": null }, "OtherSubscriber": null, "CorrectedEntity": { "CorrectedUniqueId": null, "OtherInsuredGroupNumber": null, "EntityType": "Individual", "CommonName": null, "FirstName": null, "MiddleName": "A", "Suffix": null }, "RenderingProvider": null, "CrossoverPayer": null, "CorrectedPriorityPayer": null, "OutpatientAdjudicationInformation": null, "InpatientAdjudicationInformation": null, "ServicePayments": [ { "AdjudicatedProcedure1": { "Type": "Unknown", "ProcedureCode": "80307", "Description": null, "Modifiers": [] }, "AdjudicatedProcedure2": null, "LineItemChargeAmount": 250.0, "LineItemProviderPaymentAmount": 0.0, "ServiceDates": { "Start": "2017-02-21", "End": null }, "NubcRevenueCode": null, "PaidUnitsOfServiceCount": 1.0, "OriginalUnitsOfServiceCount": null, "Adjustments": [ { "GroupCode": "PatientResponsibility", "Adjustments": [ { "Reason": "1", "Amount": 87.79, "Quantity": null }, { "Reason": "45", "Amount": 162.21, "Quantity": null } ] } ], "AmbulatoryPatientGroupNumber": null, "AmbulatoryPatientClassification": null, "AuthorizationNumber": null, "AttachmentCode": null, "PriorAuthorizationNumber": null, "PredeterminationOfBenefitsId": null, "LocationNumber": null, "RateCode": null, "LineItemControlNumber": "EDI.JOHSUE000.244", "RenderingProviderIds": null, "HealthCarePolicyNumbers": null, "AllowedActualAmount": 87.79, "LateFilingReductionAmount": null, "TaxAmount": null, "TotalClaimBeforeTaxesAmount": null, "FederallyMandatedPayments": null, "Remarks": null }, { "AdjudicatedProcedure1": { "Type": "Unknown", "ProcedureCode": "83516", "Description": null, "Modifiers": [ "91" ] }, "AdjudicatedProcedure2": null, "LineItemChargeAmount": 232.0, "LineItemProviderPaymentAmount": 0.0, "ServiceDates": { "Start": "2017-02-21", "End": null }, "NubcRevenueCode": null, "PaidUnitsOfServiceCount": 4.0, "OriginalUnitsOfServiceCount": null, "Adjustments": [ { "GroupCode": "PatientResponsibility", "Adjustments": [ { "Reason": "1", "Amount": 69.61, "Quantity": null }, { "Reason": "45", "Amount": 162.39, "Quantity": null } ] } ], "AmbulatoryPatientGroupNumber": null, "AmbulatoryPatientClassification": null, "AuthorizationNumber": null, "AttachmentCode": null, "PriorAuthorizationNumber": null, "PredeterminationOfBenefitsId": null, "LocationNumber": null, "RateCode": null, "LineItemControlNumber": "EDI.JOHSUE000.245", "RenderingProviderIds": null, "HealthCarePolicyNumbers": null, "AllowedActualAmount": 69.61, "LateFilingReductionAmount": null, "TaxAmount": null, "TotalClaimBeforeTaxesAmount": null, "FederallyMandatedPayments": null, "Remarks": null }, { "AdjudicatedProcedure1": { "Type": "Unknown", "ProcedureCode": "82542", "Description": null, "Modifiers": [ "91" ] }, "AdjudicatedProcedure2": null, "LineItemChargeAmount": 462.0, "LineItemProviderPaymentAmount": 0.0, "ServiceDates": { "Start": "2017-02-21", "End": null }, "NubcRevenueCode": null, "PaidUnitsOfServiceCount": 6.0, "OriginalUnitsOfServiceCount": null, "Adjustments": [ { "GroupCode": "PatientResponsibility", "Adjustments": [ { "Reason": "1", "Amount": 157.74, "Quantity": null }, { "Reason": "45", "Amount": 304.26, "Quantity": null } ] } ], "AmbulatoryPatientGroupNumber": null, "AmbulatoryPatientClassification": null, "AuthorizationNumber": null, "AttachmentCode": null, "PriorAuthorizationNumber": null, "PredeterminationOfBenefitsId": null, "LocationNumber": null, "RateCode": null, "LineItemControlNumber": "EDI.JOHSUE000.246", "RenderingProviderIds": null, "HealthCarePolicyNumbers": null, "AllowedActualAmount": 157.74, "LateFilingReductionAmount": null, "TaxAmount": null, "TotalClaimBeforeTaxesAmount": null, "FederallyMandatedPayments": null, "Remarks": null }, { "AdjudicatedProcedure1": { "Type": "Unknown", "ProcedureCode": "80299", "Description": null, "Modifiers": [ "91" ] }, "AdjudicatedProcedure2": null, "LineItemChargeAmount": 141.0, "LineItemProviderPaymentAmount": 0.0, "ServiceDates": { "Start": "2017-02-21", "End": null }, "NubcRevenueCode": null, "PaidUnitsOfServiceCount": 3.0, "OriginalUnitsOfServiceCount": null, "Adjustments": [ { "GroupCode": "PatientResponsibility", "Adjustments": [ { "Reason": "1", "Amount": 70.5, "Quantity": null }, { "Reason": "45", "Amount": 70.5, "Quantity": null } ] } ], "AmbulatoryPatientGroupNumber": null, "AmbulatoryPatientClassification": null, "AuthorizationNumber": null, "AttachmentCode": null, "PriorAuthorizationNumber": null, "PredeterminationOfBenefitsId": null, "LocationNumber": null, "RateCode": null, "LineItemControlNumber": "EDI.JOHSUE000.247", "RenderingProviderIds": null, "HealthCarePolicyNumbers": null, "AllowedActualAmount": 70.5, "LateFilingReductionAmount": null, "TaxAmount": null, "TotalClaimBeforeTaxesAmount": null, "FederallyMandatedPayments": null, "Remarks": null }, { "AdjudicatedProcedure1": { "Type": "Unknown", "ProcedureCode": "G0483", "Description": null, "Modifiers": [] }, "AdjudicatedProcedure2": null, "LineItemChargeAmount": 650.0, "LineItemProviderPaymentAmount": 0.0, "ServiceDates": { "Start": "2017-02-21", "End": null }, "NubcRevenueCode": null, "PaidUnitsOfServiceCount": 1.0, "OriginalUnitsOfServiceCount": null, "Adjustments": [ { "GroupCode": "PatientResponsibility", "Adjustments": [ { "Reason": "1", "Amount": 269.48, "Quantity": null }, { "Reason": "45", "Amount": 380.52, "Quantity": null } ] } ], "AmbulatoryPatientGroupNumber": null, "AmbulatoryPatientClassification": null, "AuthorizationNumber": null, "AttachmentCode": null, "PriorAuthorizationNumber": null, "PredeterminationOfBenefitsId": null, "LocationNumber": null, "RateCode": null, "LineItemControlNumber": "EDI.JOHSUE000.248", "RenderingProviderIds": null, "HealthCarePolicyNumbers": null, "AllowedActualAmount": 269.48, "LateFilingReductionAmount": null, "TaxAmount": null, "TotalClaimBeforeTaxesAmount": null, "FederallyMandatedPayments": null, "Remarks": null } ], "GroupOrPolicyNumber": "6Q8787", "MemberIdentificationNumber": null, "EmployeeIdentificationNumber": null, "RepricedClaimReferenceNumber": null, "AdjustedRepricedClaimReferenceNumber": null, "AuthorizationNumber": null, "ClassOfContractCode": "CHOYC+", "MedicalReferenceId": null, "OriginalReferenceNumber": null, "PriorAuthorizationNumber": null, "PredeterminationOfBenefitsId": null, "InsurancePolicyNumber": null, "SocialSecurityNumber": null, "StatementDate": { "Start": "2017-02-21", "End": "2017-02-21" }, "CoverageExpirationDate": null, "ClaimReceivedDate": "2017-02-28", "PrimaryPayerContact": { "Name": "HIGH POINT SMALL GROUP", "Methods": [ { "EmailAddress": null, "PhoneNumber": "8668668668", "PhoneNumberExtension": null, "FaxNumber": null } ] }, "SecondaryPayerContact": null, "CovergeAmount": 655.12, "PromptPayDiscountAmount": null, "PerDayLimitAmount": null, "PatientAmountPaid": null, "InterestAmount": null, "NegativeLedgerAmount": null, "TaxAmount": null, "TotalClaimBeforeTaxesAmount": null, "FederallyMandatedPayments": null, "CoveredQuantityActual": null, "NonCoveredQuantityEstimated": null, "CoinsuredQuantityActual": null, "LifetimeReservedQuantityActual": null, "LifetimeReservedQuantityEstimated": null, "NotReplacedBloodUnits": null, "OutlierDays": null, "PrescriptionQuantity": null, "Visits": null }, { "PatientControlNumber": "EDI.WILFR000", "PayerControlNumber": "7992341002 3542340901", "ClaimType": "PointOfService", "PayerStatus": "ProcessedAsPrimary", "TotalClaimCharges": 1735.0, "PaymentAmount": 0.0, "PatientResponsibility": 1735.0, "PlaceOfService": "Office", "ClaimFrequency": "AdmitThroughDischarge", "DischargeFraction": null, "ClaimLevelAdjustments": null, "Patient": { "SocialSecurityNumber": null, "StandardUniqueHealthIdentifier": null, "MemberIdentificationNumber": null, "HealthInsuranceClaimNumber": null, "MedicaidIdentificationNumber": null, "Address": null, "EntityType": "Individual", "CommonName": "WILLIAMS", "FirstName": "FRED", "MiddleName": null, "Suffix": null }, "Subscriber": { "TaxIdentificationNumber": null, "StandardUniqueHealthIdentifier": null, "MemberIdentificationNumber": "383838383", "GroupPolicyNumber": null, "GroupName": null, "EntityType": "Individual", "CommonName": "WILLIAMS", "FirstName": "FRED", "MiddleName": null, "Suffix": null }, "OtherSubscriber": null, "CorrectedEntity": { "CorrectedUniqueId": null, "OtherInsuredGroupNumber": null, "EntityType": "Individual", "CommonName": "WILLIAMS", "FirstName": "FRED", "MiddleName": "J", "Suffix": null }, "RenderingProvider": null, "CrossoverPayer": null, "CorrectedPriorityPayer": null, "OutpatientAdjudicationInformation": null, "InpatientAdjudicationInformation": null, "ServicePayments": [ { "AdjudicatedProcedure1": { "Type": "Unknown", "ProcedureCode": "80307", "Description": null, "Modifiers": [] }, "AdjudicatedProcedure2": null, "LineItemChargeAmount": 250.0, "LineItemProviderPaymentAmount": 0.0, "ServiceDates": { "Start": "2017-02-06", "End": null }, "NubcRevenueCode": null, "PaidUnitsOfServiceCount": 1.0, "OriginalUnitsOfServiceCount": null, "Adjustments": [ { "GroupCode": "PatientResponsibility", 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"FirstName": null, "MiddleName": null, "Suffix": null }, "SubmitterPrimaryId": "AW95595595", "SubmitterBatchNumber": "0", "TransactionStatus": [ { "EffectiveDate": "2017-03-07", "Action": "Accept", "TotalChargeAmount": 160057.0, "StatusMessage": null, "Details": { "StatusCategory": "AckReceipt", "Status": "20", "Entity": "None" }, "AdditionalDetails": null } ], "TotalAcceptedCount": 89.0, "TotalAcceptedAmount": 160057.0, "TotalRejectedCount": null, "TotalRejectedAmount": null }, "BillingProvider": { "NationalProviderId": "5959595959", "TaxpayerNumber": "343434343", "StateLicenseNumber": null, "UpinNumber": null, "CommercialNumber": null, "LocationNumber": null, "SocialSecurityNumber": null, "InformationTraceId": "0", "TotalAcceptedCount": 89.0, "TotalAcceptedAmount": 160057.0, "TotalRejectedCount": null, "TotalRejectedAmount": null, "ProviderStatus": null, "PhysicalAddress": null, "EntityType": "Organization", "CommonName": "TIP-TOP DIAGNOSTICS LLC", "FirstName": null, "MiddleName": null, "Suffix": null }, "Patient": { "SocialSecurityNumber": null, "StandardUniqueHealthIdentifier": null, "MemberIdentificationNumber": "2U4552525525", "HealthInsuranceClaimNumber": null, "MedicaidIdentificationNumber": null, "Address": null, "EntityType": "Unknown", "CommonName": "DAVIS", "FirstName": "BRITTANY", "MiddleName": null, "Suffix": null }, "PatientControlNumber": "EDI.DAVBR000", "PayerControlNumber": "8068068068068", "BillTypeId": null, "Status": [ { "EffectiveDate": "2017-03-07", "Action": "Accept", "TotalChargeAmount": 4195.0, "StatusMessage": null, "Details": { "StatusCategory": "AckReceipt", "Status": "20", "Entity": "None" }, "AdditionalDetails": null } ], "ClearinghouseControlNumber": "M97979797", "ClaimServiceDate": { "Start": "2015-08-18", "End": "2015-08-18" }, "ServiceErrors": null, "Subscriber": null, "VendorClaimId": "289486", "DocumentId": "IEKSLFIEL389LK845AS6D87ER354ASDF57ER6543ASDF5JYUOL4482", "CreateDate": "2017-03-07", "ResponseType": "ClaimStatus" }, { "Level": "Claim", "TransactionDetails": { "SenderType": "Payer", "SenderName": "FIRST-RATE INSURANCE CO.", "SenderApplicationTraceId": "24242424242424242", "SenderTransmitterIdNumber": null, "SenderTaxIdNumber": null, "SenderPayerId": "00621", "SenderCmsPlanId": null, "ClaimReceivedDate": "2017-03-06", "ClaimProcessDate": "2017-03-07", "Submitter": { "EntityType": "Organization", "CommonName": "APEX EDI INC", "FirstName": null, "MiddleName": null, "Suffix": null }, "SubmitterPrimaryId": "MW83942087", "SubmitterBatchNumber": "0", "TransactionStatus": [ { "EffectiveDate": "2017-03-07", "Action": "Accept", "TotalChargeAmount": 160057.0, "StatusMessage": null, "Details": { "StatusCategory": "AckReceipt", "Status": "20", "Entity": "None" }, "AdditionalDetails": null } ], "TotalAcceptedCount": 89.0, "TotalAcceptedAmount": 160057.0, "TotalRejectedCount": null, "TotalRejectedAmount": null }, "BillingProvider": { "NationalProviderId": "5959595959", "TaxpayerNumber": "343434343", "StateLicenseNumber": null, "UpinNumber": null, "CommercialNumber": null, "LocationNumber": null, "SocialSecurityNumber": null, "InformationTraceId": "0", "TotalAcceptedCount": 89.0, "TotalAcceptedAmount": 160057.0, "TotalRejectedCount": null, "TotalRejectedAmount": null, "ProviderStatus": null, "PhysicalAddress": null, "EntityType": "Organization", "CommonName": "TIP-TOP DIAGNOSTICS LLC", "FirstName": null, "MiddleName": null, "Suffix": null }, "Patient": { "SocialSecurityNumber": null, "StandardUniqueHealthIdentifier": null, "MemberIdentificationNumber": "2U4552525525", "HealthInsuranceClaimNumber": null, "MedicaidIdentificationNumber": null, "Address": null, "EntityType": "Unknown", "CommonName": "DAVIS", "FirstName": "BRITTANY", "MiddleName": null, "Suffix": null }, "PatientControlNumber": "EDI.DAVBR000", "PayerControlNumber": "82490071234XX", "BillTypeId": null, "Status": [ { "EffectiveDate": "2017-03-07", "Action": "Accept", "TotalChargeAmount": 4195.0, "StatusMessage": null, "Details": { "StatusCategory": "AckReceipt", "Status": "20", "Entity": "None" }, "AdditionalDetails": null } ], "ClearinghouseControlNumber": "M74747474", "ClaimServiceDate": { "Start": "2015-09-15", "End": "2015-09-15" }, "ServiceErrors": null, "Subscriber": null, "VendorClaimId": "289487", "DocumentId": "JRWEIJI893492JKJASKFJLIE8423LK34FJ1890FASDKEW8342KS89L", "CreateDate": "2017-03-07", "ResponseType": "ClaimStatus" } ] }
Bad Document IDs Passed In
- No errors, but no response documents returned, i.e., if 20 doc IDs are submitted, and 5 have invalid IDs, then only the 15 documents that had valid Doc IDs will be returned.
Invalid VendorSiteID Used:
- HttpStatusCode: 400 (Bad Request)
- Body:
{
"Message": "Invalid VendorSiteId"
}
Parameter Has No Content for VendorSiteId
- HttpStatusCode: 400 (Bad Request)
- Body:
{
"Message": "Value cannot be null.\r\nParameter name: vendorSiteId"
}
Missing vendorSiteId
- HttpStatusCode: 404 (Not Found)
- Body:
{
"Message":"No HTTP resource was found that matches the request URI 'http://sandbox.services.apexedi.com/api/v3/claims/get_by_doc_id/'."
}