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Webhook for Claims

Webhooks enable you to receive data to a specific URL whenever certain actions are performed on your integration. Each action is referred to as an event.

A webhook URL is an endpoint on your server where you can receive notifications about such events.

To Setup your webhook URL

  • Login to the settings page of your organization's account on the web platform
  • Go to developer access, there you would see where to specify your webhook URL.

Events

Possible types of events to expect are below:

Claim Pile Vetting Done

This event is triggered after all claims in a pile have been vetted, gone through the entire process (including multiple audits if configured) and the pile has a status of 'Vetting Done'. It will be triggered for every single claim within the pile.

Note

The notification for each claim within a pile will be sent one after the other and not all at once, considering there are typically many claims in a pile so as not to overload your servers.

The payload structure to expect is below:

JSON
{
"event":"claim.pile.vetting_done",
"data":{
"id": {integer},
"pile_id": {integer},
"ref": {string},
"provider": {
"id": {integer},
"name": {string},
"code": {string}
},
"encounter_date": "2021-09-05T00:00:00.000000Z",
"enrollee_id": {integer},
"billed_amount": {float},
"approved_amount": {float},
"approval_status": {null, 0 or 1},
"vetted_at": "2022-02-16T16:17:32.000000Z",
"diagnoses": [
{
"name": {string},
"icd_code": {string}
}
],
"items": [
{
"ref": {string},
"description": {string},
"unit_price_billed": {integer},
"unit_price_approved": {integer},
"qty_billed": {integer},
"qty_approved": {integer},
"sub_total_billed": {integer},
"sub_total_approved": {integer},
"comments": {array} //
"approval_status": {null, 0 or 1}
}
]
}
}

Claim Vetted

This event is triggered when an individual claim has been vetted successfully regardless of whether the pile has been completely vetted or not.

The payload structure to expect is below:

JSON
{
"event": "claim.vetted",
"data": {
"id": "{integer}",
"pile_id": "{integer}",
"ref": "{string|null}",
"encounter_date": "{datetime}",
"provider": {
"id": "{integer}",
"name": "{string}"
},
"enrollee": {
"id": "{integer}",
"insurance_no": "{string}",
"first_name": "{string}",
"last_name": "{string}",
"status": "{string}",
"type": "{string}"
},
"approved_amount": "{float}",
"vetted_at": "{datetime}",
"status": "{string}",
"approval_status": "{null, 0 or 1}",
"diagnoses": [
{
"name": "{string}",
"icd_code": "{string}"
}
// Additional diagnosis objects...
],
"items": [
{
"ref": "{string|null}",
"description": "{string}",
"unit_price_billed": "{float}",
"unit_price_approved": "{float}",
"qty_billed": "{integer}",
"qty_approved": "{float}",
"sub_total_billed": "{float}",
"sub_total_approved": "{float}",
"comments": "{array}",
"status": "{null, 0 or 1}"
}
// Additional item objects...
]
}
}

Payload Data Description

AttributeDescription
idId of the auto-vetted claim
pile_idId of the pile the claim belongs to
refUnique identifier for the claim on the source's system.
providerProvider to which claim is attached
provider.idThe id of the provider
provider.nameThe name of the provider
provider.codeThe provider code
encounter_dateThe encounter date
enrollee.idId of the enrollee
approved_amountdecimal-based value of the approved amount after auto-vetting
approval_statusstatus of the claim (0 = rejected, null = pending, 1 = approved).
vetted_atA timestamp indicating when the claim was vetted
diagnoses[n]Collection of claim diagnoses.
diagnoses[n].nameUnique name of the diagnosis
diagnoses[n].icd_codeUnique icd code of diagnosis
items[n].refUnique identifier for the claim item as it is on the source system. E.g it’s id
items[n].descriptionDescription of the service rendered to the enrollee
items[n].unit_price_billedRequested unit price of the item
items[n].unit_price_approvedThe approved unit price of the item after auto-vetting.
items[n].qty_billedQuantity of the claim item
items[n].qty_approvedApproved quantity of claim item after auto-vetting
items[n].sub_total_billedThe total amount of claim item (unit_price_billed * qty)
items[n].sub_total_approvedThe total amount of claim item (unit_price_approved * qty_approved)
items[n].commentsA collection of the claim item comments after auto-vetting
items[n].approval_statusApproval status of the claim item. (null = pending, 0 = rejected, 1 = approved)