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Create a claim

POST 
/v1/claims

Create a claim

Request​

Body

required

Claims Information

    hmo_code string

    Required only for Provider / EMR integrations

    The human friendly unique code of the Insurer who should receive this claim.

    See insurer list endpoint for available Insurers

    hmo_id number

    The ID of the Insurer who should receive this claim. Used when hmo_code is not supplied

    provider_code string

    Required for Insurer / HMO integrations only. This is the unique code/ID with which you(The Insurer) identify the provider within your database. NB: This code must be attached to the provider on your curacel account.

    enrollee objectrequired

    Specifies the Enrollee / Patient for whom this claim is created

    insurance_no string

    The insurance number of the enrollee as supplied by the HMO. This would be validated against existing insurance numbers.

    first_name string

    The name to be saved for floating enrollee.

    last_name string

    The name to be saved for floating enrollee.

    is_floating boolean

    Default value: false

    Floating enrollees are those whose insurance numbers are not yet registered with Curacel. Pass this as true when this is the case and the insurance number will no longer be validated (Avoid using this as much as possible)

    create_if_not_found boolean

    Default value: false

    Insurer / HMO integrations only.

    Automatically creates a new record for the enrollee if the insurance number doesn't match an existing record.

    First_name and last_name should be supplied if this is true as they would be used to create the record.

    encounter_date daterequired

    The date of the patient’s visit to the provider.

    admission_date date

    If the patient was admitted, date admission started.

    discharge_date date

    If the patient was admitted, date of discharge.

    diagnoses objectrequired

    The collection of diagnoses that should be attached to this claim.

    icd_codes string[]

    (Recommended)If ICD10 codes are available, an array of the icd10 codes which represent the diagnoses concerned. E.g [‘b54’, ‘k27’]

    names string[]

    Where ICD codes are not available, the names / descriptions of the diagnoses can be used as an alternative to identify them.

    pa_code string

    Pre-authorization code for the claim.

    items object[]required

    Collection of all the line items that make up the claim.

  • Array [
    • description string

    Description of the service rendered to the enrollee.

    unit_price_billed double

    Unit price of the item

    qty integer

    Qty of the item. Would be automatically multiplied with unit price to derive sub_total for the item

    tariff_code string

    If the tariff code as agreed between the hospital and HMO is available, this can be supplied to aid precise validation of the tariff.

    tariff_id integer

    If the unique ID of the tariff on Curacel for the service is available, supply it to aid validation

  • ]
    • is_draft boolean

    Default value: true

    Applies only to Provider / EMR integrations Always false for HMO / Insurer integrations

    Determines whether the claim should be created as a draft (true) or submitted to the HMO immediately (false) after successful creation. Creating as a draft would make it possible to review and edit the claim on the curacel platform before final submission to the HMO.

    ref string

    Required for insurer / HMO integrations

    Unique identifier for the claim as is on the source system. E.g it’s ID

    auto_vet boolean

    Default value: false

    Insurer / HMO integrations only.

    When true, the claim would be passed through the Curacel auto-vetting engine after successful creation.

    create_missing_tariffs boolean

    Default value: false

    Insurer / HMO integrations only.

    When true, new tariffs would be automatically created for items that have no match. They would be created under the account of the provider to which the claim belongs.

    attachments integer[]

    An optional array of IDs of previously/already created attachments. Supplied Attachments must be owned by caller's organization.

Responses​

Success

Schema
    id integer

    The ID of the created claim.

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