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Fetch a List of Claims

GET 
/v1/claims

Get list of Claims for Insurer or hospital

Request​

Query Parameters

    status string

    Possible values: [approved, pending, rejected, partially_approved]

    The status of the claim.

    Note: 'partially_approved' points to claims that have been approved but whose approved amount is less than the total amount.

    with_fields string

    When present, value should be comma seperated names of field the user would like returned with the response.

    is_submitted boolean

    This parameter is applicable to Providers/Hospitals only. It filters the claims based on if they have been submitted or drafted claims. Returns all claims when absent.

    is_vetted boolean

    This parameter is used to filter the claims based on if they have been vetted or not.

    is_synced boolean

    This parameter is used to filter the claims based on if they have been synced with external db or not.

    insurer_id integer

    Applicable if fetching list as a provider/hospital

    The ID of the Insurer that owns the created claims.

    provider_id integer

    Applicable if fetching list as an Insurer

    The ID of the hospital that created the claims

    enrollee_id integer

    The ID of the enrollee the claims were created for.

    insurance_no string

    The insurance number of the enrollee the claims were created for. This is only considered when no value is provided for enrollee_id

    created_at any

    Filter returned claims by the creation date.

    This implements a range filtering on the claims when set to an object with keys of 'start' and 'end' bearing date values. Setting it to a single date string also filters the claims with a direct comparison to the value given.

    submitted_at any

    Filter returned claims by the submission date.

    This implements a range filtering on the claims when set to an object with keys of 'start' and 'end' bearing date values. Setting it to a single date string also filters the claims with a direct comparison to the value given.

    vetted_at any

    Filter returned claims by the vetting date.

    This implements a range filtering on the claims when set to an object with keys of 'start' and 'end' bearing date values. Setting it to a single date string also filters the claims with a direct comparison to the value given.

    encounter_date any

    Filter returned claims by the encounter date.

    This implements a range filtering on the claims when set to an object with keys of 'start' and 'end' bearing date values. Setting it to a single date string also filters the claims with a direct comparison to the value given.

    synced_at any

    Filter returned claims by the synced date if available.

    This implements a range filtering on the claims when set to an object with keys of 'start' and 'end' bearing date values. Setting it to a single date string also filters the claims with a direct comparison to the value given.

    page integer

    The presence of this param would return results in paginated format Better used together with the 'per_page' param

    This is used to indicate the offset from which results are fetched in paginated format.

    per_page integer

    Better used together with the 'page' param

    This is used to indicate the how many results are to be in an offset for pagination.

    for_export boolean

    Possible values: [1, 0]

    Used to fetch an exported list of Claims requests in Excel format. Can be used in conjunction with other filters to achieve results.

    search string

    This is used to search for claims by the key word supplied to it.

    The search is applied to the enrollee firstname, lastname, and insurance number as well as diagnoses icd codes and names.

Responses​

Success

Schema
    page integer
    per_page integer
    total integer
    data object[]
  • Array [
    • id integer
    ref string

    This is the hmo_erp_id when user is an Insurer, and provider_ref when user is a provider.

    pile_id integer
    insurer object

    Present only when user is a provider/hospital.

    id integer
    code string
    name string
    provider object

    Present only when user is an Insurer

    id integer
    code string
    name string
    enrollee object
    id integer

    This is absent if is_floating is truthy.

    insurance_no string
    firstname string
    lastname string
    is_floating boolean
    encounter_date date
    created_at date
    submitted_at date
    vetted_at date
    diagnoses object[]
  • Array [
    • id integer
    icd_code string
    name string
  • ]
    • amount_billed double
    amount_approved double
    status string

    Status includes: PENDING, APPROVED, PARTIALLY_APPROVED, REJECTED.

    PARTIALLY_APPROVED represents when total amount is not equal to the amount approved but not equal to zero(0).

    attachments object[]
  • Array [
    • id integer
    title string
    file_type string
    filename string

    This is the uploaded filename.

    file_url string

    The file URL on Storage.

    thumbnail_url string

    Images Only Auto-generated URL that utilizes Cloudinary transformations to give a thumbnail of the image attachment, 150px by 150px dimensions.

    preview_url string

    Images Only Similar to thumbnail URL, but no width specified, only a reduced height to produce a smaller-sized image that can be suitable for previewing the attachment in a modal before the full file is downloaded.

  • ]
    • items object[]
  • Array [
    • ref string

    This is the hmo_erp_id of the Insurer the claim and claim item belongs.

    description string
    unit_price_billed double
    unit_price_approved double
    qty_billed integer
    qty_approved integer
    sub_total_billed double
    sub_total_approved double
    comments string[]
    status string

    Status includes: PENDING, APPROVED, PARTIALLY_APPROVED, REJECTED.

  • ]
  • ]
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