Webhook for Claims

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.

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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:

{
    "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}
            }
        ]
    }
}

Payload Data Description

Attribute	Description
id	Id of the auto-vetted claim
pile_id	Id of the pile the claim belongs to
ref	Unique identifier for the claim on the source's system.
provider	Provider to which claim is attached
provider.id
provider.name
provider.code
encounter_date
enrollee_id	Id of the enrollee
approved_amount	decimal-based value of the approved amount after auto-vetting
approval_status	status of the claim (0 = rejected, null = pending, 1 = approved).
vetted_at
diagnoses[n]	Collection of claim diagnoses.
diagnoses[n].name	Unique name of the diagnosis
diagnoses[n].icd_code	Unique icd code of diagnosis
items[n].ref	Unique identifier for the claim item as it is on the source system. E.g it’s id
items[n].description	Description of the service rendered to the enrollee
items[n].unit_price_billed	Requested unit price of the item
items[n].unit_price_approved	The approved unit price of the item after auto-vetting.
items[n].qty_billed	Quantity of the claim item
items[n].qty_approved	Approved quantity of claim item after auto-vetting
items[n].sub_total_billed	The total amount of claim item (unit_price_billed * qty)
items[n].sub_total_approved	The total amount of claim item (unit_price_approved * qty_approved)
items[n].comments	A collection of the claim item comments after auto-vetting
items[n].approval_status	Approval status of the claim item. (null = pending, 0 = rejected, 1 = approved)

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:

{
  "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

Attribute	Description
id	Id of the auto-vetted claim
pile_id	Id of the pile the claim belongs to
ref	Unique identifier for the claim on the source's system.
provider	Provider to which claim is attached
provider.id	The id of the provider
provider.name	The name of the provider
provider.code	The provider code
encounter_date	The encounter date
enrollee.id	Id of the enrollee
approved_amount	decimal-based value of the approved amount after auto-vetting
approval_status	status of the claim (0 = rejected, null = pending, 1 = approved).
vetted_at	A timestamp indicating when the claim was vetted
diagnoses[n]	Collection of claim diagnoses.
diagnoses[n].name	Unique name of the diagnosis
diagnoses[n].icd_code	Unique icd code of diagnosis
items[n].ref	Unique identifier for the claim item as it is on the source system. E.g it’s id
items[n].description	Description of the service rendered to the enrollee
items[n].unit_price_billed	Requested unit price of the item
items[n].unit_price_approved	The approved unit price of the item after auto-vetting.
items[n].qty_billed	Quantity of the claim item
items[n].qty_approved	Approved quantity of claim item after auto-vetting
items[n].sub_total_billed	The total amount of claim item (unit_price_billed * qty)
items[n].sub_total_approved	The total amount of claim item (unit_price_approved * qty_approved)
items[n].comments	A collection of the claim item comments after auto-vetting
items[n].approval_status	Approval status of the claim item. (null = pending, 0 = rejected, 1 = approved)