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.

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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

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.id
provider.name
provider.code
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_at
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)

Updated about 2 months ago

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