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:
-
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.Claim Pile Vetting Done
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) |
Updated 10 months ago
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