The claim object contains all the information required to send a claim to an insurer:
insurer
patient details
primary member details (can be same as patient details)
list of services
During claim submission, the API validates the claim payload against known insurer requirements and will reject claims that we know will be rejected by the insurer. However, this does not guarantee the opposite; a claim accepted by the API can still be rejected by the insurer.Insurers can change their claim requirements without notifying us. When this happens, as soon as we understand the new requirements, we will update the validation rules and inform you. It is advisable to be prepared to adopt the updated rules as quickly as possible.
primary_member: JSON object, representing primary patient member
services: list of JSON objects, representing services that can be reimbursed
status: Claim status - draft or ready (default). Use draft to create a claim for manual review in the Anagram web app and manual submission.
Both patient and primary_member must be provided even if the claim is created for a primary member. In this case, both the patient object and primary_member object must contain the same data.
Identifies the location that the claim will be linked to. When this field is empty, the claim will be linked with the default location. Example: LOC4242B
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