OutpatientCareClaimRequest

Payload used to create an outpatient care claim.

beneficiary_idinteger<int64>required

Beneficiary identifier.

sponsor_slugstringrequired

Sponsor slug. Lowercase alphanumeric identifier.

doctor_medical_license_numberstringrequired

Attending doctor's medical license number.

doctor_country_codestringrequired

ISO 3166-1 alpha-2 country code of the doctor's license.

doctor_specialty_namestring

Attending doctor's medical specialty.

doctor_namestringrequired

Attending doctor's full name.

beneficiary_categorystring

Optional. Sponsor-defined beneficiary category (for example, plan tier).

sponsor_parameters object

Optional. Free-form additional data required by the sponsor. Object shape depends on the sponsor's configuration.

property name*object

diagnoses object[]

Diagnoses associated with the outpatient visit.

Array [

coding_systemstringrequired

Coding system used for the diagnosis (for example, ICD-10, CIE-10).

codestringrequired

Diagnosis code within the coding system.

typestring

Diagnosis type as a free-form string.

type_enumstring

Diagnosis type. One of CHIEF_COMPLAINT, DIFFERENTIAL_DIAGNOSIS, MEDICAL_DIAGNOSIS.

Role of the diagnosis in the encounter.

• CHIEF_COMPLAINT: the primary reason the beneficiary sought care.
• DIFFERENTIAL_DIAGNOSIS: an alternative diagnosis being considered.
• MEDICAL_DIAGNOSIS: the confirmed medical diagnosis.

Possible values: [CHIEF_COMPLAINT, DIFFERENTIAL_DIAGNOSIS, MEDICAL_DIAGNOSIS]

]

external_verifications object[]

Additional verification tokens (for example, OTP) required by the sponsor.

Array [

typestring

valuestring

verification_statusstring

]