Claim.MD

Claim.MD API (1.17)

Download OpenAPI specification:Download

Claim.MD API Service calls. Locate your AccountKey under the Settings->Account Settings menu in the web portal. Contact support if no key is available.

API calls should not exceed 100 requests per-minute.

[Additional Code Samples Available]

Upload Batch Files

Batch file upload. Submit claims, eligibility, ERA or attachment files. Acceptable claim file formats include 837P, 837I, CSV, JSON, XML, XLS, XLSX.
Claim files uploaded via the API may contain between 1 - 2000 claims per API call.

Request
header Parameters
Accept
string
Default: application/xml
Enum: "application/xml" "application/json"
Request Body schema: multipart/form-data
AccountKey
required
string

Claim.MD API Key. Locate this value in the portal under Settings - Account Settings.

File
required
string <binary>

Claim file data.

Filename
string

Name of file. Required if File parameter is not submitted with Content-Disposition: 'filename' header, and data type is not X12.

Responses
200

OK

post/services/upload/
Request samples 
curl -i -X POST \
  https://svc.claim.md/services/upload/ \
  -H 'Accept: application/xml' \
  -H 'Content-Type: multipart/form-data' \
  -F AccountKey=string \
  -F File=@filepath
Response samples 
<result messages="Received 2 claims in file: sample837.txt">
  <claim batchid="13388918" bill_npi="1234567893" bill_taxid="741111111" claimid="396723060" claimmd_id="396891541" fdos="2022-08-22" fileid="662053345" filename="sample837.txt" ins_number="ZGQ23333352902" payerid="22099" pcn="151068-1" remote_claimid="396723060" sender_icn="" sender_name="CLAIM.MD" senderid="CLMMD" status="A" total_charge="165.00">
    <messages fields="" mesgid="ACK" message="Acknowledged" status="A" />
  </claim>
  <claim batchid="13388919" bill_npi="1234567893" bill_taxid="741111111" claimid="396723069" claimmd_id="396891542" fdos="2022-08-22" fileid="662053345" filename="sample837.txt" ins_number="BXYZ99PA" payerid="60054" pcn="107026-1" remote_claimid="396723069" sender_icn="" sender_name="CLAIM.MD" senderid="CLMMD" status="A" total_charge="75.00">
    <messages fields="" mesgid="ACK" message="Acknowledged" status="A" />
  </claim>
</result>

List Uploaded Files

List of files uploaded into Claim.MD

Request
header Parameters
Accept
string
Default: application/xml
Enum: "application/xml" "application/json"
Request Body schema: application/x-www-form-urlencoded
AccountKey
required
string

Claim.MD API Key. Locate this value in the portal under Settings - Account Settings.

Page
string

Up to 500 results returned at a time. Use Page to request additional pages. (i.e. Page=2, for the second page of results)

UploadDate
string

Return files uploaded on a specific date. Format yyyy-mm-dd.

Responses
200

OK

post/services/uploadlist/
Request samples
application/x-www-form-urlencoded
AccountKey=string
Response samples 
<result>
  <file file_amount="1297271.00" file_count="294" file_type="claim" filename="myfile.txt" inboundid="12345" uploadtime="1542326648" />
  <file file_amount="3990.00" file_count="1" file_type="claim" filename="medicare_claims.txt" inboundid="12346" uploadtime="1542326648" />
  <file file_amount="2000070.00" file_count="62" file_type="claim" filename="bcbs_claims.txt" inboundid="12347" uploadtime="1542241184" />
</result>

Response Request

Receive delayed claim status updates. Periodically call this service to download the most recent updates on all claims submitted from this account. Max 20,000 results per request.

Request
header Parameters
Accept
string
Default: application/xml
Enum: "application/xml" "application/json"
Request Body schema: application/x-www-form-urlencoded
AccountKey
required
string

Claim.MD API Key. Locate this value in the portal under Settings - Account Settings.

ResponseID
required
string

Download all responses greater than a specific ResponseID. First request should contain ResponseID=0, save the last_responseid to use on follow up requests.

ClaimID
string

Download all responses received for a particular Claim.MD claim ID. Do not use this option for periodic status updates.[optional]

Responses
200

OK

post/services/response/
Request samples
application/x-www-form-urlencoded
AccountKey=string&ResponseID=string
Response samples 
<result last_responseid="755595618">
  <claim batchid="13388918" bill_npi="1234567893" bill_taxid="741111111" claimid="396723060" claimmd_id="396891541" fdos="2022-08-22" fileid="662053345" filename="sample837.txt" ins_number="ZGQ23333352902" payerid="22099" pcn="151068-1" remote_claimid="396723060" response_time="2022-09-01 11:34:59am" sender_icn="" sender_name="CLAIM.MD" senderid="CLMMD" status="A" total_charge="165.00">
    <messages fields="" mesgid="ACK" message="Acknowledged" responseid="755534642" status="A" />
  </claim>
  <claim batchid="13388919" bill_npi="1234567893" bill_taxid="741111111" claimid="396723069" claimmd_id="396891542" fdos="2022-08-22" fileid="662053345" filename="sample837.txt" ins_number="BXYZ99PA" payerid="60054" pcn="107026-1" remote_claimid="396723069" response_time="2022-09-01 11:34:59am" sender_icn="" sender_name="CLAIM.MD" senderid="CLMMD" status="A" total_charge="75.00">
    <messages fields="" mesgid="ACK" message="Acknowledged" responseid="755534643" status="A" />
  </claim>
  <claim batchid="13388918" bill_npi="1234567893" bill_taxid="741111111" claimid="396723060" claimmd_id="396891541" fdos="2022-08-22" fileid="662053345" filename="sample837.txt" ins_number="ZGQ23333352902" payerid="22099" pcn="151068-1" remote_claimid="396723060" response_time="2022-09-01 12:44:49pm" sender_icn="TST396891541" sender_name="NJ BCBS" senderid="FAKE" status="A" total_charge="165.00">
    <messages fields="" mesgid="ACK" message="CLAIM ACKNOWLEDGED" responseid="755595616" status="A" />
  </claim>
  <claim batchid="13388919" bill_npi="1234567893" bill_taxid="741111111" claimid="396723069" claimmd_id="396891542" fdos="2022-08-22" fileid="662053345" filename="sample837.txt" ins_number="BXYZ99PA" payerid="60054" pcn="107026-1" remote_claimid="396723069" response_time="2022-09-01 12:44:49pm" sender_icn="TST396891542" sender_name="AETNA HMO" senderid="FAKE" status="A" total_charge="75.00">
    <messages fields="" mesgid="ACK" message="CLAIM ACKNOWLEDGED" responseid="755595617" status="A" />
    <messages fields="" mesgid="ACK" message="STATUS - Finalized/Payment-The claim/line has been paid. - Payment reflects usual and customary charges." responseid="755595618" status="A" />
  </claim>
</result>

Eligibility Request 270/271

Realtime eligibility request in the X12 270/271 formats. Send one request per 270 file.

Request
header Parameters
Accept
string
Default: application/xml
Enum: "application/xml" "application/json"
Request Body schema: multipart/form-data
AccountKey
required
string

Claim.MD API Key. Locate this value in the portal under Settings - Account Settings.

File
required
string <binary>

270 file data

Responses
200

OK

post/services/elig/
Request samples 
Response samples 
<result>
  <eligibility data="ISA... DATA ...IEA" eligid="43830230" />
</result>

Eligibility Request XML/JSON
Realtime eligibility request, send parameters. Results return in XML or JSON formats.
Service formerly /eligxml/, this legacy URL is still supported.


Reference
Request 
header Parameters
Accept
string
 Default:  application/xml
 Enum: "application/xml" "application/json"  
Request Body schema: application/x-www-form-urlencoded
AccountKey
required
string
Claim.MD API Key. Locate this value in the portal under Settings - Account Settings.


 
ins_name_l
required
string
Insured/Patient last name


 
ins_name_f
required
string
Insured/Patient first name


 
ins_name_m
string
Insured/Patient middle name


 
payerid
required
string
Payer ID to identify which payer to query.


 
pat_rel
required
any
Patient relationship code.
Valid values:
18 = Self
G8 = Dependent


 Enum: "18" "G8"  
service_code
string
Eligibility benefit type codes requested. Comma separated values. Corresponds with 'benefit_type_code' listed in reference above. Defaults to '30', Health Benefit Plan Coverage.


 Enum: "1" "2" "3" "4" "5" "6" "7" "8" "9" "10" "11" "12" "13" "14" "15" "16" "17" "18" "19" "20" "21" "22" "23" "24" "25" "26" "27" "28" "30" "32" "33" "34" "35" "36" "37" "38" "39" "40" "41" "42" "43" "44" "45" "46" "47" "48" "49" "50" "51" "52" "53" "54" "55" "56" "57" "58" "59" "60" "61" "62" "63" "64" "65" "66" "67" "68" "69" "70" "71" "72" "73" "74" "75" "76" "77" "78" "79" "80" "81" "82" "83" "84" "85" "86" "87" "88" "89" "90" "91" "92" "93" "94" "95" "96" "97" "98" "99" "A0" "A1" "A3" "A4" "A5" "A6" "A7" "A8" "A9" "AA" "AB" "AC" "AD" "AE" "AF" "AG" "AH" "AI" "AJ" "AK" "AL" "AM" "AN" "AO" "AP" "AQ" "AR" "B1" "B2" "B3" "BA" "BB" "BC" "BD" "BE" "BF" "BG" "BH" "BI" "BJ" "BK" "BL" "BM" "BN" "BP" "BQ" "BR" "BS" "BT" "BU" "BV" "BW" "BX" "BY" "BZ" "C1" "CA" "CB" "CC" "CD" "CE" "CF" "CG" "CH" "CI" "CJ" "CK" "CL" "CM" "CN" "CO" "CP" "CQ" "DG" "DM" "DS" "GF" "GN" "GY" "IC" "MH" "NI" "ON" "PT" "PU" "RN" "RT" "TC" "TN" "UC" "E0" "E1" "E2" "E3" "E4" "E5" "E6" "E7" "E8" "E9" "E10" "E11" "E12" "E13" "E14" "E15" "E16" "E17" "E18" "E19" "E20" "E21" "E22" "E23" "E24" "E25" "E26" "E27" "E28" "E29" "E30" "E31" "E32" "E33" "E34" "E35" "E36" "EA" "EB" "EC" "ED" "EE" "EF" "GF" "GN" "GY" "IC" "MH" "NI" "ON" "PE" "PT" "PU" "RN" "RT" "SMH" "TC" "TN" "UC"  
proc_code
string
CPT Code. Used in place of service_code.


 
fdos
required
string
Service date. Format yyyymmdd.


 
prov_npi
required
string
Provider NPI


 
ins_number
string
Insured policy/MBI


 
ins_dob
string
Insured date of birth. Format yyyymmdd.


 
ins_sex
string
Insured gender. M = Male, F = Female.


 
pat_name_l
string
Patient last name (used when pat_rel = G8)


 
pat_name_f
string
Patient first name (used when pat_rel = G8)


 
pat_name_m
string
Patient middle name (used when pat_rel = G8)


 
pat_dob
string
Patient date of birth. Format yyyymmdd. (used when pat_rel = G8)


 
pat_sex
string
Patient gender. M = Male, F = Female.


 
prov_name_l
string
Provider organization name, or individual provider last name.


 
prov_name_f
string
Individual provider first name.


 
prov_taxonomy
string
Provider taxonomy code.


 
prov_taxid
required
string
Provider tax ID.


 
prov_taxid_type
any
Provider tax ID Type
E = EIN
S = SSN


 Enum: "E" "S"  
prov_addr_1
string
Provider street address.


 
prov_city
string
Provider city.


 
prov_state
string
Provider state.


 
prov_zip
string
Provider zip.


 
Responses 
200
OK


post/services/eligdata/
Request samples 
application/x-www-form-urlencoded
AccountKey=string&ins_name_l=string&ins_name_f=string&payerid=string&pat_rel=18&fdos=string&prov_npi=string&prov_taxid=string
Response samples 
<result>
  <elig elig_result_date="20220909" elig_result_time="1341" eligid="28277016" group_number="202GROUP" ins_addr_1="21 JUMP ST" ins_city="MEMPHIS" ins_dob="19800101" ins_name_f="JOE" ins_name_l="SMITH" ins_number="12345678" ins_sex="M" ins_state="TN" ins_zip="871019998" plan_begin_date="20220810-20221009" plan_number="PLAN101">
    <benefit benefit_code="30" benefit_coverage_code="1" benefit_coverage_description="Active Coverage" benefit_description="Health Benefit Plan Coverage" benefit_notes="FUNDING TYPE = FULLY INSURED" date_of_last_update="20160702" insurance_plan="UNITED HEALTH CARE CHOICE PLUS" insurance_type_code="C1" insurance_type_description="Commercial">
      <entity_addr_1>P.O. BOX 30555</entity_addr_1>
      <entity_city>SALT LAKE CITY</entity_city>
      <entity_code>PR</entity_code>
      <entity_description>Payer</entity_description>
      <entity_name>UNITED HEALTH CARE</entity_name>
      <entity_state>UT</entity_state>
      <entity_zip>841300555</entity_zip>
    </benefit>
    <benefit benefit_amount="0" benefit_code="30" benefit_coverage_code="C" benefit_coverage_description="Deductible" benefit_description="Health Benefit Plan Coverage" benefit_level_code="FAM" benefit_level_description="Family" benefit_period_code="24" benefit_period_description="Year to Date" inplan_network="W" />
    <benefit benefit_amount="0" benefit_code="30" benefit_coverage_code="C" benefit_coverage_description="Deductible" benefit_description="Health Benefit Plan Coverage" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="24" benefit_period_description="Year to Date" inplan_network="W" />
    <benefit benefit_amount="0" benefit_code="30" benefit_coverage_code="G" benefit_coverage_description="Out of Pocket (Stop Loss)" benefit_description="Health Benefit Plan Coverage" benefit_level_code="FAM" benefit_level_description="Family" benefit_period_code="24" benefit_period_description="Year to Date" inplan_network="W" insurance_type_code="C1" insurance_type_description="Commercial" />
    <benefit benefit_amount="0" benefit_code="30" benefit_coverage_code="G" benefit_coverage_description="Out of Pocket (Stop Loss)" benefit_description="Health Benefit Plan Coverage" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="24" benefit_period_description="Year to Date" inplan_network="W" insurance_type_code="C1" insurance_type_description="Commercial" />
    <benefit benefit_amount="3000" benefit_code="30" benefit_coverage_code="C" benefit_coverage_description="Deductible" benefit_description="Health Benefit Plan Coverage" benefit_level_code="FAM" benefit_level_description="Family" benefit_period_code="23" benefit_period_description="Calendar Year" inplan_network="N" />
    <benefit benefit_amount="0" benefit_code="30" benefit_coverage_code="C" benefit_coverage_description="Deductible" benefit_description="Health Benefit Plan Coverage" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="29" benefit_period_description="Remaining" inplan_network="Y" />
    <benefit benefit_amount="9000" benefit_code="30" benefit_coverage_code="G" benefit_coverage_description="Out of Pocket (Stop Loss)" benefit_description="Health Benefit Plan Coverage" benefit_level_code="FAM" benefit_level_description="Family" benefit_period_code="23" benefit_period_description="Calendar Year" inplan_network="N" insurance_type_code="C1" insurance_type_description="Commercial" />
    <benefit benefit_amount="1500" benefit_code="30" benefit_coverage_code="C" benefit_coverage_description="Deductible" benefit_description="Health Benefit Plan Coverage" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="29" benefit_period_description="Remaining" inplan_network="N" />
    <benefit benefit_amount="99999" benefit_code="30" benefit_coverage_code="G" benefit_coverage_description="Out of Pocket (Stop Loss)" benefit_description="Health Benefit Plan Coverage" benefit_level_code="FAM" benefit_level_description="Family" benefit_period_code="29" benefit_period_description="Remaining" inplan_network="Y" insurance_type_code="C1" insurance_type_description="Commercial" />
    <benefit benefit_amount="99999" benefit_code="30" benefit_coverage_code="G" benefit_coverage_description="Out of Pocket (Stop Loss)" benefit_description="Health Benefit Plan Coverage" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="29" benefit_period_description="Remaining" inplan_network="Y" insurance_type_code="C1" insurance_type_description="Commercial" />
    <benefit benefit_amount="4500" benefit_code="30" benefit_coverage_code="G" benefit_coverage_description="Out of Pocket (Stop Loss)" benefit_description="Health Benefit Plan Coverage" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="23" benefit_period_description="Calendar Year" inplan_network="N" insurance_type_code="C1" insurance_type_description="Commercial" />
    <benefit benefit_amount="99999" benefit_code="30" benefit_coverage_code="G" benefit_coverage_description="Out of Pocket (Stop Loss)" benefit_description="Health Benefit Plan Coverage" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="23" benefit_period_description="Calendar Year" inplan_network="Y" insurance_type_code="C1" insurance_type_description="Commercial" />
    <benefit benefit_amount="1500" benefit_code="30" benefit_coverage_code="C" benefit_coverage_description="Deductible" benefit_description="Health Benefit Plan Coverage" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="23" benefit_period_description="Calendar Year" inplan_network="N" />
    <benefit benefit_amount="3000" benefit_code="30" benefit_coverage_code="C" benefit_coverage_description="Deductible" benefit_description="Health Benefit Plan Coverage" benefit_level_code="FAM" benefit_level_description="Family" benefit_period_code="29" benefit_period_description="Remaining" inplan_network="N" />
    <benefit benefit_amount="0" benefit_code="30" benefit_coverage_code="C" benefit_coverage_description="Deductible" benefit_description="Health Benefit Plan Coverage" benefit_level_code="FAM" benefit_level_description="Family" benefit_period_code="29" benefit_period_description="Remaining" inplan_network="Y" />
    <benefit benefit_amount="9000" benefit_code="30" benefit_coverage_code="G" benefit_coverage_description="Out of Pocket (Stop Loss)" benefit_description="Health Benefit Plan Coverage" benefit_level_code="FAM" benefit_level_description="Family" benefit_period_code="29" benefit_period_description="Remaining" inplan_network="N" insurance_type_code="C1" insurance_type_description="Commercial" />
    <benefit benefit_amount="99999" benefit_code="30" benefit_coverage_code="G" benefit_coverage_description="Out of Pocket (Stop Loss)" benefit_description="Health Benefit Plan Coverage" benefit_level_code="FAM" benefit_level_description="Family" benefit_period_code="23" benefit_period_description="Calendar Year" inplan_network="Y" insurance_type_code="C1" insurance_type_description="Commercial" />
    <benefit benefit_amount="0" benefit_code="30" benefit_coverage_code="C" benefit_coverage_description="Deductible" benefit_description="Health Benefit Plan Coverage" benefit_level_code="FAM" benefit_level_description="Family" benefit_period_code="23" benefit_period_description="Calendar Year" inplan_network="Y" />
    <benefit benefit_amount="0" benefit_code="30" benefit_coverage_code="C" benefit_coverage_description="Deductible" benefit_description="Health Benefit Plan Coverage" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="23" benefit_period_description="Calendar Year" inplan_network="Y" />
    <benefit benefit_amount="4500" benefit_code="30" benefit_coverage_code="G" benefit_coverage_description="Out of Pocket (Stop Loss)" benefit_description="Health Benefit Plan Coverage" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="29" benefit_period_description="Remaining" inplan_network="N" insurance_type_code="C1" insurance_type_description="Commercial" />
    <benefit benefit_code="1" benefit_coverage_code="1" benefit_coverage_description="Active Coverage" benefit_description="Medical Care" inplan_network="W" />
    <benefit benefit_code="33" benefit_coverage_code="1" benefit_coverage_description="Active Coverage" benefit_description="Chiropractic" inplan_network="W" />
    <benefit benefit_code="47" benefit_coverage_code="1" benefit_coverage_description="Active Coverage" benefit_description="Hospital" inplan_network="W" />
    <benefit benefit_code="48" benefit_coverage_code="1" benefit_coverage_description="Active Coverage" benefit_description="Hospital - Inpatient" inplan_network="W" />
    <benefit benefit_code="50" benefit_coverage_code="1" benefit_coverage_description="Active Coverage" benefit_description="Hospital - Outpatient" inplan_network="W" />
    <benefit benefit_code="86" benefit_coverage_code="1" benefit_coverage_description="Active Coverage" benefit_description="Emergency Services" inplan_network="W" />
    <benefit benefit_code="98" benefit_coverage_code="1" benefit_coverage_description="Active Coverage" benefit_description="Professional (Physician) Visit - Office" inplan_network="W" />
    <benefit benefit_code="AL" benefit_coverage_code="1" benefit_coverage_description="Active Coverage" benefit_description="Vision (Optometry)" inplan_network="W" />
    <benefit benefit_code="MH" benefit_coverage_code="1" benefit_coverage_description="Active Coverage" benefit_description="Mental Health" inplan_network="W" />
    <benefit benefit_code="PT" benefit_coverage_code="1" benefit_coverage_description="Active Coverage" benefit_description="Physical Therapy" inplan_network="W" />
    <benefit benefit_code="UC" benefit_coverage_code="1" benefit_coverage_description="Active Coverage" benefit_description="Urgent Care" inplan_network="W" />
    <benefit benefit_code="96" benefit_coverage_code="1" benefit_coverage_description="Active Coverage" benefit_description="Professional (Physician)" benefit_notes="SPECIALIST" inplan_network="W" />
    <benefit benefit_code="96" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Professional (Physician)" benefit_level_code="IND" benefit_level_description="Individual" benefit_notes="SPECIALIST" benefit_percent="0" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_code="33" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Chiropractic" benefit_level_code="IND" benefit_level_description="Individual" benefit_percent="0" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_code="98" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Professional (Physician) Visit - Office" benefit_level_code="IND" benefit_level_description="Individual" benefit_p rcent="0" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_code="PT" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Physical Therapy" benefit_level_code="IND" benefit_level_description="Individual" benefit_percent="0" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_code="UC" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Urgent Care" benefit_level_code="IND" benefit_level_description="Individual" benefit_percent="0" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_code="48" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Hospital - Inpatient" benefit_level_code="IND" benefit_level_description="Individual" benefit_percent="0" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_code="50" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Hospital - Outpatient" benefit_level_code="IND" benefit_level_description="Individual" benefit_percent="0" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_code="86" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Emergency Services" benefit_level_code="IND" benefit_level_description="Individual" benefit_percent="0" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_code="33" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Chiropractic" benefit_level_code="IND" benefit_level_description="Individual" benefit_percent="50" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_code="50" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Hospital - Outpatient" benefit_level_code="IND" benefit_level_description="Individual" benefit_percent="50" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_code="86" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Emergency Services" benefit_level_code="IND" benefit_level_description="Individual" benefit_percent="50" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_code="98" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Professional (Physician) Visit - Office" benefit_level_code="IND" benefit_level_description="Individual" benefit_percent="50" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_code="UC" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Urgent Care" benefit_level_code="IND" benefit_level_description="Individual" benefit_percent="50" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_code="PT" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Physical Therapy" benefit_level_code="IND" benefit_level_description="Individual" benefit_percent="50" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_code="48" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Hospital - Inpatient" benefit_level_code="IND" benefit_level_description="Individual" benefit_percent="50" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_code="96" benefit_coverage_code="A" benefit_coverage_description="Co-Insurance" benefit_description="Professional (Physician)" benefit_level_code="IND" benefit_level_description="Individual" benefit_notes="SPECIALIST" benefit_percent="50" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_amount="0" benefit_code="96" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Professional (Physician)" benefit_level_code="IND" benefit_level_description="Individual" benefit_notes="SPECIALIST" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_amount="35" benefit_code="UC" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Urgent Care" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_amount="0" benefit_code="UC" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Urgent Care" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_amount="0" benefit_code="48" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Hospital - Inpatient" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_amount="0" benefit_code="PT" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Physical Therapy" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_amount="0" benefit_code="98" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Professional (Physician) Visit - Office" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_amount="0" benefit_code="33" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Chiropractic" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_amount="0" benefit_code="86" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Emergency Services" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_amount="0" benefit_code="50" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Hospital - Outpatient" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="27" benefit_period_description="Visit" inplan_network="N" />
    <benefit benefit_amount="125" benefit_code="50" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Hospital - Outpatient" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_amount="15" benefit_code="96" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Professional (Physician)" benefit_level_code="IND" benefit_level_description="Individual" benefit_notes="SPECIALIST" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_amount="15" benefit_code="98" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Professional (Physician) Visit - Office" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_amount="15" benefit_code="33" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Chiropractic" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_amount="15" benefit_code="PT" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Physical Therapy" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_amount="250" benefit_code="48" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Hospital - Inpatient" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_amount="75" benefit_code="86" benefit_coverage_code="B" benefit_coverage_description="Co-Payment" benefit_description="Emergency Services" benefit_level_code="IND" benefit_level_description="Individual" benefit_period_code="27" benefit_period_description="Visit" inplan_network="Y" />
    <benefit benefit_amount="999999.99" benefit_code="33" benefit_coverage_code="F" benefit_coverage_description="Limitations" benefit_description="Chiropractic" benefit_level_code="IND" benefit_level_description="Individual" benefit_notes="ADDITIONAL VISITS AVAILABLE BASED ON MEDICAL NECESSITY REVIEW REHABILITATIVE" benefit_period_code="23" benefit_period_description="Calendar Year" benefit_qnty="30" inplan_network="W" />
    <benefit benefit_amount="999999.99" benefit_code="33" benefit_coverage_code="F" benefit_coverage_description="Limitations" benefit_description="Chiropractic" benefit_level_code="IND" benefit_level_description="Individual" benefit_notes="ADDITIONAL VISITS AVAILABLE BASED ON MEDICAL NECESSITY REVIEW REHABILITATIVE" benefit_period_code="29" benefit_period_description="Remaining" benefit_qnty="30" inplan_network="W" />
    <benefit benefit_code="PT" benefit_coverage_code="F" benefit_coverage_description="Limitations" benefit_description="Physical Therapy" benefit_level_code="IND" benefit_level_description="Individual" benefit_notes="REHABILITATIVE ADDITIONAL BENEFIT FOR MUSCULOSKELETAL PAIN MANAGEMENT PROGRAM" benefit_period_code="29" benefit_period_description="Remaining" benefit_qnty="3" inplan_network="Y" />
    <benefit benefit_code="33" benefit_coverage_code="F" benefit_coverage_description="Limitations" benefit_description="Chiropractic" benefit_level_code="IND" benefit_level_description="Individual" benefit_notes="REHABILITATIVE ADDITIONAL BENEFIT FOR MUSCULOSKELETAL PAIN MANAGEMENT PROGRAM" benefit_period_code="29" benefit_period_description="Remaining" benefit_qnty="3" inplan_network="Y" />
    <benefit benefit_amount="999999.99" benefit_code="PT" benefit_coverage_code="F" benefit_coverage_description="Limitations" benefit_description="Physical Therapy" benefit_level_code="IND" benefit_level_description="Individual" benefit_notes="REHABILITATIVE" benefit_period_code="23" benefit_period_description="Calendar Year" benefit_qnty="20" inplan_network="W" />
    <benefit benefit_amount="999999.99" benefit_code="PT" benefit_coverage_code="F" benefit_coverage_description="Limitations" benefit_description="Physical Therapy" benefit_level_code="IND" benefit_level_description="Individual" benefit_notes="REHABILITATIVE" benefit_period_code="29" benefit_period_description="Remaining" benefit_qnty="20" inplan_network="W" />
    <benefit benefit_code="88" benefit_coverage_code="U" benefit_coverage_description="Contact Following Entity for Eligibility or Benefit Information" benefit_description="Pharmacy">
      <entity_code>VN</entity_code>
      <entity_description>Vendor</entity_description>
      <entity_name>OPTUMRX</entity_name>
      <entity_website>PROFESSIONALS.OPTUMRX.COM</entity_website>
    </benefit>
  </elig>
</result>

Electronic Remittance Advice (ERA) List
This service will return a list of ERA received. To keep your system updated with all new remittance it is recommended you use the "ERAID" parameter to download the latest updates. After successfully loading all results returned, store the value of "last_eraid", and use it as the parameter in "ERAID" to only receive the latest remits. [For remittance details see the below service options.]Service formerly /era/, this legacy URL is still supported.


Request 
header Parameters
Accept
string
 Default:  application/xml
 Enum: "application/xml" "application/json"  
Request Body schema: application/x-www-form-urlencoded
required
AccountKey
required
string
Locate this value under Settings - Account Settings in the web portal.


 
CheckDate
string
Search for ERA with a specific payment date. Format mm-dd-yyyy.


 
ReceivedDate
string
Search for ERA using the date Claim.MD received the file.Format mm-dd-yyyy, or ‘today’ or ‘yesterday’


 
ReceivedAfterData
string
Returns all ERA received after a specific date. Format mm-dd-yyyy, or ‘today’ or ‘yesterday’


 
CheckNumber
string
Search for ERA with specific Check/EFT


 
CheckAmount
string
Search for ERA with specific payment amoun


 
PayerID
string
Search for ERA with specific PayerID


 
NPI
string
Search for ERA with specific Billing Provider NPI


 
TaxID
string
Search for ERA with specific Billing Provider Tax ID


 
NewOnly
string
Only list ERA not yet downloaded, true or false (use ‘1’ or ‘0’). Defaults to ‘1’ if no search options are given.


 
ERAID
string
Return only remits with an ERAID greater than this


 
Page
string
If more than 100 results are available use Page to return additional results. Defaults to ‘1’.


 
Responses 
200
OK


post/services/eralist/
Request samples 
application/x-www-form-urlencoded
AccountKey=string
Response samples 
<result last_eraid="23853671">
  <era check_number="397547097-1662491256" check_type="eft" claimmd_prov_name="MEDICAL CARE CENTER" download_time="" eraid="23853666" paid_amount="182.00" paid_date="2022-09-06" payer_name="NJ BCBS" payerid="22099" prov_name="MEDICAL CARE CENTER" prov_npi="1234567893" prov_taxid="741111111" received_time="09-06-2022 13:07" />
  <era check_number="397547116-1662491256" check_type="eft" claimmd_prov_name="MEDICAL CARE CENTER" download_time="" eraid="23853667" paid_amount="86.00" paid_date="2022-09-06" payer_name="TML HMP" payerid="39026" prov_name="MEDICAL CARE CENTER" prov_npi="1234567893" prov_taxid="741111111" received_time="09-06-2022 13:07" />
  <era check_number="397547086-1662491256" check_type="eft" claimmd_prov_name="MEDICAL CARE CENTER" download_time="" eraid="23853668" paid_amount="45.00" paid_date="2022-09-06" payer_name="AETNA HMO" payerid="60054" prov_name="MEDICAL CARE CENTER" prov_npi="1234567893" prov_taxid="741111111" received_time="09-06-2022 13:07" />
  <era check_number="397547087-1662491256" check_type="eft" claimmd_prov_name="MEDICAL CARE CENTER" download_time="" eraid="23853669" paid_amount="795.00" paid_date="2022-09-06" payer_name="AETNA" payerid="60054" prov_name="MEDICAL CARE CENTER" prov_npi="1234567893" prov_taxid="741111111" received_time="09-06-2022 13:07" />
  <era check_number="397547090-1662491257" check_type="eft" claimmd_prov_name="MEDICAL CARE CENTER" download_time="" eraid="23853670" paid_amount="490.40" paid_date="2022-09-06" payer_name="CIGNA" payerid="62308" prov_name="MEDICAL CARE CENTER" prov_npi="1234567893" prov_taxid="741111111" received_time="09-06-2022 13:07" />
  <era check_number="397547083-1662491258" check_type="eft" claimmd_prov_name="MEDICAL CARE CENTER" download_time="" eraid="23853671" paid_amount="346.00" paid_date="2022-09-06" payer_name="UNITED HEALTHCARE PPO" payerid="87726" prov_name="MEDICAL CARE CENTER" prov_npi="1234567893" prov_taxid="741111111" received_time="09-06-2022 13:07" />
</result>

ERA Details (835 Format)
Download a specific electronic remittance in the 835 file format.


Request 
header Parameters
Accept
string
 Default:  application/xml
 Enum: "application/xml" "application/json"  
Request Body schema: application/x-www-form-urlencoded
required
AccountKey
required
string
Locate this value under Settings - Account Settings in the web portal.


 
eraid
required
string
Claim.MD ERA ID, found using /era/ service


 
Responses 
200
OK


post/services/era835/
Request samples 
application/x-www-form-urlencoded
AccountKey=string&eraid=string
Response samples 
<result check_number="397547083-1662491258" check_type="eft" eraid="23853671" paid_amount="346.00" paid_date="2022-09-06" payer_name="UNITED HEALTHCARE PPO" payerid="87726" prov_name="MEDICAL CARE CENTER" prov_npi="1234567893">
  <data>ISA... DATA ...IEA</data>
</result>

ERA Details (PDF Format)
Download a specific electronic remittance in the human readable PDF report format. Results are Base64 encoded.


Request 
header Parameters
Accept
string
 Default:  application/xml
 Enum: "application/xml" "application/json"  
Request Body schema: application/x-www-form-urlencoded
required
AccountKey
required
string
Locate this value under Settings - Account Settings in the web portal.


 
eraid
required
string
Claim.MD ERA ID, found using /era/ service


 
pcn
string
Generate remittance for only the given Acct #. [Optional]


 
Responses 
200
OK


post/services/erapdf/
Request samples 
application/x-www-form-urlencoded
AccountKey=string&eraid=string
Response samples 
<result check_number="397547083-1662491258" eraid="23853671" paid_amount="346.00" paid_date="2022-09-06" payer_name="UNITED HEALTHCARE PPO" payerid="87726" prov_name="MEDICAL CARE CENTER" prov_npi="1234567893">
  <data>BASE64 ENCODED PDF DATA</data>
</result>

ERA Details (XML/JSON Format)
Download a specific electronic remittance in the XML/JSON formats.
Service formerly /eraxml/, this legacy URL is still supported.


Claim Adjustment Codes Reference
Request 
header Parameters
Accept
string
 Default:  application/xml
 Enum: "application/xml" "application/json"  
Request Body schema: application/x-www-form-urlencoded
required
AccountKey
required
string
Account associated


 
eraid
required
string
Claim.MD ERA ID, found using /era/ service


 
Responses 
200
OK


post/services/eradata/
Request samples 
application/x-www-form-urlencoded
AccountKey=string&eraid=string
Response samples 
<result check_number="397547083-1662491258" eraid="23853671" paid_amount="346.00" paid_date="2022-09-06" payer_account="700000000" payer_addr_1="" payer_city="ATLANTA" payer_companyid="" payer_name="UNITED HEALTHCARE PPO" payer_routing="111111111" payer_state="GA" payer_zip="303740800" payerid="87726" payment_format="CCP" payment_method="ACH" prov_account="111111111" prov_addr_1="" prov_city="SANTA FE" prov_name="MEDICAL CARE CENTER" prov_npi="1234567893" prov_routing="111111111" prov_state="NM" prov_taxid="741111111" prov_zip="875059998">
  <claim crossover_carrier="" crossover_id="" from_dos="20220827" ins_name_f="NORMAN" ins_name_l="BATES" ins_number="412098745" pat_name_f="ETHYL" pat_name_l="BATES" payer_icn="TST397547083" pcn="124974-1" prov_npi="1111111112" status_code="4" thru_dos="" total_charge="48" total_paid="0">
    <charge allowed="0" charge="48" chgid="221043771" from_dos="20220827" mod1="" mod2="" mod3="" mod4="" paid="0" proc_code="99212" thru_dos="" units="1">
      <adjustment amount="48" code="109" group="OA" />
    </charge>
  </claim>
  <claim crossover_carrier="" crossover_id="" from_dos="20220827" ins_name_f="ROBERT" ins_name_l="DENNIS" ins_number="223444467" pat_name_f="MARYLOU" pat_name_l="DENNIS" payer_icn="TST397547094" pcn="21830-1" prov_npi="1111111112" status_code="1" thru_dos="" total_charge="75" total_paid="45">
    <charge allowed="60" charge="75" chgid="221043716" from_dos="20220827" mod1="" mod2="" mod3="" mod4="" paid="45" proc_code="99213" thru_dos="" units="1">
      <adjustment amount="15" code="45" group="CO" />
      <adjustment amount="10" code="2" group="PR" />
      <adjustment amount="5" code="3" group="PR" />
    </charge>
  </claim>
  <claim crossover_carrier="" crossover_id="" from_dos="20220827" ins_name_f="VIRGINIA" ins_name_l="GUNTHRIE" ins_number="412341611" pat_name_f="BRISTER" pat_name_l="GUNTHRIE" payer_icn="TST397547101" pcn="103756-1" prov_npi="1111111112" status_code="1" thru_dos="" total_charge="75" total_paid="45">
    <charge allowed="60" charge="75" chgid="221043755" from_dos="20220827" mod1="" mod2="" mod3="" mod4="" paid="45" proc_code="99213" thru_dos="" units="1">
      <adjustment amount="15" code="45" group="CO" />
      <adjustment amount="10" code="2" group="PR" />
      <adjustment amount="5" code="3" group="PR" />
    </charge>
  </claim>
  <claim crossover_carrier="" crossover_id="" from_dos="20220827" ins_name_f="OHPELIA" ins_name_l="HAQUE" ins_number="42211616100" pat_name_f="OHPELIA" pat_name_l="HAQUE" payer_icn="TST397547102" pcn="109126-1" prov_npi="1111111112" status_code="1" thru_dos="" total_charge="100" total_paid="65">
    <charge allowed="80" charge="100" chgid="221043774" from_dos="20220827" mod1="" mod2="" mod3="" mod4="" paid="65" proc_code="99214" thru_dos="" units="1">
      <adjustment amount="20" code="45" group="CO" />
      <adjustment amount="10" code="2" group="PR" />
      <adjustment amount="5" code="3" group="PR" />
    </charge>
  </claim>
  <claim crossover_carrier="" crossover_id="" from_dos="20220827" ins_name_f="JANET" ins_name_l="IMHOFF" ins_number="22222933300" pat_name_f="JANET" pat_name_l="IMHOFF" payer_icn="TST397547104" pcn="47147-1" prov_npi="1111111112" status_code="1" thru_dos="" total_charge="100" total_paid="65">
    <charge allowed="80" charge="100" chgid="221043722" from_dos="20220827" mod1="" mod2="" mod3="" mod4="" paid="65" proc_code="99214" thru_dos="" units="1">
      <adjustment amount="20" code="45" group="CO" />
      <adjustment amount="10" code="2" group="PR" />
      <adjustment amount="5" code="3" group="PR" />
    </charge>
  </claim>
  <claim crossover_carrier="" crossover_id="" from_dos="20220827" ins_name_f="JAMES" ins_name_l="NEAL" ins_number="329223333" pat_name_f="BOYCE" pat_name_l="NEAL" payer_icn="TST397547120" pcn="107417-1" prov_npi="1111111112" status_code="1" thru_dos="" total_charge="100" total_paid="65">
    <charge allowed="80" charge="100" chgid="221043779" from_dos="20220827" mod1="" mod2="" mod3="" mod4="" paid="65" proc_code="99214" thru_dos="" units="1">
      <adjustment amount="20" code="45" group="CO" />
      <adjustment amount="10" code="2" group="PR" />
      <adjustment amount="5" code="3" group="PR" />
    </charge>
  </claim>
  <claim crossover_carrier="" crossover_id="" from_dos="20220508" ins_name_f="LYDIA" ins_name_l="WEEKS" ins_number="123461616" pat_name_f="MARISSA" pat_name_l="WEEKS" payer_icn="TST397547134" pcn="11762-1" prov_npi="1111111112" status_code="1" thru_dos="" total_charge="95" total_paid="61">
    <charge allowed="16" charge="20" chgid="221043759" from_dos="20220508" mod1="" mod2="" mod3="" mod4="" paid="16" proc_code="81000" thru_dos="" units="1">
      <adjustment amount="4" code="45" group="CO" />
    </charge>
    <charge allowed="60" charge="75" chgid="221043760" from_dos="20220508" mod1="" mod2="" mod3="" mod4="" paid="45" proc_code="99213" thru_dos="" units="1">
      <adjustment amount="15" code="45" group="CO" />
      <adjustment amount="10" code="2" group="PR" />
      <adjustment amount="5" code="3" group="PR" />
    </charge>
  </claim>
</result>

Archive Claim
Remove a claim from the Manage Claims Menu. delete_status of ‘archived’ will be returned on claims that were removed from the Manage Claims menu that have been transmitted previously. delete_status of ‘deleted’ will be returned on claims that have never been transmitted.


Request 
header Parameters
Accept
string
 Default:  application/xml
 Enum: "application/xml" "application/json"  
Request Body schema: application/x-www-form-urlencoded
required
AccountKey
required
string
Locate this value under Settings - Account Settings in the web portal.


 
claimid
required
string
Claim.MD Claim ID, this argument can be sent multiple times.


 
Responses 
200
OK


post/services/archive/
Request samples 
application/x-www-form-urlencoded
AccountKey=string&claimid=string
Response samples 
application/xml
{
  "result": [
    {
      "claimid": "160050620",
      "delete_status": "archived",
      "success": "1"
    },
    {
      "claimid": "160050631",
      "delete_status": "deleted",
      "success": "1"
    },
    {
      "claimid": "160050632",
      "delete_status": "archived",
      "success": "1"
    }
  ]
}
Claim Modification Event
List all modifications made to any claims within Claim.MD. This may include changes that occur due to a corrected claim upload. Save the value of "LastModid" and pass as parameter in ModID to always download only new modification updates.


Request 
header Parameters
Accept
string
 Default:  application/xml
 Enum: "application/xml" "application/json"  
Request Body schema: application/x-www-form-urlencoded
required
AccountKey
required
string
Locate this value under Settings - Account Settings in the web portal.


 
ModID
string
Return all modifications that have occurred after ModID [Optional]


 
ClaimMD_ID
string
Download all responses that have been returned for a particular “claimmd_id”[Optional]


 
Field
string
Only return changes on a particular field. Note that further requests using ModID will not contain any modifications skipped over in sequence. [Optional]


 
Responses 
200
OK


post/services/modify/
Request samples 
application/x-www-form-urlencoded
AccountKey=string
Response samples 
{
  "LastModid": "12345678",
  "claim": [
    {
      "claimid": "ABCD1",
      "claimmd_id": "135961467",
      "pcn": "A1234",
      "modification": [
        {
          "modid": "123000001",
          "field": "pcn",
          "was": "A1234",
          "value": "A1111",
          "mod_time": "2015-08-01 10:48:00am",
          "username": "bob"
        },
        {
          "modid": "12300190",
          "field": "ins_number",
          "value": "1000034A",
          "mod_time": "2015-08-01 10:49:00am",
          "username": "bob"
        },
        {
          "modid": "12345677",
          "field": "proc_code_1",
          "value": "90054",
          "mod_time": "2015-08-01 11:60:00am",
          "username": "sara"
        },
        {
          "modid": "12345678",
          "field": "from_date_1",
          "value": "2016-01-12",
          "mod_time": "2015-08-01 11:60:00am",
          "username": "sara"
        }
      ]
    }
  ]
}
Provider Enrollment Request
Initiate provider enrollment. Request will add provider to Claim.MD account and return a link to be displayed to customer. Link will contain one of the following: Online Enrollment Form, Quick Enrollment Option, Enrollment Instructions, Existing Enrollment Status


Request 
header Parameters
Accept
string
 Default:  application/xml
 Enum: "application/xml" "application/json"  
Request Body schema: application/x-www-form-urlencoded
required
AccountKey
required
string
Locate this value under Settings - Account Settings in the web portal.


 
payerid
required
string
Payer ID for the desired payer


 
enroll_type
required
string
Enrollment Type:
era = Electronic Remittance Advice / 835
1500 = Professional Claims / 837P / CMS-1500
ub = Institutional Claims / 837I / UB-04
elig = Eligibility
attach = Electronic Attachments


 Enum: "era" "500" "ub" "elig" "attach"  
prov_taxid
required
string
Tax ID for the provider


 
prov_npi
string
(situational) Provider Group or individual NPI. *Required unless the provider is atypical.


 
prov_name_l
string
(situational) Provider organization name or individual provider last name. *Required if no NPI given


 
prov_name_f
string
(situational) Individual provider first name. *Required if no NPI given and the provider is not an organization


 
prov_name_m
string
Individual provider middle name [optional]


 
contact
string
Individual who will be completing this enrollment form. (recommended)


 
contact_title
string
Title for the Individual who will be completing this enrollment form. (recommended)


 
contact_email
string
(optional) Phone number for the individual completing this form. (recommended)


 
contact_phone
string
(optional) Phone number for the individual completing this form. (recommended)


 
contact_fax
string
(optional) Fax number for the individual completing this form.


 
prov_id
string
(optional) Payer specific provider ID (Medicare/Medicaid provider ID)


 
prov_addr_1
string
(optional) Provider address line (auto completed when NPI given)


 
prov_addr_2
string
(optional) Provider address line (auto completed when NPI given)


 
prov_city
string
(optional) Provider city (auto completed when NPI given)


 
prov_state
string
(optional) Provider state (auto completed when NPI given)


 
prov_zip
string
Provider zip code (auto completed when NPI given)


 
Responses 
200
OK


post/services/enroll/
Request samples 
application/x-www-form-urlencoded
AccountKey=string&payerid=string&enroll_type=era&prov_taxid=string
Response samples 
<result success="1">
  <link url="https://www.claim.md/enroll/11074_DmtGQYjHVZtCscQxrHosXjRzZyWCysWS/" />
</result>

Claim Appeal Request
Initiate an appeal from an existing claim. Request will return a link to be loaded in iframe or popup. Link will contain online form for completing an appeal to be submitted to the payer. Choices include options to fax, mail, download or submit electronic appeals. Service fees may apply for faxed or mailed appeals. Either claimid OR remote_claimid MUST be sent


Request 
header Parameters
Accept
string
 Default:  application/xml
 Enum: "application/xml" "application/json"  
Request Body schema: application/x-www-form-urlencoded
required
AccountKey
required
string
Locate this value under Settings - Account Settings in the web portal.


 
claimid
string
Claim.MD Claim ID - ID assigned by Claim.MD on claim upload.


 
remote_claimid
string
Unique claim identifier sent on original claim submission. (In 837 this is the REF*D9 segment, in XML/CSV/XLS this is the remote_claimid field).


 
contact_name
string
Individual who will be completing this appeal. (recommended)


 
contact_title
string
Title for the Individual who will be completing this appeal. (recommended)


 
contact_email
string
(optional) Phone number for the individual completing appeal. (recommended)


 
contact_phone
string
(optional) Phone number for the individual completing appeal. (recommended)


 
contact_fax
string
(optional) Fax number for the individual completing appeal.


 
contact_addr_1
string
(optional) Contact address line 1 (Defaults to claim billing provider address)


 
contact_addr_2
string
(optional) Contact address line 2 (Defaults to claim billing provider address)


 
contact_city
string
(optional) Contact city (Defaults to claim billing provider address)


 
contact_state
string
(optional) Contact state (Defaults to claim billing provider address)


 
contact_zip
string
(optional) Contact zip code (Defaults to claim billing provider address)


 
Responses 
200
OK


post/services/appeal/
Request samples 
application/x-www-form-urlencoded
AccountKey=string
Response samples 
<result success="1">
  <link url="https://www.claim.md/appeal/11074_DmtGQYjHVZtCscQxrHosXjRzZyWCysWS/" />
</result>

Payer List
Current Payer List and available services.


Request 
header Parameters
Accept
string
 Default:  application/xml
 Enum: "application/xml" "application/json"  
Request Body schema: application/x-www-form-urlencoded
required
AccountKey
required
string
Account associated


 
payerid
string
Request specific payer ID.


 
payer_name
string
Wildcard search for matching payer name or alt payer name.


 
Responses 
200
OK


post/services/payerlist/
Request samples 
application/x-www-form-urlencoded
AccountKey=string
Response samples 
<result>
  <payer 1500_claims="yes" attachment="no" auto="no" dent_claims="no" eligibility="yes" era="enrollment" payer_name="Aetna TX Medicaid CHIP" payer_state="" payer_type="medicaid" payerid="38692" secondary_support="yes" ub_claims="yes" workers_comp="no" avg_era_enroll_days="19">
    <payer_alt_names alt_payer_name="Aetna Better Health of Texas" />
  </payer>
  <payer 1500_claims="yes" attachment="no" auto="no" dent_claims="no" eligibility="no" era="no" payer_name="Texas Medicaid - Yes Waiver Claims" payer_state="" payer_type="medicaid" payerid="TXYES" secondary_support="" ub_claims="no" workers_comp="no">
    <payer_alt_names alt_payer_name="TX Medicaid - Yes Waiver" />
    <payer_alt_names alt_payerid="TXYWB" />
  </payer>
  <payer 1500_claims="enrollment" attachment="no" auto="no" dent_claims="enrollment" eligibility="no" era="enrollment" payer_name="TMHP Long Term Care" payer_state="" payer_type="medicaid" payerid="TXLTC" secondary_support="yes" ub_claims="enrollment" workers_comp="no">
    <payer_alt_names alt_payer_name="TX Medicaid LTC" />
    <payer_alt_names alt_payer_name="Local intellectual and development disability authorities (LIDDAs)" />
    <payer_alt_names alt_payer_name="Texas Home Living (TxHmL)" />
    <payer_alt_names alt_payer_name="Home and Community-based Services (HCS)" />
    <payer_alt_names alt_payer_name="TDMHMR" />
    <payer_alt_names alt_payerid="SKTX1" />
    <payer_alt_names alt_payer_name="617591011CMSP" />
  </payer>
  <payer 1500_claims="yes" attachment="no" auto="no" dent_claims="no" eligibility="yes" era="enrollment" payer_name="TX Medicaid" payer_state="TX" payer_type="medicaid" payerid="86916" secondary_support="yes" ub_claims="yes" workers_comp="no" avg_era_enroll_days="25">
    <payer_alt_names alt_payerid="SKTX0" />
    <payer_alt_names alt_payerid="CKTX1" />
    <payer_alt_names alt_payerid="12K64" />
    <payer_alt_names alt_payer_name="Texas Medicaid" />
    <payer_alt_names alt_payerid="MCDTX" />
    <payer_alt_names alt_payer_name="TMHP" />
    <payer_alt_names alt_payer_name="Texas Medicaid/Healthcare Services" />
    <payer_alt_names alt_payer_name="999999999" />
    <payer_alt_names alt_payer_name="617591011C21P" />
  </payer>
  <payer 1500_claims="yes" attachment="no" auto="no" dent_claims="no" eligibility="no" era="no" payer_name="TX Medicaid - LTSS" payer_state="TX" payer_type="medicaid" payerid="TXLTS" secondary_support="" ub_claims="no" workers_comp="no">
    <payer_alt_names alt_payer_name="Texas Medicaid - Long Term Support Services" />
    <payer_alt_names alt_payer_name="TX EVV - LTSS" />
    <payer_alt_names alt_payer_name="TMHP" />
  </payer>
</result>          

Claim Notes Request
List all notes made to any claims within Claim.MD. This includes any notes made by users from the web portal.


Request 
header Parameters
Accept
string
 Default:  application/xml
 Enum: "application/xml" "application/json"  
Request Body schema: application/x-www-form-urlencoded
required
AccountKey
required
string
Locate this value under Settings - Account Settings in the web portal.


 
NoteID
string
Return all notes that have occurred after NoteID [Optional] [Recommended]


 
ClaimMD_ID
string
Download all notes that have been returned for a particular “claimmd_id” [Optional]


 
Responses 
200
OK


post/services/notes/
Request samples 
application/x-www-form-urlencoded
AccountKey=string
Response samples 
{
  "LastNoteID": "111111112",
  "notes": [
    {
      "note": "I updated this claim.",
      "claimmd_id": "135961467",
      "claimid": "123ABC",
      "username": "Joe S.",
      "date_time": "2021-03-19 11:20:48am",
      "noteid": "111111111",
      "pcn": "ACNT456"
    },
    {
      "note": "Following up next week.",
      "claimmd_id": "135934535",
      "claimid": "124BBB",
      "username": "Joe S.",
      "date_time": "2021-03-19 11:20:48am",
      "noteid": "111111112",
      "pcn": "ACNT999"
    }
  ]
}
WebhookWebhook 
Request 
Request Body schema: application/json
Webhook results. Claim.MD Webhook will return provider enrollment updates and appeal form creation/updates. Open a support ticket to request setup of webhook to your HTTPS server.


UTCTime
string
UTC current time.


 
acct_number
string
Claim.MD Account Number.


 
remote_acct_number
string
Customer assigned account number.


 
Array of objects
 
Responses 
200
Return a 200 status to indicate that the data was received successfully


Request samples 
application/json
{
  • "UTCTime": "string",
  • "acct_number": "string",
  • "remote_acct_number": "string",
  • "events": [
    ]
}