Tross
ATHENA PROD

Create claim

Create claim in Athena Prod

POSThttps://api.ontross.com/api/integrations/athena-prod/create-claim
Request Fields
input.org_id
integer
required
Org id
Example
1
input.patient_id
integer
required
Patient id
Example
1
input.validation_token
string
required
Must be an unexpired create-purpose token; all correction-purpose tokens are rejected.
Example
"string"
input.requested_behavior
string
required
Requested behavior
Example
"create_only"
Accepted values
create_only
input.auto_scan_and_submit
boolean
required
Auto scan and submit
Example
false
input.department_id
integer
required
Runtime Athena context department; distinct from the portal route number.
Example
1
auth_id
string
required
Saved connection to run this operation through, from the Authentication page. It decides which practice and login the call uses.
Example
"00000000-0000-4000-8000-000000000000"
Output Fields
outcome
string
Outcome
claim_ids
array
List of claim ids.
claims
array
List of claims.
claims[].claim_id
string
Source identifiers remain strings.
claims[].patient_id
string
Source identifiers remain strings.
claims[].patient_department_id
string
Source identifiers remain strings.
claims[].department_id
string
Source identifiers remain strings.
claims[].place_of_service_code
string
Place of service code
claims[].insurances
array
List of insurances.
claims[].insurances[].sequence
string
Sequence
claims[].insurances[].patient_insurance_id
string
Source identifiers remain strings.
claims[].insurances[].package_id
string
Package id
claims[].insurances[].name
string
Name
claims[].insurances[].is_self_pay
boolean
Is self pay
claims[].insurances[].eligibility
object
Eligibility object.
claims[].insurances[].eligibility.status
string
Status
claims[].insurances[].eligibility.source_status
string
Source status
claims[].insurances[].eligibility.service_date
string
Service date
claims[].insurances[].eligibility.checked_at
string
Checked at
claims[].rendering_provider_id
string
Source identifiers remain strings.
claims[].supervising_provider_id
string
Source identifiers remain strings.
claims[].lines
array
List of lines.
claims[].lines[].line_id
string
Line id
claims[].lines[].service_date
string
Service date
claims[].lines[].service_end_date
string
Service end date
claims[].lines[].procedure_code
string
Procedure code
claims[].lines[].modifiers
array
List of modifiers.
claims[].lines[].units
string
Units
claims[].lines[].diagnosis_codes
array
List of diagnosis codes.
claims[].lines[].charge_amount
string
Charge amount
claims[].lines[].unit_fee
string
Unit fee
claims[].lines[].procedure_description
string
Procedure description
claims[].lines[].rvu
string
Rvu
claims[].lines[].diagnosis_descriptions
array
List of diagnosis descriptions.
claims[].states
array
List of states.
claims[].states[].sequence
string
Sequence
claims[].states[].source_status
string
Source status
claims[].states[].outstanding_amount
string
Outstanding amount
claims[].active_holds
array
List of active holds.
claims[].active_holds[].source_rule_id
string
Source rule id
claims[].active_holds[].name
string
Name
claims[].active_holds[].sequence
string
Sequence
claims[].active_holds[].source_status
string
Source status
claims[].active_holds[].next_action
string
Next action
claims[].last_billed_dates
object
Last billed dates object.
claims[].last_billed_dates.primary
string
Primary
claims[].last_billed_dates.secondary
string
Secondary
claims[].last_billed_dates.patient
string
Patient
claims[].source_version
string
Source version
claims[].submission_status
string
Submission status
claims[].service_start_date
string
Service start date
claims[].service_end_date
string
Service end date
claims[].post_date
string
Post date
claims[].signatures
object
Signatures object.
claims[].signatures.release_of_information
boolean
Release of information
Example
false
claims[].signatures.assignment_of_benefits
boolean
Assignment of benefits
Example
false
claims[].signatures.signature_source_code
string
Signature source code
Example
"string"
claims[].authorization
object
Authorization object.
claims[].authorization.mode
string
Mode
Example
"none"
claims[].authorization.authorization_id
string
Authorization id
Example
"12345"
claims[].authorization.authorization_number
string
Authorization number
Example
"string"
claims[].claim_notes
array
List of claim notes.
claims[].claim_notes[].note_id
string
Note id
claims[].claim_notes[].sequence
string
Sequence
claims[].claim_notes[].text
string
Text
claims[].readback_missing_fields
array
List of readback missing fields.
claims[].patient_department_name
string
Patient department name
claims[].service_department_name
string
Service department name
claims[].rendering_provider_name
string
Rendering provider name
claims[].supervising_provider_name
string
Supervising provider name
requested_behavior
string
Requested behavior
Example
"create_only"
auto_scan_and_submit_requested
boolean
Auto scan and submit requested
submission_evidence_status
string
Submission evidence status
metadata_verified
boolean
True only after every supplied field, ordered line, fee, signature, note and authorization is compared with source readback. Missing or mismatched fields require false plus verification_issues.
warnings
array
List of warnings.
verification_issues
array
List of verification issues.
verification_issues[].field
string
Field
verification_issues[].code
string
Code
verification_issues[].message
string
Message
Code
curl --request POST \
  --url https://api.ontross.com/api/integrations/athena-prod/create-claim \
  --header 'X-API-Key: REPLACE_KEY_VALUE' \
  --header 'content-type: application/json' \
  --data '{"input":{"org_id":1,"patient_id":1,"validation_token":"string","requested_behavior":"create_only","auto_scan_and_submit":false,"department_id":1},"auth_id":"auth_uuid_here"}'
Request BODY
{
  "input": {
    "org_id": 1,
    "patient_id": 1,
    "validation_token": "string",
    "requested_behavior": "create_only",
    "auto_scan_and_submit": false,
    "department_id": 1
  },
  "auth_id": "auth_uuid_here"
}
Response BODY
{
  "id": "string",
  "workflow_id": "string",
  "auth_id": "string",
  "status": "string",
  "input": {},
  "output": {
    "outcome": "created",
    "claim_ids": [
      "string"
    ],
    "claims": [
      {
        "claim_id": "string",
        "patient_id": "string",
        "patient_department_id": "string",
        "department_id": "string",
        "place_of_service_code": "string",
        "insurances": [
          {
            "sequence": "primary",
            "patient_insurance_id": "string",
            "package_id": "string",
            "name": "string",
            "is_self_pay": true,
            "eligibility": {
              "status": "eligible",
              "source_status": "string",
              "service_date": "2019-08-24",
              "checked_at": "2019-08-24T14:15:22Z"
            }
          }
        ],
        "rendering_provider_id": "string",
        "supervising_provider_id": "string",
        "lines": [
          {
            "line_id": "string",
            "service_date": "2019-08-24",
            "service_end_date": "2019-08-24",
            "procedure_code": "string",
            "modifiers": [
              "string"
            ],
            "units": "string",
            "diagnosis_codes": [
              "string"
            ],
            "charge_amount": "string",
            "unit_fee": "string",
            "procedure_description": "string",
            "rvu": "string",
            "diagnosis_descriptions": [
              "string"
            ]
          }
        ],
        "states": [
          {
            "sequence": "primary",
            "source_status": "string",
            "outstanding_amount": "string"
          }
        ],
        "active_holds": [
          {
            "source_rule_id": "string",
            "name": "string",
            "sequence": "primary",
            "source_status": "string",
            "next_action": "string"
          }
        ],
        "last_billed_dates": {
          "primary": "2019-08-24",
          "secondary": "2019-08-24",
          "patient": "2019-08-24"
        },
        "source_version": "string",
        "submission_status": "string",
        "service_start_date": "2019-08-24",
        "service_end_date": "2019-08-24",
        "post_date": "2019-08-24",
        "signatures": {
          "release_of_information": false,
          "assignment_of_benefits": false,
          "signature_source_code": "string"
        },
        "authorization": {
          "mode": "none",
          "authorization_id": "12345",
          "authorization_number": "string"
        },
        "claim_notes": [
          {
            "note_id": "string",
            "sequence": "primary",
            "text": "string"
          }
        ],
        "readback_missing_fields": [
          "string"
        ],
        "patient_department_name": "string",
        "service_department_name": "string",
        "rendering_provider_name": "string",
        "supervising_provider_name": "string"
      }
    ],
    "requested_behavior": "create_only",
    "auto_scan_and_submit_requested": false,
    "submission_evidence_status": "not_observed",
    "metadata_verified": true,
    "warnings": [
      "string"
    ],
    "verification_issues": [
      {
        "field": "string",
        "code": "string",
        "message": "string"
      }
    ]
  },
  "files": null,
  "created_at": "2019-08-24T14:15:22Z",
  "started_at": "2019-08-24T14:15:22Z",
  "completed_at": "2019-08-24T14:15:22Z"
}