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API reference
Redox Data Models
Claim
PaymentBatch

Claim

This data model facilitates transactions between providers and payers. We support submitting claims and sending payment notifications in batches.

Typically, the claims workflow kicks off with providers grouping (i.e., batching) and sending claims to payers with details about services rendered to a patient and a request for payment. After processing the claims, payers send batched payment notifications to the provider with a status of whether the payment request was accepted or denied. In some cases, the status may indicate that a third party transferred funds to the provider.

This data model has event types that allow you to:

  • submit a batch of claims; or
  • sent a batch of payment notifications.

PaymentBatch

Send a batch of payment notifications or statuses to a provider.

A status may confirm whether funds were transferred from a third party to the provider or if a payment request was denied.

A batch message contains multiple payment notifications for multiple claims.

Dev preview

Request Body Schema

  • Meta
    required, object
    • DataModel
      required, string
      Reliable

      Claim

    • EventType
      required, string
      Reliable

      PaymentBatch

    • EventDateTime
      string, null
      Reliable

      Displays the UTC date and time that an outgoing request is delivered or an incoming request is received.
      ISO 8601 Format

    • Test
      boolean, null
      Reliable

      Indicates whether the request is a test or not.

    • Source
      object

      Contains the information for the system initiating the message, including the source ID and name.
      Included in messages from Redox

      • ID
        string, null
        Reliable

        Identifies the system initiating the message. If you have multiple OAuth API keys per environment type, this value is required. If you have only one OAuth API key per environment type, or you're using legacy API keys, this value is optional.
        UUID

      • Name
        string, null
        Reliable

        Displays the name of the system initiating the message.

    • Destinations
      Array of object

      Contains the information for the endpoint(s) receiving the request. A request must contain at least one destination, but asynchronous requests can have more than one destination. Synchronous requests like queries can only support one destination.
      Required when sending data to Redox.

      • ID
        string, null
        Reliable

        Identifies the endpoint that the request is directed to.
        UUID

      • Name
        string, null
        Reliable

        Displays the name of the endpoint that the request is directed to.

    • Logs
      Array of object

      Contains the log identifier(s) for the request.

      • ID
        string, null
        Reliable

        Identifies the request log(s) that correspond to this request. You can use this value to locate the relevant log in the Redox dashboard for support and reference.
        UUID

      • AttemptID
        string, null
        Reliable

        Identifies the request log attempt value, which is useful when retries are possible.
        UUID

    • FacilityCode
      string, null
      Possible

      Code for the facility related to the message.
      Only use this field if a health system indicates you should. The code is specific to the health system's EHR and might not be unique across health systems. In general, the facility fields within the data models (e.g. OrderingFacility) are more reliable and informative.

  • Transactions
    Array of object
    • ID
      string, null
      Reliable

      ID used by submitter to reference this Claims

    • IDType
      string, null
      Reliable

      Type of ID

    • Type
      string, null
      Reliable
      Value Set

      The type of Claims, Institutional or Professional

    • TotalPaymentAmount
      string, null
      Probable

      The total amount of all of the payments listed in the Payments array.
      Redox recommends sending it as an additional layer of validation.

    • CreditOrDebit
      string, null
      Probable
      Value Set

      A flag indicating whether the monetary amount in Transaction.TotalPaymentAmount is a credit or debit.

    • PaymentMethod
      string, null
      Probable
      Value Set

      How the payment was/will be transferred.

    • PaymentDateTime
      string, null
      Probable

      When the transaction should be processed by the destination.
      For example, if the "Check" is used in Transaction.PaymentMethod this would be the date on the check. ISO 8601 Format

    • TrackingNumber
      string, null
      Probable

      A number used to by the Payer to trace the payment.
      For example, if the "Check" is used in Transaction.PaymentMethod this would be the check number.

    • Submitter
      object

      Submitter of a Claims

      • Identifiers
        Array of object

        List of IDs and ID Types that identify the concept

        • ID
          string, null
          Reliable

          ID for the submitter

        • IDType
          string, null
          Reliable

          The type of ID

      • Name
        string, null
        Reliable
      • Address
        object

        Address of the Submitter

        • StreetAddress
          string, null
          Probable

          Street address

        • City
          string, null
          Probable

          City

        • State
          string, null
          Probable

          State

        • ZIP
          string, null
          Probable

          ZIP

        • County
          string, null
          Possible

          County

        • Country
          string, null
          Possible
          Value Set

          Country

      • EmailAddress
        string, null
        Probable
      • PhoneNumber
        object
        • Office
          string, null
          Probable

          In E. 164 Format. (e.g. +16085551234)

        • Fax
          string, null
          Probable

          In E. 164 Format. (e.g. +16085551234)

    • Receiver
      object

      Receiver of a Claims

      • Identifiers
        Array of object

        List of IDs and ID Types that identify the concept

        • ID
          string, null
          Reliable

          ID for the receiver

        • IDType
          string, null
          Reliable

          The type of ID

      • Name
        string, null
        Reliable
      • Address
        object

        Address of the Receiver

        • StreetAddress
          string, null
          Probable

          Street address

        • City
          string, null
          Probable

          City

        • State
          string, null
          Probable

          State

        • ZIP
          string, null
          Probable

          ZIP

        • County
          string, null
          Possible

          County

        • Country
          string, null
          Possible
          Value Set

          Country

      • EmailAddress
        string, null
        Probable
      • PhoneNumber
        object
        • Office
          string, null
          Probable

          In E. 164 Format. (e.g. +16085551234)

        • Fax
          string, null
          Probable

          In E. 164 Format. (e.g. +16085551234)

    • Payments
      Array of object
      • DateTime
        string, null
        Probable

        The DateTime this payment was processed.
        ISO 8601 Format

      • Patient
        object
        • Identifiers
          Array of object

          List of IDs and ID types that identify the patient

          • ID
            string, null
            Reliable

            ID for the patient

          • IDType
            string, null
            Reliable

            Type of ID.
            E.g. MRN, EPI

        • Demographics
          object
          • FirstName
            string, null
            Reliable

            Patient's first name

          • MiddleName
            string, null
            Possible

            Patient's middle name or middle initial. For patients with multiple middle names, all their middle names are included in this field.

          • LastName
            string, null
            Reliable

            Patient's last name

          • DOB
            string, null
            Reliable

            Patient's date of birth.
            In ISO 8601 format

          • SSN
            string, null
            Probable

            Patient's social security number

          • Sex
            string, null
            Reliable
            Value Set

            Patient's sex

          • Race
            string, null
            Possible
            Value Set

            Patient's race

          • IsHispanic
            boolean, null
            Possible
            Value Set

            Indicates if the patient is of hispanic origin.

          • Religion
            string, null
            Possible
            Value Set

            Patient's religious affiliation

          • MaritalStatus
            string, null
            Possible
            Value Set

            Patient's marital status

          • IsDeceased
            boolean, null
            Possible

            Indicates if the patient is deceased

          • DeathDateTime
            string, null
            Possible

            Date and Time the patient was proclaimed deceased.
            ISO 8601 Format

          • PhoneNumber
            object
            • Home
              string, null
              Probable

              Patient's home phone number.
              In E. 164 Format. (e.g. +16085551234)

            • Office
              string, null
              Probable

              Patient's office phone number.
              In E. 164 Format. (e.g. +16085551234)

            • Mobile
              string, null
              Probable

              Patient's mobile phone number.
              In E. 164 Format. (e.g. +16085551234)

          • EmailAddresses
            Array of string

            Patient's email address(es)

          • Language
            string, null
            Possible
            Value Set

            Patient's primary spoken language.
            In ISO 639-1 alpha values (e.g. 'en'). Supported Values

          • Citizenship
            Array of string

            Patient's nation(s) of citizenship.
            In ISO 3166 alpha 2 format (e.g. 'US').

          • Address
            object

            Patient's home address

            • StreetAddress
              string, null
              Probable

              Street address

            • City
              string, null
              Probable

              City

            • State
              string, null
              Probable

              State

            • ZIP
              string, null
              Probable

              ZIP

            • County
              string, null
              Possible

              County

            • Country
              string, null
              Possible
              Value Set

              Country

        • Notes
          Array of string

          Patient-level notes

      • Claims
        Array of object
        • ControlNumber
          string, null
          Reliable

          The Payer's reference number

        • SubmissionNumber
          string, null
          Reliable

          This will generally be the claim number sent on the initial claim submission.

        • ReceivedDate
          string, null
          Probable

          Date the claim was submitted.
          ISO 8601 Format

        • StartDateTime
          string, null
          Probable

          Date the statement period started.
          ISO 8601 Format

        • EndDateTime
          string, null
          Probable

          Date the statement period ended.
          ISO 8601 Format

        • Status
          string, null
          Reliable
          Value Set

          Status of the claim

        • ChargedAmount
          string, null
          Reliable

          Total monetary amount of the claim

        • PaymentAmount
          string, null
          Probable

          Monetary amount of the claim paid

        • PatientResponsibilityAmount
          string, null
          Reliable

          Monetary amount of the claim the patient is responsible for

        • ReferenceNumbers
          Array of object

          Reference numbers associated to the claim like Prior Auth Number, Member ID, and Provider IDs

          • ID
            string, null
            Probable

            ID for the claim

          • IDType
            string, null
            Probable

            The type of ID

        • Adjustments
          Array of object

          Adjustments explain why a claim was paid differently than it was billed.
          Adjustments may not exist at the claim level if they exist at the service level

          • Amount
            string, null
            Probable

            Monetary amount of the adjustment.
            A negative number indicates a payment increase, while a positive number indicates a payment reduction.

          • Quantity
            string, null
            Probable
          • Type
            string, null
            Probable
            Value Set

            Type of Adjustment

          • Reason
            string, null
            Probable
            Value Set

            Adjustment reason

        • Services
          Array of object

          This array will provide additional detail for claims processed at the line level.

          • ChargedAmount
            string, null
            Probable

            The monetory amount charged

          • PaymentAmount
            string, null
            Reliable

            The monetory amount paid

          • ChargedUnits
            string, null
            Probable

            The number of units of service charged for

          • PaymentUnits
            string, null
            Probable

            The number of units of service paid for

          • AllowedAmount
            string, null
            Reliable

            Maximum monetary amount of payment

          • SubmittedService
            object

            Submitted service information

            • Code
              string, null
              Probable

              Code for the submitted service

            • Codeset
              string, null
              Probable

              Code set used to identify the submitted service

            • Description
              string, null
              Probable

              Description of the submitted service

            • Modifiers
              Array of string

              Array of modifiers

          • AdjudicatedService
            object

            Adjudicated service information

            • Code
              string, null
              Probable

              Code for the adjudicated service

            • Codeset
              string, null
              Probable

              Code set used to identify the adjudicated service

            • Description
              string, null
              Probable

              Description of the adjudicated service

            • Modifiers
              Array of string

              Array of modifiers

          • Adjustments
            Array of object

            Adjustments explain why a claim was paid differently than it was billed.

            • Amount
              string, null
              Probable

              Monetary amount of the adjustment.
              A negative number indicates a payment increase, while a positive number indicates a payment reduction.

            • Quantity
              string, null
              Probable
            • Type
              string, null
              Probable
              Value Set

              Type of Adjustment

            • Reason
              string, null
              Probable
              Value Set

              Adjustment reason

          • StartDateTime
            string, null
            Probable

            Date the claim was submitted.
            ISO 8601 Format

          • EndDateTime
            string, null
            Probable

            Date the statement period started.
            ISO 8601 Format

          • ReferenceNumbers
            Array of object

            Reference numbers associated to the claim service line

            • ID
              string, null
              Probable

              ID for the service line

            • IDType
              string, null
              Probable

              The type of ID

Example
json
1
{
2
  "Meta": {
3
    "DataModel": "Claim",
4
    "EventType": "PaymentBatch",
5
    "EventDateTime": "2024-11-18T21:23:08.746Z",
6
    "Test": true,
7
    "Source": {
8
      "ID": "7ce6f387-c33c-417d-8682-81e83628cbd9",
9
      "Name": "Redox Dev Tools"
10
    },
11
    "Destinations": [
12
      {
13
        "ID": "af394f14-b34a-464f-8d24-895f370af4c9",
14
        "Name": "Redox EMR"
15
      }
16
    ],
17
    "Logs": [
18
      {
19
        "ID": "d9f5d293-7110-461e-a875-3beb089e79f3",
20
        "AttemptID": "925d1617-2fe0-468c-a14c-f8c04b572c54"
21
      }
22
    ],
23
    "FacilityCode": null
24
  },
25
  "Transactions": [
26
    {
27
      "ID": "000000001",
28
      "IDType": null,
29
      "Type": "Profressional",
30
      "TotalPaymentAmount": "580.00",
31
      "CreditOrDebit": "Credit",
32
      "PaymentMethod": "Check",
33
      "PaymentDateTime": "2016-11-11T02:11:03.111Z",
34
      "TrackingNumber": "8675309",
35
      "Submitter": {
36
        "Identifiers": [
37
          {
38
            "ID": "123456",
39
            "IDType": "TIN"
40
          }
41
        ],
42
        "Name": "National Insurance Company of Redox",
43
        "Address": {
44
          "StreetAddress": null,
45
          "City": null,
46
          "State": null,
47
          "ZIP": null,
48
          "County": null,
49
          "Country": null
50
        },
51
        "EmailAddress": null,
52
        "PhoneNumber": {
53
          "Office": null,
54
          "Fax": null
55
        }
56
      },
57
      "Receiver": {
58
        "Identifiers": [
59
          {
60
            "ID": "8675309",
61
            "IDType": "TIN"
62
          }
63
        ],
64
        "Name": "Redox Health System",
65
        "Address": {
66
          "StreetAddress": null,
67
          "City": null,
68
          "State": null,
69
          "ZIP": null,
70
          "County": null,
71
          "Country": null
72
        },
73
        "EmailAddress": null,
74
        "PhoneNumber": {
75
          "Office": null,
76
          "Fax": null
77
        }
78
      },
79
      "Payments": [
80
        {
81
          "DateTime": "2016-11-08T02:11:03.111Z",
82
          "Patient": {
83
            "Identifiers": [
84
              {
85
                "ID": "0000000001",
86
                "IDType": "MR"
87
              },
88
              {
89
                "ID": "e167267c-16c9-4fe3-96ae-9cff5703e90a",
90
                "IDType": "EHRID"
91
              },
92
              {
93
                "ID": "a1d4ee8aba494ca",
94
                "IDType": "NIST"
95
              }
96
            ],
97
            "Demographics": {
98
              "FirstName": "Timothy",
99
              "MiddleName": "Paul",
100
              "LastName": "Bixby",
101
              "DOB": "2008-01-06",
102
              "SSN": "101-01-0001",
103
              "Sex": "Male",
104
              "Race": "White",
105
              "IsHispanic": null,
106
              "Religion": null,
107
              "MaritalStatus": "Single",
108
              "IsDeceased": null,
109
              "DeathDateTime": null,
110
              "PhoneNumber": {
111
                "Home": "+18088675301",
112
                "Office": null,
113
                "Mobile": null
114
              },
115
              "EmailAddresses": [],
116
              "Language": "en",
117
              "Citizenship": [],
118
              "Address": {
119
                "StreetAddress": "4762 Hickory Street",
120
                "City": "Monroe",
121
                "State": "WI",
122
                "ZIP": "53566",
123
                "County": "Green",
124
                "Country": "US"
125
              }
126
            },
127
            "Notes": []
128
          },
129
          "Claims": [
130
            {
131
              "ControlNumber": "94151100100",
132
              "SubmissionNumber": "66729659983",
133
              "ReceivedDate": "2016-10-31",
134
              "StartDateTime": null,
135
              "EndDateTime": null,
136
              "Status": "Processed as Primary",
137
              "ChargedAmount": "100.00",
138
              "PaymentAmount": "65.00",
139
              "PatientResponsibilityAmount": "20.00",
140
              "ReferenceNumbers": [
141
                {
142
                  "ID": "AUTH000000",
143
                  "IDType": "Prior Authorization"
144
                }
145
              ],
146
              "Adjustments": [],
147
              "Services": [
148
                {
149
                  "ChargedAmount": "100.00",
150
                  "PaymentAmount": "65.00",
151
                  "ChargedUnits": null,
152
                  "PaymentUnits": null,
153
                  "AllowedAmount": "85.00",
154
                  "SubmittedService": {
155
                    "Code": null,
156
                    "Codeset": null,
157
                    "Description": null,
158
                    "Modifiers": []
159
                  },
160
                  "AdjudicatedService": {
161
                    "Code": null,
162
                    "Codeset": null,
163
                    "Description": null,
164
                    "Modifiers": []
165
                  },
166
                  "Adjustments": [
167
                    {
168
                      "Amount": "20.00",
169
                      "Quantity": null,
170
                      "Type": "Patient responsibility",
171
                      "Reason": "Deductible amount"
172
                    },
173
                    {
174
                      "Amount": "15.00",
175
                      "Quantity": null,
176
                      "Type": "Contractual obligations",
177
                      "Reason": "Claim specific negotiated discount"
178
                    }
179
                  ],
180
                  "StartDateTime": null,
181
                  "EndDateTime": null,
182
                  "ReferenceNumbers": [
183
                    {
184
                      "ID": "1",
185
                      "IDType": "Control Number"
186
                    }
187
                  ]
188
                }
189
              ]
190
            }
191
          ]
192
        },
193
        {
194
          "DateTime": "2016-11-08T02:11:03.111Z",
195
          "Patient": {
196
            "Identifiers": [
197
              {
198
                "ID": "0000000001",
199
                "IDType": "MR"
200
              },
201
              {
202
                "ID": "e167267c-16c9-4fe3-96ae-9cff5703e90a",
203
                "IDType": "EHRID"
204
              },
205
              {
206
                "ID": "a1d4ee8aba494ca",
207
                "IDType": "NIST"
208
              }
209
            ],
210
            "Demographics": {
211
              "FirstName": "Timothy",
212
              "MiddleName": "Paul",
213
              "LastName": "Bixby",
214
              "DOB": "2008-01-06",
215
              "SSN": "101-01-0001",
216
              "Sex": "Male",
217
              "Race": "White",
218
              "IsHispanic": null,
219
              "Religion": null,
220
              "MaritalStatus": "Single",
221
              "IsDeceased": null,
222
              "DeathDateTime": null,
223
              "PhoneNumber": {
224
                "Home": "+18088675301",
225
                "Office": null,
226
                "Mobile": null
227
              },
228
              "EmailAddresses": [],
229
              "Language": "en",
230
              "Citizenship": [],
231
              "Address": {
232
                "StreetAddress": "4762 Hickory Street",
233
                "City": "Monroe",
234
                "State": "WI",
235
                "ZIP": "53566",
236
                "County": "Green",
237
                "Country": "US"
238
              }
239
            },
240
            "Notes": []
241
          },
242
          "Claims": [
243
            {
244
              "ControlNumber": "94151100200",
245
              "SubmissionNumber": "774466586",
246
              "ReceivedDate": "2016-10-31",
247
              "StartDateTime": null,
248
              "EndDateTime": null,
249
              "Status": "Processed as Primary",
250
              "ChargedAmount": "100.00",
251
              "PaymentAmount": "75.00",
252
              "PatientResponsibilityAmount": "20.00",
253
              "ReferenceNumbers": [
254
                {
255
                  "ID": "AUTH000000",
256
                  "IDType": "Prior Authorization"
257
                }
258
              ],
259
              "Adjustments": [],
260
              "Services": [
261
                {
262
                  "ChargedAmount": "100.00",
263
                  "PaymentAmount": "75.00",
264
                  "ChargedUnits": null,
265
                  "PaymentUnits": null,
266
                  "AllowedAmount": "95.00",
267
                  "SubmittedService": {
268
                    "Code": null,
269
                    "Codeset": null,
270
                    "Description": null,
271
                    "Modifiers": []
272
                  },
273
                  "AdjudicatedService": {
274
                    "Code": null,
275
                    "Codeset": null,
276
                    "Description": null,
277
                    "Modifiers": []
278
                  },
279
                  "Adjustments": [
280
                    {
281
                      "Amount": "20.00",
282
                      "Quantity": null,
283
                      "Type": "Patient responsibility",
284
                      "Reason": "Deductible amount"
285
                    },
286
                    {
287
                      "Amount": "5.00",
288
                      "Quantity": null,
289
                      "Type": "Contractual obligations",
290
                      "Reason": "Claim specific negotiated discount"
291
                    }
292
                  ],
293
                  "StartDateTime": null,
294
                  "EndDateTime": null,
295
                  "ReferenceNumbers": [
296
                    {
297
                      "ID": "1",
298
                      "IDType": "Control Number"
299
                    }
300
                  ]
301
                }
302
              ]
303
            }
304
          ]
305
        }
306
      ]
307
    }
308
  ]
309
}