candidhealth 0.43.1 → 0.45.0

This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
@@ -37,15 +37,15 @@ require_relative "../../custom_schemas/v_1/types/schema_instance"
37
37
  require_relative "types/epsdt_referral"
38
38
  require_relative "types/claim_supplemental_information"
39
39
  require_relative "types/encounter_create_from_pre_encounter"
40
- require_relative "../../individual/types/patient_update"
41
40
  require_relative "types/vitals_update"
41
+ require_relative "../../guarantor/v_1/types/guarantor_update"
42
+ require_relative "../../encounter_providers/v_2/types/initial_referring_provider_update"
43
+ require_relative "../../encounter_providers/v_2/types/referring_provider_update"
44
+ require_relative "../../individual/types/patient_update"
42
45
  require_relative "../../encounter_providers/v_2/types/rendering_provider_update"
43
46
  require_relative "../../service_facility/types/encounter_service_facility_update"
44
- require_relative "../../guarantor/v_1/types/guarantor_update"
45
- require_relative "../../encounter_providers/v_2/types/billing_provider_update"
46
47
  require_relative "../../encounter_providers/v_2/types/supervising_provider_update"
47
- require_relative "../../encounter_providers/v_2/types/referring_provider_update"
48
- require_relative "../../encounter_providers/v_2/types/initial_referring_provider_update"
48
+ require_relative "../../encounter_providers/v_2/types/billing_provider_update"
49
49
  require "async"
50
50
 
51
51
  module CandidApiClient
@@ -576,6 +576,8 @@ module CandidApiClient
576
576
  # * :attachment_report_type_code (CandidApiClient::Encounters::V4::Types::ReportTypeCode)
577
577
  # * :attachment_transmission_code (CandidApiClient::Encounters::V4::Types::ReportTransmissionCode)
578
578
  # * :attachment_control_number (String)
579
+ # @param secondary_payer_carrier_code [String] When Medicaid is billed as the secondary payer the Carrier Code is used to
580
+ # identify the primary payer. This is required for certain states.
579
581
  # @param request_options [CandidApiClient::RequestOptions]
580
582
  # @return [CandidApiClient::Encounters::V4::Types::Encounter]
581
583
  # @example
@@ -605,10 +607,11 @@ module CandidApiClient
605
607
  # schema_instances: [{ schema_id: "ec096b13-f80a-471d-aaeb-54b021c9d582", content: { "provider_category": "internist", "is_urgent_care": true, "bmi": 24.2, "age": 38 } }],
606
608
  # referral_number: "string",
607
609
  # epsdt_referral: { condition_indicator_1: AV, condition_indicator_2: AV, condition_indicator_3: AV },
608
- # claim_supplemental_information: [{ attachment_report_type_code: C_03, attachment_transmission_code: CBM }]
610
+ # claim_supplemental_information: [{ attachment_report_type_code: C_03, attachment_transmission_code: CBM }],
611
+ # secondary_payer_carrier_code: "string"
609
612
  # )
610
613
  def create(external_id:, patient_authorized_release:, benefits_assigned_to_provider:,
611
- provider_accepts_assignment:, billable_status:, patient:, billing_provider:, rendering_provider:, responsible_party:, diagnoses:, place_of_service_code:, date_of_service: nil, end_date_of_service: nil, appointment_type: nil, existing_medications: nil, vitals: nil, interventions: nil, pay_to_address: nil, synchronicity: nil, additional_information: nil, service_authorization_exception_code: nil, admission_date: nil, discharge_date: nil, onset_of_current_illness_or_symptom_date: nil, last_menstrual_period_date: nil, delay_reason_code: nil, additional_properties: nil, _field_set: nil, referring_provider: nil, initial_referring_provider: nil, supervising_provider: nil, service_facility: nil, subscriber_primary: nil, subscriber_secondary: nil, subscriber_tertiary: nil, prior_authorization_number: nil, clinical_notes: nil, billing_notes: nil, patient_histories: nil, service_lines: nil, guarantor: nil, external_claim_submission: nil, tag_ids: nil, schema_instances: nil, referral_number: nil, epsdt_referral: nil, claim_supplemental_information: nil, request_options: nil)
614
+ provider_accepts_assignment:, billable_status:, patient:, billing_provider:, rendering_provider:, responsible_party:, diagnoses:, place_of_service_code:, date_of_service: nil, end_date_of_service: nil, appointment_type: nil, existing_medications: nil, vitals: nil, interventions: nil, pay_to_address: nil, synchronicity: nil, additional_information: nil, service_authorization_exception_code: nil, admission_date: nil, discharge_date: nil, onset_of_current_illness_or_symptom_date: nil, last_menstrual_period_date: nil, delay_reason_code: nil, additional_properties: nil, _field_set: nil, referring_provider: nil, initial_referring_provider: nil, supervising_provider: nil, service_facility: nil, subscriber_primary: nil, subscriber_secondary: nil, subscriber_tertiary: nil, prior_authorization_number: nil, clinical_notes: nil, billing_notes: nil, patient_histories: nil, service_lines: nil, guarantor: nil, external_claim_submission: nil, tag_ids: nil, schema_instances: nil, referral_number: nil, epsdt_referral: nil, claim_supplemental_information: nil, secondary_payer_carrier_code: nil, request_options: nil)
612
615
  response = @request_client.conn.post do |req|
613
616
  req.options.timeout = request_options.timeout_in_seconds unless request_options&.timeout_in_seconds.nil?
614
617
  req.headers["Authorization"] = request_options.token unless request_options&.token.nil?
@@ -665,7 +668,8 @@ module CandidApiClient
665
668
  schema_instances: schema_instances,
666
669
  referral_number: referral_number,
667
670
  epsdt_referral: epsdt_referral,
668
- claim_supplemental_information: claim_supplemental_information
671
+ claim_supplemental_information: claim_supplemental_information,
672
+ secondary_payer_carrier_code: secondary_payer_carrier_code
669
673
  }.compact
670
674
  req.url "#{@request_client.get_url(environment: CandidApi,
671
675
  request_options: request_options)}/api/encounters/v4"
@@ -850,13 +854,6 @@ module CandidApiClient
850
854
  # patient encounters.Request of type Array<CandidApiClient::Encounters::V4::Types::ClinicalNoteCategoryCreate>, as a Hash
851
855
  # * :category (CandidApiClient::Encounters::V4::Types::NoteCategory)
852
856
  # * :notes (Array<CandidApiClient::Encounters::V4::Types::ClinicalNote>)
853
- # @param pay_to_address [Hash] Specifies the address to which payments for the claim should be sent.Request of type CandidApiClient::Commons::Types::StreetAddressLongZip, as a Hash
854
- # * :zip_plus_four_code (String)
855
- # * :address_1 (String)
856
- # * :address_2 (String)
857
- # * :city (String)
858
- # * :state (CandidApiClient::Commons::Types::State)
859
- # * :zip_code (String)
860
857
  # @param billable_status [CandidApiClient::Encounters::V4::Types::BillableStatusType] Defines if the Encounter is to be billed by Candid to the responsible_party.
861
858
  # Examples for when this should be set to NOT_BILLABLE include if the Encounter
862
859
  # has not occurred yet or if there is no intention of ever billing the
@@ -991,26 +988,6 @@ module CandidApiClient
991
988
  # related to the patient's pregnancy.de
992
989
  # @param delay_reason_code [CandidApiClient::Commons::Types::DelayReasonCode] 837i Loop2300, CLM-1300 Box 20
993
990
  # Code indicating the reason why a request was delayed
994
- # @param patient [Hash] Contains the identification information of the individual receiving medical
995
- # services.Request of type CandidApiClient::Individual::Types::PatientUpdate, as a Hash
996
- # * :first_name (String)
997
- # * :last_name (String)
998
- # * :gender (CandidApiClient::Individual::Types::Gender)
999
- # * :external_id (String)
1000
- # * :date_of_birth (Date)
1001
- # * :address (Hash)
1002
- # * :zip_plus_four_code (String)
1003
- # * :address_1 (String)
1004
- # * :address_2 (String)
1005
- # * :city (String)
1006
- # * :state (CandidApiClient::Commons::Types::State)
1007
- # * :zip_code (String)
1008
- # * :phone_numbers (Array<CandidApiClient::Commons::Types::PhoneNumber>)
1009
- # * :phone_consent (Boolean)
1010
- # * :email (String)
1011
- # * :email_consent (Boolean)
1012
- # * :non_insurance_payers (Array<String>)
1013
- # * :non_insurance_payers_info (Array<CandidApiClient::Individual::Types::PatientNonInsurancePayerInfoCreate>)
1014
991
  # @param patient_authorized_release [Boolean] Whether this patient has authorized the release of medical information
1015
992
  # for billing purpose.
1016
993
  # Box 12 on the CMS-1500 claim form.
@@ -1042,11 +1019,54 @@ module CandidApiClient
1042
1019
  # * :dosage_form (String)
1043
1020
  # * :frequency (String)
1044
1021
  # * :as_needed (Boolean)
1045
- # @param rendering_provider [Hash] The rendering provider is the practitioner -- physician, nurse practitioner,
1046
- # etc. -- performing the service.
1047
- # For telehealth services, the rendering provider performs the visit, asynchronous
1048
- # communication, or other service. The rendering provider address should generally
1049
- # be the same as the service facility address.Request of type CandidApiClient::EncounterProviders::V2::Types::RenderingProviderUpdate, as a Hash
1022
+ # @param guarantor [Hash] Personal and contact info for the guarantor of the patient responsibility.Request of type CandidApiClient::Guarantor::V1::Types::GuarantorUpdate, as a Hash
1023
+ # * :first_name (String)
1024
+ # * :last_name (String)
1025
+ # * :external_id (String)
1026
+ # * :date_of_birth (Date)
1027
+ # * :address (Hash)
1028
+ # * :zip_plus_four_code (String)
1029
+ # * :address_1 (String)
1030
+ # * :address_2 (String)
1031
+ # * :city (String)
1032
+ # * :state (CandidApiClient::Commons::Types::State)
1033
+ # * :zip_code (String)
1034
+ # * :phone_numbers (Array<CandidApiClient::Commons::Types::PhoneNumber>)
1035
+ # * :phone_consent (Boolean)
1036
+ # * :email (String)
1037
+ # * :email_consent (Boolean)
1038
+ # @param referral_number [String] Refers to REF\*9F on the 837p. Value cannot be greater than 50 characters.
1039
+ # @param epsdt_referral [Hash] Refers Box 24H on the CMS1500 form and Loop 2300 CRC - EPSDT Referral on the
1040
+ # 837P formRequest of type CandidApiClient::Encounters::V4::Types::EpsdtReferral, as a Hash
1041
+ # * :condition_indicator_1 (CandidApiClient::Commons::Types::EpsdtReferralConditionIndicatorCode)
1042
+ # * :condition_indicator_2 (CandidApiClient::Commons::Types::EpsdtReferralConditionIndicatorCode)
1043
+ # * :condition_indicator_3 (CandidApiClient::Commons::Types::EpsdtReferralConditionIndicatorCode)
1044
+ # @param claim_supplemental_information [Array<Hash>] Refers to Loop 2300 - Segment PWK on the 837P form. No more than 10 entries are
1045
+ # permitted.Request of type Array<CandidApiClient::Encounters::V4::Types::ClaimSupplementalInformation>, as a Hash
1046
+ # * :attachment_report_type_code (CandidApiClient::Encounters::V4::Types::ReportTypeCode)
1047
+ # * :attachment_transmission_code (CandidApiClient::Encounters::V4::Types::ReportTransmissionCode)
1048
+ # * :attachment_control_number (String)
1049
+ # @param secondary_payer_carrier_code [String] When Medicaid is billed as the secondary payer the Carrier Code is used to
1050
+ # identify the primary payer. This is required for certain states.
1051
+ # @param additional_properties [OpenStruct] Additional properties unmapped to the current class definition
1052
+ # @param _field_set [Object]
1053
+ # @param pay_to_address [Hash] Specifies the address to which payments for the claim should be sent.Request of type CandidApiClient::Commons::Types::StreetAddressLongZip, as a Hash
1054
+ # * :zip_plus_four_code (String)
1055
+ # * :address_1 (String)
1056
+ # * :address_2 (String)
1057
+ # * :city (String)
1058
+ # * :state (CandidApiClient::Commons::Types::State)
1059
+ # * :zip_code (String)
1060
+ # @param diagnosis_ids [Array<String>] Ideally, this field should contain no more than 12 diagnoses. However, more
1061
+ # diagnoses
1062
+ # may be submitted at this time, and coders will later prioritize the 12 that will
1063
+ # be
1064
+ # submitted to the payor.
1065
+ # @param initial_referring_provider [Hash] The second iteration of Loop ID-2310. Use code "P3 - Primary Care Provider" in
1066
+ # this loop to
1067
+ # indicate the initial referral from the primary care provider or whatever
1068
+ # provider wrote the initial referral for this patient's episode of care being
1069
+ # billed/reported in this transaction.Request of type CandidApiClient::EncounterProviders::V2::Types::InitialReferringProviderUpdate, as a Hash
1050
1070
  # * :npi (String)
1051
1071
  # * :taxonomy_code (String)
1052
1072
  # * :address (Hash)
@@ -1056,20 +1076,15 @@ module CandidApiClient
1056
1076
  # * :city (String)
1057
1077
  # * :state (CandidApiClient::Commons::Types::State)
1058
1078
  # * :zip_code (String)
1079
+ # * :qualifier (CandidApiClient::Commons::Types::QualifierCode)
1059
1080
  # * :first_name (String)
1060
1081
  # * :last_name (String)
1061
1082
  # * :organization_name (String)
1062
- # @param service_facility [Hash] Encounter Service facility is typically the location a medical service was
1063
- # rendered, such as a provider office or hospital. For telehealth, service
1064
- # facility can represent the provider's location when the service was delivered
1065
- # (e.g., home), or the location where an in-person visit would have taken place,
1066
- # whichever is easier to identify. If the provider is in-network, service facility
1067
- # may be defined in payer contracts. Box 32 on the CMS-1500 claim form. Note that
1068
- # for an in-network claim to be successfully adjudicated, the service facility
1069
- # address listed on claims must match what was provided to the payer during the
1070
- # credentialing process.Request of type CandidApiClient::ServiceFacility::Types::EncounterServiceFacilityUpdate, as a Hash
1071
- # * :organization_name (String)
1083
+ # @param referring_provider [Hash] The final provider who referred the services that were rendered.
1084
+ # All physicians who order services or refer Medicare beneficiaries must
1085
+ # report this data.Request of type CandidApiClient::EncounterProviders::V2::Types::ReferringProviderUpdate, as a Hash
1072
1086
  # * :npi (String)
1087
+ # * :taxonomy_code (String)
1073
1088
  # * :address (Hash)
1074
1089
  # * :zip_plus_four_code (String)
1075
1090
  # * :address_1 (String)
@@ -1077,10 +1092,14 @@ module CandidApiClient
1077
1092
  # * :city (String)
1078
1093
  # * :state (CandidApiClient::Commons::Types::State)
1079
1094
  # * :zip_code (String)
1080
- # * :secondary_identification (String)
1081
- # @param guarantor [Hash] Personal and contact info for the guarantor of the patient responsibility.Request of type CandidApiClient::Guarantor::V1::Types::GuarantorUpdate, as a Hash
1082
1095
  # * :first_name (String)
1083
1096
  # * :last_name (String)
1097
+ # * :organization_name (String)
1098
+ # @param patient [Hash] Contains the identification information of the individual receiving medical
1099
+ # services.Request of type CandidApiClient::Individual::Types::PatientUpdate, as a Hash
1100
+ # * :first_name (String)
1101
+ # * :last_name (String)
1102
+ # * :gender (CandidApiClient::Individual::Types::Gender)
1084
1103
  # * :external_id (String)
1085
1104
  # * :date_of_birth (Date)
1086
1105
  # * :address (Hash)
@@ -1094,15 +1113,15 @@ module CandidApiClient
1094
1113
  # * :phone_consent (Boolean)
1095
1114
  # * :email (String)
1096
1115
  # * :email_consent (Boolean)
1097
- # @param billing_provider [Hash] The billing provider is the provider or business entity submitting the claim.
1098
- # Billing provider may be, but is not necessarily, the same person/NPI as the
1099
- # rendering provider. From a payer's perspective, this represents the person or
1100
- # entity being reimbursed. When a contract exists with the target payer, the
1101
- # billing provider should be the entity contracted with the payer. In some
1102
- # circumstances, this will be an individual provider. In that case, submit that
1103
- # provider's NPI and the tax ID (TIN) that the provider gave to the payer during
1104
- # contracting. In other cases, the billing entity will be a medical group. If so,
1105
- # submit the group NPI and the group's tax ID. Box 33 on the CMS-1500 claim form.Request of type CandidApiClient::EncounterProviders::V2::Types::BillingProviderUpdate, as a Hash
1116
+ # * :non_insurance_payers (Array<String>)
1117
+ # * :non_insurance_payers_info (Array<CandidApiClient::Individual::Types::PatientNonInsurancePayerInfoCreate>)
1118
+ # @param rendering_provider [Hash] The rendering provider is the practitioner -- physician, nurse practitioner,
1119
+ # etc. -- performing the service.
1120
+ # For telehealth services, the rendering provider performs the visit, asynchronous
1121
+ # communication, or other service. The rendering provider address should generally
1122
+ # be the same as the service facility address.Request of type CandidApiClient::EncounterProviders::V2::Types::RenderingProviderUpdate, as a Hash
1123
+ # * :npi (String)
1124
+ # * :taxonomy_code (String)
1106
1125
  # * :address (Hash)
1107
1126
  # * :zip_plus_four_code (String)
1108
1127
  # * :address_1 (String)
@@ -1110,17 +1129,20 @@ module CandidApiClient
1110
1129
  # * :city (String)
1111
1130
  # * :state (CandidApiClient::Commons::Types::State)
1112
1131
  # * :zip_code (String)
1113
- # * :tax_id (String)
1114
- # * :npi (String)
1115
- # * :taxonomy_code (String)
1116
- # * :provider_commercial_license_type (CandidApiClient::Commons::Types::BillingProviderCommercialLicenseType)
1117
1132
  # * :first_name (String)
1118
1133
  # * :last_name (String)
1119
1134
  # * :organization_name (String)
1120
- # @param supervising_provider [Hash] Required when the rendering provider is supervised by a physician. If not
1121
- # required by this implementation guide, do not send.Request of type CandidApiClient::EncounterProviders::V2::Types::SupervisingProviderUpdate, as a Hash
1135
+ # @param service_facility [Hash] Encounter Service facility is typically the location a medical service was
1136
+ # rendered, such as a provider office or hospital. For telehealth, service
1137
+ # facility can represent the provider's location when the service was delivered
1138
+ # (e.g., home), or the location where an in-person visit would have taken place,
1139
+ # whichever is easier to identify. If the provider is in-network, service facility
1140
+ # may be defined in payer contracts. Box 32 on the CMS-1500 claim form. Note that
1141
+ # for an in-network claim to be successfully adjudicated, the service facility
1142
+ # address listed on claims must match what was provided to the payer during the
1143
+ # credentialing process.Request of type CandidApiClient::ServiceFacility::Types::EncounterServiceFacilityUpdate, as a Hash
1144
+ # * :organization_name (String)
1122
1145
  # * :npi (String)
1123
- # * :taxonomy_code (String)
1124
1146
  # * :address (Hash)
1125
1147
  # * :zip_plus_four_code (String)
1126
1148
  # * :address_1 (String)
@@ -1128,12 +1150,9 @@ module CandidApiClient
1128
1150
  # * :city (String)
1129
1151
  # * :state (CandidApiClient::Commons::Types::State)
1130
1152
  # * :zip_code (String)
1131
- # * :first_name (String)
1132
- # * :last_name (String)
1133
- # * :organization_name (String)
1134
- # @param referring_provider [Hash] The final provider who referred the services that were rendered.
1135
- # All physicians who order services or refer Medicare beneficiaries must
1136
- # report this data.Request of type CandidApiClient::EncounterProviders::V2::Types::ReferringProviderUpdate, as a Hash
1153
+ # * :secondary_identification (String)
1154
+ # @param supervising_provider [Hash] Required when the rendering provider is supervised by a physician. If not
1155
+ # required by this implementation guide, do not send.Request of type CandidApiClient::EncounterProviders::V2::Types::SupervisingProviderUpdate, as a Hash
1137
1156
  # * :npi (String)
1138
1157
  # * :taxonomy_code (String)
1139
1158
  # * :address (Hash)
@@ -1146,13 +1165,15 @@ module CandidApiClient
1146
1165
  # * :first_name (String)
1147
1166
  # * :last_name (String)
1148
1167
  # * :organization_name (String)
1149
- # @param initial_referring_provider [Hash] The second iteration of Loop ID-2310. Use code "P3 - Primary Care Provider" in
1150
- # this loop to
1151
- # indicate the initial referral from the primary care provider or whatever
1152
- # provider wrote the initial referral for this patient's episode of care being
1153
- # billed/reported in this transaction.Request of type CandidApiClient::EncounterProviders::V2::Types::InitialReferringProviderUpdate, as a Hash
1154
- # * :npi (String)
1155
- # * :taxonomy_code (String)
1168
+ # @param billing_provider [Hash] The billing provider is the provider or business entity submitting the claim.
1169
+ # Billing provider may be, but is not necessarily, the same person/NPI as the
1170
+ # rendering provider. From a payer's perspective, this represents the person or
1171
+ # entity being reimbursed. When a contract exists with the target payer, the
1172
+ # billing provider should be the entity contracted with the payer. In some
1173
+ # circumstances, this will be an individual provider. In that case, submit that
1174
+ # provider's NPI and the tax ID (TIN) that the provider gave to the payer during
1175
+ # contracting. In other cases, the billing entity will be a medical group. If so,
1176
+ # submit the group NPI and the group's tax ID. Box 33 on the CMS-1500 claim form.Request of type CandidApiClient::EncounterProviders::V2::Types::BillingProviderUpdate, as a Hash
1156
1177
  # * :address (Hash)
1157
1178
  # * :zip_plus_four_code (String)
1158
1179
  # * :address_1 (String)
@@ -1160,28 +1181,13 @@ module CandidApiClient
1160
1181
  # * :city (String)
1161
1182
  # * :state (CandidApiClient::Commons::Types::State)
1162
1183
  # * :zip_code (String)
1163
- # * :qualifier (CandidApiClient::Commons::Types::QualifierCode)
1184
+ # * :tax_id (String)
1185
+ # * :npi (String)
1186
+ # * :taxonomy_code (String)
1187
+ # * :provider_commercial_license_type (CandidApiClient::Commons::Types::BillingProviderCommercialLicenseType)
1164
1188
  # * :first_name (String)
1165
1189
  # * :last_name (String)
1166
1190
  # * :organization_name (String)
1167
- # @param referral_number [String] Refers to REF\*9F on the 837p. Value cannot be greater than 50 characters.
1168
- # @param epsdt_referral [Hash] Refers Box 24H on the CMS1500 form and Loop 2300 CRC - EPSDT Referral on the
1169
- # 837P formRequest of type CandidApiClient::Encounters::V4::Types::EpsdtReferral, as a Hash
1170
- # * :condition_indicator_1 (CandidApiClient::Commons::Types::EpsdtReferralConditionIndicatorCode)
1171
- # * :condition_indicator_2 (CandidApiClient::Commons::Types::EpsdtReferralConditionIndicatorCode)
1172
- # * :condition_indicator_3 (CandidApiClient::Commons::Types::EpsdtReferralConditionIndicatorCode)
1173
- # @param claim_supplemental_information [Array<Hash>] Refers to Loop 2300 - Segment PWK on the 837P form. No more than 10 entries are
1174
- # permitted.Request of type Array<CandidApiClient::Encounters::V4::Types::ClaimSupplementalInformation>, as a Hash
1175
- # * :attachment_report_type_code (CandidApiClient::Encounters::V4::Types::ReportTypeCode)
1176
- # * :attachment_transmission_code (CandidApiClient::Encounters::V4::Types::ReportTransmissionCode)
1177
- # * :attachment_control_number (String)
1178
- # @param additional_properties [OpenStruct] Additional properties unmapped to the current class definition
1179
- # @param _field_set [Object]
1180
- # @param diagnosis_ids [Array<String>] Ideally, this field should contain no more than 12 diagnoses. However, more
1181
- # diagnoses
1182
- # may be submitted at this time, and coders will later prioritize the 12 that will
1183
- # be
1184
- # submitted to the payor.
1185
1191
  # @param place_of_service_code_as_submitted [CandidApiClient::Commons::Types::FacilityTypeCode] Box 24B on the CMS-1500 claim form. 837p Loop2300, CLM-05-1. 02 for
1186
1192
  # telemedicine, 11 for in-person. Full list
1187
1193
  # //www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set).
@@ -1191,11 +1197,19 @@ module CandidApiClient
1191
1197
  # api = CandidApiClient::Client.new(base_url: "https://api.example.com", environment: CandidApiClient::Environment::PRODUCTION)
1192
1198
  # api.encounters.v_4.update(
1193
1199
  # encounter_id: "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
1200
+ # pay_to_address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" },
1194
1201
  # diagnosis_ids: ["d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32"],
1202
+ # initial_referring_provider: { npi: "string", taxonomy_code: "string", address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" }, qualifier: DQ, first_name: "string", last_name: "string", organization_name: "string" },
1203
+ # referring_provider: { npi: "string", taxonomy_code: "string", address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" }, first_name: "string", last_name: "string", organization_name: "string" },
1204
+ # patient: { first_name: "string", last_name: "string", gender: MALE, external_id: "string", date_of_birth: DateTime.parse(2023-01-15), address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" }, phone_numbers: [{ number: "1234567890", type: HOME }], phone_consent: true, email: "johndoe@joincandidhealth.com", email_consent: true, non_insurance_payers: ["d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32"], non_insurance_payers_info: [{ non_insurance_payer_id: "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32", member_id: "string", clinical_trial_info: [{ clinical_trial_id: "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32" }] }] },
1205
+ # rendering_provider: { npi: "string", taxonomy_code: "string", address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" }, first_name: "string", last_name: "string", organization_name: "string" },
1206
+ # service_facility: { organization_name: "Test Organization", address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" } },
1207
+ # supervising_provider: { npi: "string", taxonomy_code: "string", address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" }, first_name: "string", last_name: "string", organization_name: "string" },
1208
+ # billing_provider: { address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" }, tax_id: "string", npi: "string", taxonomy_code: "string", provider_commercial_license_type: LICENSED_CLINICAL_SOCIAL_WORKER, first_name: "string", last_name: "string", organization_name: "string" },
1195
1209
  # place_of_service_code_as_submitted: PHARMACY
1196
1210
  # )
1197
1211
  def update(encounter_id:, benefits_assigned_to_provider: nil, prior_authorization_number: nil,
1198
- external_id: nil, date_of_service: nil, tag_ids: nil, clinical_notes: nil, pay_to_address: nil, billable_status: nil, responsible_party: nil, provider_accepts_assignment: nil, synchronicity: nil, place_of_service_code: nil, appointment_type: nil, end_date_of_service: nil, subscriber_primary: nil, subscriber_secondary: nil, subscriber_tertiary: nil, additional_information: nil, service_authorization_exception_code: nil, admission_date: nil, discharge_date: nil, onset_of_current_illness_or_symptom_date: nil, last_menstrual_period_date: nil, delay_reason_code: nil, patient: nil, patient_authorized_release: nil, schema_instances: nil, vitals: nil, existing_medications: nil, rendering_provider: nil, service_facility: nil, guarantor: nil, billing_provider: nil, supervising_provider: nil, referring_provider: nil, initial_referring_provider: nil, referral_number: nil, epsdt_referral: nil, claim_supplemental_information: nil, additional_properties: nil, _field_set: nil, diagnosis_ids: nil, place_of_service_code_as_submitted: nil, request_options: nil)
1212
+ external_id: nil, date_of_service: nil, tag_ids: nil, clinical_notes: nil, billable_status: nil, responsible_party: nil, provider_accepts_assignment: nil, synchronicity: nil, place_of_service_code: nil, appointment_type: nil, end_date_of_service: nil, subscriber_primary: nil, subscriber_secondary: nil, subscriber_tertiary: nil, additional_information: nil, service_authorization_exception_code: nil, admission_date: nil, discharge_date: nil, onset_of_current_illness_or_symptom_date: nil, last_menstrual_period_date: nil, delay_reason_code: nil, patient_authorized_release: nil, schema_instances: nil, vitals: nil, existing_medications: nil, guarantor: nil, referral_number: nil, epsdt_referral: nil, claim_supplemental_information: nil, secondary_payer_carrier_code: nil, additional_properties: nil, _field_set: nil, pay_to_address: nil, diagnosis_ids: nil, initial_referring_provider: nil, referring_provider: nil, patient: nil, rendering_provider: nil, service_facility: nil, supervising_provider: nil, billing_provider: nil, place_of_service_code_as_submitted: nil, request_options: nil)
1199
1213
  response = @request_client.conn.patch do |req|
1200
1214
  req.options.timeout = request_options.timeout_in_seconds unless request_options&.timeout_in_seconds.nil?
1201
1215
  req.headers["Authorization"] = request_options.token unless request_options&.token.nil?
@@ -1212,7 +1226,6 @@ module CandidApiClient
1212
1226
  date_of_service: date_of_service,
1213
1227
  tag_ids: tag_ids,
1214
1228
  clinical_notes: clinical_notes,
1215
- pay_to_address: pay_to_address,
1216
1229
  billable_status: billable_status,
1217
1230
  responsible_party: responsible_party,
1218
1231
  provider_accepts_assignment: provider_accepts_assignment,
@@ -1230,24 +1243,26 @@ module CandidApiClient
1230
1243
  onset_of_current_illness_or_symptom_date: onset_of_current_illness_or_symptom_date,
1231
1244
  last_menstrual_period_date: last_menstrual_period_date,
1232
1245
  delay_reason_code: delay_reason_code,
1233
- patient: patient,
1234
1246
  patient_authorized_release: patient_authorized_release,
1235
1247
  schema_instances: schema_instances,
1236
1248
  vitals: vitals,
1237
1249
  existing_medications: existing_medications,
1238
- rendering_provider: rendering_provider,
1239
- service_facility: service_facility,
1240
1250
  guarantor: guarantor,
1241
- billing_provider: billing_provider,
1242
- supervising_provider: supervising_provider,
1243
- referring_provider: referring_provider,
1244
- initial_referring_provider: initial_referring_provider,
1245
1251
  referral_number: referral_number,
1246
1252
  epsdt_referral: epsdt_referral,
1247
1253
  claim_supplemental_information: claim_supplemental_information,
1254
+ secondary_payer_carrier_code: secondary_payer_carrier_code,
1248
1255
  additional_properties: additional_properties,
1249
1256
  _field_set: _field_set,
1257
+ pay_to_address: pay_to_address,
1250
1258
  diagnosis_ids: diagnosis_ids,
1259
+ initial_referring_provider: initial_referring_provider,
1260
+ referring_provider: referring_provider,
1261
+ patient: patient,
1262
+ rendering_provider: rendering_provider,
1263
+ service_facility: service_facility,
1264
+ supervising_provider: supervising_provider,
1265
+ billing_provider: billing_provider,
1251
1266
  place_of_service_code_as_submitted: place_of_service_code_as_submitted
1252
1267
  }.compact
1253
1268
  req.url "#{@request_client.get_url(environment: CandidApi,
@@ -1786,6 +1801,8 @@ module CandidApiClient
1786
1801
  # * :attachment_report_type_code (CandidApiClient::Encounters::V4::Types::ReportTypeCode)
1787
1802
  # * :attachment_transmission_code (CandidApiClient::Encounters::V4::Types::ReportTransmissionCode)
1788
1803
  # * :attachment_control_number (String)
1804
+ # @param secondary_payer_carrier_code [String] When Medicaid is billed as the secondary payer the Carrier Code is used to
1805
+ # identify the primary payer. This is required for certain states.
1789
1806
  # @param request_options [CandidApiClient::RequestOptions]
1790
1807
  # @return [CandidApiClient::Encounters::V4::Types::Encounter]
1791
1808
  # @example
@@ -1815,10 +1832,11 @@ module CandidApiClient
1815
1832
  # schema_instances: [{ schema_id: "ec096b13-f80a-471d-aaeb-54b021c9d582", content: { "provider_category": "internist", "is_urgent_care": true, "bmi": 24.2, "age": 38 } }],
1816
1833
  # referral_number: "string",
1817
1834
  # epsdt_referral: { condition_indicator_1: AV, condition_indicator_2: AV, condition_indicator_3: AV },
1818
- # claim_supplemental_information: [{ attachment_report_type_code: C_03, attachment_transmission_code: CBM }]
1835
+ # claim_supplemental_information: [{ attachment_report_type_code: C_03, attachment_transmission_code: CBM }],
1836
+ # secondary_payer_carrier_code: "string"
1819
1837
  # )
1820
1838
  def create(external_id:, patient_authorized_release:, benefits_assigned_to_provider:,
1821
- provider_accepts_assignment:, billable_status:, patient:, billing_provider:, rendering_provider:, responsible_party:, diagnoses:, place_of_service_code:, date_of_service: nil, end_date_of_service: nil, appointment_type: nil, existing_medications: nil, vitals: nil, interventions: nil, pay_to_address: nil, synchronicity: nil, additional_information: nil, service_authorization_exception_code: nil, admission_date: nil, discharge_date: nil, onset_of_current_illness_or_symptom_date: nil, last_menstrual_period_date: nil, delay_reason_code: nil, additional_properties: nil, _field_set: nil, referring_provider: nil, initial_referring_provider: nil, supervising_provider: nil, service_facility: nil, subscriber_primary: nil, subscriber_secondary: nil, subscriber_tertiary: nil, prior_authorization_number: nil, clinical_notes: nil, billing_notes: nil, patient_histories: nil, service_lines: nil, guarantor: nil, external_claim_submission: nil, tag_ids: nil, schema_instances: nil, referral_number: nil, epsdt_referral: nil, claim_supplemental_information: nil, request_options: nil)
1839
+ provider_accepts_assignment:, billable_status:, patient:, billing_provider:, rendering_provider:, responsible_party:, diagnoses:, place_of_service_code:, date_of_service: nil, end_date_of_service: nil, appointment_type: nil, existing_medications: nil, vitals: nil, interventions: nil, pay_to_address: nil, synchronicity: nil, additional_information: nil, service_authorization_exception_code: nil, admission_date: nil, discharge_date: nil, onset_of_current_illness_or_symptom_date: nil, last_menstrual_period_date: nil, delay_reason_code: nil, additional_properties: nil, _field_set: nil, referring_provider: nil, initial_referring_provider: nil, supervising_provider: nil, service_facility: nil, subscriber_primary: nil, subscriber_secondary: nil, subscriber_tertiary: nil, prior_authorization_number: nil, clinical_notes: nil, billing_notes: nil, patient_histories: nil, service_lines: nil, guarantor: nil, external_claim_submission: nil, tag_ids: nil, schema_instances: nil, referral_number: nil, epsdt_referral: nil, claim_supplemental_information: nil, secondary_payer_carrier_code: nil, request_options: nil)
1822
1840
  Async do
1823
1841
  response = @request_client.conn.post do |req|
1824
1842
  req.options.timeout = request_options.timeout_in_seconds unless request_options&.timeout_in_seconds.nil?
@@ -1876,7 +1894,8 @@ module CandidApiClient
1876
1894
  schema_instances: schema_instances,
1877
1895
  referral_number: referral_number,
1878
1896
  epsdt_referral: epsdt_referral,
1879
- claim_supplemental_information: claim_supplemental_information
1897
+ claim_supplemental_information: claim_supplemental_information,
1898
+ secondary_payer_carrier_code: secondary_payer_carrier_code
1880
1899
  }.compact
1881
1900
  req.url "#{@request_client.get_url(environment: CandidApi,
1882
1901
  request_options: request_options)}/api/encounters/v4"
@@ -2064,13 +2083,6 @@ module CandidApiClient
2064
2083
  # patient encounters.Request of type Array<CandidApiClient::Encounters::V4::Types::ClinicalNoteCategoryCreate>, as a Hash
2065
2084
  # * :category (CandidApiClient::Encounters::V4::Types::NoteCategory)
2066
2085
  # * :notes (Array<CandidApiClient::Encounters::V4::Types::ClinicalNote>)
2067
- # @param pay_to_address [Hash] Specifies the address to which payments for the claim should be sent.Request of type CandidApiClient::Commons::Types::StreetAddressLongZip, as a Hash
2068
- # * :zip_plus_four_code (String)
2069
- # * :address_1 (String)
2070
- # * :address_2 (String)
2071
- # * :city (String)
2072
- # * :state (CandidApiClient::Commons::Types::State)
2073
- # * :zip_code (String)
2074
2086
  # @param billable_status [CandidApiClient::Encounters::V4::Types::BillableStatusType] Defines if the Encounter is to be billed by Candid to the responsible_party.
2075
2087
  # Examples for when this should be set to NOT_BILLABLE include if the Encounter
2076
2088
  # has not occurred yet or if there is no intention of ever billing the
@@ -2205,26 +2217,6 @@ module CandidApiClient
2205
2217
  # related to the patient's pregnancy.de
2206
2218
  # @param delay_reason_code [CandidApiClient::Commons::Types::DelayReasonCode] 837i Loop2300, CLM-1300 Box 20
2207
2219
  # Code indicating the reason why a request was delayed
2208
- # @param patient [Hash] Contains the identification information of the individual receiving medical
2209
- # services.Request of type CandidApiClient::Individual::Types::PatientUpdate, as a Hash
2210
- # * :first_name (String)
2211
- # * :last_name (String)
2212
- # * :gender (CandidApiClient::Individual::Types::Gender)
2213
- # * :external_id (String)
2214
- # * :date_of_birth (Date)
2215
- # * :address (Hash)
2216
- # * :zip_plus_four_code (String)
2217
- # * :address_1 (String)
2218
- # * :address_2 (String)
2219
- # * :city (String)
2220
- # * :state (CandidApiClient::Commons::Types::State)
2221
- # * :zip_code (String)
2222
- # * :phone_numbers (Array<CandidApiClient::Commons::Types::PhoneNumber>)
2223
- # * :phone_consent (Boolean)
2224
- # * :email (String)
2225
- # * :email_consent (Boolean)
2226
- # * :non_insurance_payers (Array<String>)
2227
- # * :non_insurance_payers_info (Array<CandidApiClient::Individual::Types::PatientNonInsurancePayerInfoCreate>)
2228
2220
  # @param patient_authorized_release [Boolean] Whether this patient has authorized the release of medical information
2229
2221
  # for billing purpose.
2230
2222
  # Box 12 on the CMS-1500 claim form.
@@ -2256,11 +2248,54 @@ module CandidApiClient
2256
2248
  # * :dosage_form (String)
2257
2249
  # * :frequency (String)
2258
2250
  # * :as_needed (Boolean)
2259
- # @param rendering_provider [Hash] The rendering provider is the practitioner -- physician, nurse practitioner,
2260
- # etc. -- performing the service.
2261
- # For telehealth services, the rendering provider performs the visit, asynchronous
2262
- # communication, or other service. The rendering provider address should generally
2263
- # be the same as the service facility address.Request of type CandidApiClient::EncounterProviders::V2::Types::RenderingProviderUpdate, as a Hash
2251
+ # @param guarantor [Hash] Personal and contact info for the guarantor of the patient responsibility.Request of type CandidApiClient::Guarantor::V1::Types::GuarantorUpdate, as a Hash
2252
+ # * :first_name (String)
2253
+ # * :last_name (String)
2254
+ # * :external_id (String)
2255
+ # * :date_of_birth (Date)
2256
+ # * :address (Hash)
2257
+ # * :zip_plus_four_code (String)
2258
+ # * :address_1 (String)
2259
+ # * :address_2 (String)
2260
+ # * :city (String)
2261
+ # * :state (CandidApiClient::Commons::Types::State)
2262
+ # * :zip_code (String)
2263
+ # * :phone_numbers (Array<CandidApiClient::Commons::Types::PhoneNumber>)
2264
+ # * :phone_consent (Boolean)
2265
+ # * :email (String)
2266
+ # * :email_consent (Boolean)
2267
+ # @param referral_number [String] Refers to REF\*9F on the 837p. Value cannot be greater than 50 characters.
2268
+ # @param epsdt_referral [Hash] Refers Box 24H on the CMS1500 form and Loop 2300 CRC - EPSDT Referral on the
2269
+ # 837P formRequest of type CandidApiClient::Encounters::V4::Types::EpsdtReferral, as a Hash
2270
+ # * :condition_indicator_1 (CandidApiClient::Commons::Types::EpsdtReferralConditionIndicatorCode)
2271
+ # * :condition_indicator_2 (CandidApiClient::Commons::Types::EpsdtReferralConditionIndicatorCode)
2272
+ # * :condition_indicator_3 (CandidApiClient::Commons::Types::EpsdtReferralConditionIndicatorCode)
2273
+ # @param claim_supplemental_information [Array<Hash>] Refers to Loop 2300 - Segment PWK on the 837P form. No more than 10 entries are
2274
+ # permitted.Request of type Array<CandidApiClient::Encounters::V4::Types::ClaimSupplementalInformation>, as a Hash
2275
+ # * :attachment_report_type_code (CandidApiClient::Encounters::V4::Types::ReportTypeCode)
2276
+ # * :attachment_transmission_code (CandidApiClient::Encounters::V4::Types::ReportTransmissionCode)
2277
+ # * :attachment_control_number (String)
2278
+ # @param secondary_payer_carrier_code [String] When Medicaid is billed as the secondary payer the Carrier Code is used to
2279
+ # identify the primary payer. This is required for certain states.
2280
+ # @param additional_properties [OpenStruct] Additional properties unmapped to the current class definition
2281
+ # @param _field_set [Object]
2282
+ # @param pay_to_address [Hash] Specifies the address to which payments for the claim should be sent.Request of type CandidApiClient::Commons::Types::StreetAddressLongZip, as a Hash
2283
+ # * :zip_plus_four_code (String)
2284
+ # * :address_1 (String)
2285
+ # * :address_2 (String)
2286
+ # * :city (String)
2287
+ # * :state (CandidApiClient::Commons::Types::State)
2288
+ # * :zip_code (String)
2289
+ # @param diagnosis_ids [Array<String>] Ideally, this field should contain no more than 12 diagnoses. However, more
2290
+ # diagnoses
2291
+ # may be submitted at this time, and coders will later prioritize the 12 that will
2292
+ # be
2293
+ # submitted to the payor.
2294
+ # @param initial_referring_provider [Hash] The second iteration of Loop ID-2310. Use code "P3 - Primary Care Provider" in
2295
+ # this loop to
2296
+ # indicate the initial referral from the primary care provider or whatever
2297
+ # provider wrote the initial referral for this patient's episode of care being
2298
+ # billed/reported in this transaction.Request of type CandidApiClient::EncounterProviders::V2::Types::InitialReferringProviderUpdate, as a Hash
2264
2299
  # * :npi (String)
2265
2300
  # * :taxonomy_code (String)
2266
2301
  # * :address (Hash)
@@ -2270,20 +2305,15 @@ module CandidApiClient
2270
2305
  # * :city (String)
2271
2306
  # * :state (CandidApiClient::Commons::Types::State)
2272
2307
  # * :zip_code (String)
2308
+ # * :qualifier (CandidApiClient::Commons::Types::QualifierCode)
2273
2309
  # * :first_name (String)
2274
2310
  # * :last_name (String)
2275
2311
  # * :organization_name (String)
2276
- # @param service_facility [Hash] Encounter Service facility is typically the location a medical service was
2277
- # rendered, such as a provider office or hospital. For telehealth, service
2278
- # facility can represent the provider's location when the service was delivered
2279
- # (e.g., home), or the location where an in-person visit would have taken place,
2280
- # whichever is easier to identify. If the provider is in-network, service facility
2281
- # may be defined in payer contracts. Box 32 on the CMS-1500 claim form. Note that
2282
- # for an in-network claim to be successfully adjudicated, the service facility
2283
- # address listed on claims must match what was provided to the payer during the
2284
- # credentialing process.Request of type CandidApiClient::ServiceFacility::Types::EncounterServiceFacilityUpdate, as a Hash
2285
- # * :organization_name (String)
2312
+ # @param referring_provider [Hash] The final provider who referred the services that were rendered.
2313
+ # All physicians who order services or refer Medicare beneficiaries must
2314
+ # report this data.Request of type CandidApiClient::EncounterProviders::V2::Types::ReferringProviderUpdate, as a Hash
2286
2315
  # * :npi (String)
2316
+ # * :taxonomy_code (String)
2287
2317
  # * :address (Hash)
2288
2318
  # * :zip_plus_four_code (String)
2289
2319
  # * :address_1 (String)
@@ -2291,10 +2321,14 @@ module CandidApiClient
2291
2321
  # * :city (String)
2292
2322
  # * :state (CandidApiClient::Commons::Types::State)
2293
2323
  # * :zip_code (String)
2294
- # * :secondary_identification (String)
2295
- # @param guarantor [Hash] Personal and contact info for the guarantor of the patient responsibility.Request of type CandidApiClient::Guarantor::V1::Types::GuarantorUpdate, as a Hash
2296
2324
  # * :first_name (String)
2297
2325
  # * :last_name (String)
2326
+ # * :organization_name (String)
2327
+ # @param patient [Hash] Contains the identification information of the individual receiving medical
2328
+ # services.Request of type CandidApiClient::Individual::Types::PatientUpdate, as a Hash
2329
+ # * :first_name (String)
2330
+ # * :last_name (String)
2331
+ # * :gender (CandidApiClient::Individual::Types::Gender)
2298
2332
  # * :external_id (String)
2299
2333
  # * :date_of_birth (Date)
2300
2334
  # * :address (Hash)
@@ -2308,15 +2342,15 @@ module CandidApiClient
2308
2342
  # * :phone_consent (Boolean)
2309
2343
  # * :email (String)
2310
2344
  # * :email_consent (Boolean)
2311
- # @param billing_provider [Hash] The billing provider is the provider or business entity submitting the claim.
2312
- # Billing provider may be, but is not necessarily, the same person/NPI as the
2313
- # rendering provider. From a payer's perspective, this represents the person or
2314
- # entity being reimbursed. When a contract exists with the target payer, the
2315
- # billing provider should be the entity contracted with the payer. In some
2316
- # circumstances, this will be an individual provider. In that case, submit that
2317
- # provider's NPI and the tax ID (TIN) that the provider gave to the payer during
2318
- # contracting. In other cases, the billing entity will be a medical group. If so,
2319
- # submit the group NPI and the group's tax ID. Box 33 on the CMS-1500 claim form.Request of type CandidApiClient::EncounterProviders::V2::Types::BillingProviderUpdate, as a Hash
2345
+ # * :non_insurance_payers (Array<String>)
2346
+ # * :non_insurance_payers_info (Array<CandidApiClient::Individual::Types::PatientNonInsurancePayerInfoCreate>)
2347
+ # @param rendering_provider [Hash] The rendering provider is the practitioner -- physician, nurse practitioner,
2348
+ # etc. -- performing the service.
2349
+ # For telehealth services, the rendering provider performs the visit, asynchronous
2350
+ # communication, or other service. The rendering provider address should generally
2351
+ # be the same as the service facility address.Request of type CandidApiClient::EncounterProviders::V2::Types::RenderingProviderUpdate, as a Hash
2352
+ # * :npi (String)
2353
+ # * :taxonomy_code (String)
2320
2354
  # * :address (Hash)
2321
2355
  # * :zip_plus_four_code (String)
2322
2356
  # * :address_1 (String)
@@ -2324,17 +2358,20 @@ module CandidApiClient
2324
2358
  # * :city (String)
2325
2359
  # * :state (CandidApiClient::Commons::Types::State)
2326
2360
  # * :zip_code (String)
2327
- # * :tax_id (String)
2328
- # * :npi (String)
2329
- # * :taxonomy_code (String)
2330
- # * :provider_commercial_license_type (CandidApiClient::Commons::Types::BillingProviderCommercialLicenseType)
2331
2361
  # * :first_name (String)
2332
2362
  # * :last_name (String)
2333
2363
  # * :organization_name (String)
2334
- # @param supervising_provider [Hash] Required when the rendering provider is supervised by a physician. If not
2335
- # required by this implementation guide, do not send.Request of type CandidApiClient::EncounterProviders::V2::Types::SupervisingProviderUpdate, as a Hash
2364
+ # @param service_facility [Hash] Encounter Service facility is typically the location a medical service was
2365
+ # rendered, such as a provider office or hospital. For telehealth, service
2366
+ # facility can represent the provider's location when the service was delivered
2367
+ # (e.g., home), or the location where an in-person visit would have taken place,
2368
+ # whichever is easier to identify. If the provider is in-network, service facility
2369
+ # may be defined in payer contracts. Box 32 on the CMS-1500 claim form. Note that
2370
+ # for an in-network claim to be successfully adjudicated, the service facility
2371
+ # address listed on claims must match what was provided to the payer during the
2372
+ # credentialing process.Request of type CandidApiClient::ServiceFacility::Types::EncounterServiceFacilityUpdate, as a Hash
2373
+ # * :organization_name (String)
2336
2374
  # * :npi (String)
2337
- # * :taxonomy_code (String)
2338
2375
  # * :address (Hash)
2339
2376
  # * :zip_plus_four_code (String)
2340
2377
  # * :address_1 (String)
@@ -2342,12 +2379,9 @@ module CandidApiClient
2342
2379
  # * :city (String)
2343
2380
  # * :state (CandidApiClient::Commons::Types::State)
2344
2381
  # * :zip_code (String)
2345
- # * :first_name (String)
2346
- # * :last_name (String)
2347
- # * :organization_name (String)
2348
- # @param referring_provider [Hash] The final provider who referred the services that were rendered.
2349
- # All physicians who order services or refer Medicare beneficiaries must
2350
- # report this data.Request of type CandidApiClient::EncounterProviders::V2::Types::ReferringProviderUpdate, as a Hash
2382
+ # * :secondary_identification (String)
2383
+ # @param supervising_provider [Hash] Required when the rendering provider is supervised by a physician. If not
2384
+ # required by this implementation guide, do not send.Request of type CandidApiClient::EncounterProviders::V2::Types::SupervisingProviderUpdate, as a Hash
2351
2385
  # * :npi (String)
2352
2386
  # * :taxonomy_code (String)
2353
2387
  # * :address (Hash)
@@ -2360,13 +2394,15 @@ module CandidApiClient
2360
2394
  # * :first_name (String)
2361
2395
  # * :last_name (String)
2362
2396
  # * :organization_name (String)
2363
- # @param initial_referring_provider [Hash] The second iteration of Loop ID-2310. Use code "P3 - Primary Care Provider" in
2364
- # this loop to
2365
- # indicate the initial referral from the primary care provider or whatever
2366
- # provider wrote the initial referral for this patient's episode of care being
2367
- # billed/reported in this transaction.Request of type CandidApiClient::EncounterProviders::V2::Types::InitialReferringProviderUpdate, as a Hash
2368
- # * :npi (String)
2369
- # * :taxonomy_code (String)
2397
+ # @param billing_provider [Hash] The billing provider is the provider or business entity submitting the claim.
2398
+ # Billing provider may be, but is not necessarily, the same person/NPI as the
2399
+ # rendering provider. From a payer's perspective, this represents the person or
2400
+ # entity being reimbursed. When a contract exists with the target payer, the
2401
+ # billing provider should be the entity contracted with the payer. In some
2402
+ # circumstances, this will be an individual provider. In that case, submit that
2403
+ # provider's NPI and the tax ID (TIN) that the provider gave to the payer during
2404
+ # contracting. In other cases, the billing entity will be a medical group. If so,
2405
+ # submit the group NPI and the group's tax ID. Box 33 on the CMS-1500 claim form.Request of type CandidApiClient::EncounterProviders::V2::Types::BillingProviderUpdate, as a Hash
2370
2406
  # * :address (Hash)
2371
2407
  # * :zip_plus_four_code (String)
2372
2408
  # * :address_1 (String)
@@ -2374,28 +2410,13 @@ module CandidApiClient
2374
2410
  # * :city (String)
2375
2411
  # * :state (CandidApiClient::Commons::Types::State)
2376
2412
  # * :zip_code (String)
2377
- # * :qualifier (CandidApiClient::Commons::Types::QualifierCode)
2413
+ # * :tax_id (String)
2414
+ # * :npi (String)
2415
+ # * :taxonomy_code (String)
2416
+ # * :provider_commercial_license_type (CandidApiClient::Commons::Types::BillingProviderCommercialLicenseType)
2378
2417
  # * :first_name (String)
2379
2418
  # * :last_name (String)
2380
2419
  # * :organization_name (String)
2381
- # @param referral_number [String] Refers to REF\*9F on the 837p. Value cannot be greater than 50 characters.
2382
- # @param epsdt_referral [Hash] Refers Box 24H on the CMS1500 form and Loop 2300 CRC - EPSDT Referral on the
2383
- # 837P formRequest of type CandidApiClient::Encounters::V4::Types::EpsdtReferral, as a Hash
2384
- # * :condition_indicator_1 (CandidApiClient::Commons::Types::EpsdtReferralConditionIndicatorCode)
2385
- # * :condition_indicator_2 (CandidApiClient::Commons::Types::EpsdtReferralConditionIndicatorCode)
2386
- # * :condition_indicator_3 (CandidApiClient::Commons::Types::EpsdtReferralConditionIndicatorCode)
2387
- # @param claim_supplemental_information [Array<Hash>] Refers to Loop 2300 - Segment PWK on the 837P form. No more than 10 entries are
2388
- # permitted.Request of type Array<CandidApiClient::Encounters::V4::Types::ClaimSupplementalInformation>, as a Hash
2389
- # * :attachment_report_type_code (CandidApiClient::Encounters::V4::Types::ReportTypeCode)
2390
- # * :attachment_transmission_code (CandidApiClient::Encounters::V4::Types::ReportTransmissionCode)
2391
- # * :attachment_control_number (String)
2392
- # @param additional_properties [OpenStruct] Additional properties unmapped to the current class definition
2393
- # @param _field_set [Object]
2394
- # @param diagnosis_ids [Array<String>] Ideally, this field should contain no more than 12 diagnoses. However, more
2395
- # diagnoses
2396
- # may be submitted at this time, and coders will later prioritize the 12 that will
2397
- # be
2398
- # submitted to the payor.
2399
2420
  # @param place_of_service_code_as_submitted [CandidApiClient::Commons::Types::FacilityTypeCode] Box 24B on the CMS-1500 claim form. 837p Loop2300, CLM-05-1. 02 for
2400
2421
  # telemedicine, 11 for in-person. Full list
2401
2422
  # //www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set).
@@ -2405,11 +2426,19 @@ module CandidApiClient
2405
2426
  # api = CandidApiClient::Client.new(base_url: "https://api.example.com", environment: CandidApiClient::Environment::PRODUCTION)
2406
2427
  # api.encounters.v_4.update(
2407
2428
  # encounter_id: "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32",
2429
+ # pay_to_address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" },
2408
2430
  # diagnosis_ids: ["d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32"],
2431
+ # initial_referring_provider: { npi: "string", taxonomy_code: "string", address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" }, qualifier: DQ, first_name: "string", last_name: "string", organization_name: "string" },
2432
+ # referring_provider: { npi: "string", taxonomy_code: "string", address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" }, first_name: "string", last_name: "string", organization_name: "string" },
2433
+ # patient: { first_name: "string", last_name: "string", gender: MALE, external_id: "string", date_of_birth: DateTime.parse(2023-01-15), address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" }, phone_numbers: [{ number: "1234567890", type: HOME }], phone_consent: true, email: "johndoe@joincandidhealth.com", email_consent: true, non_insurance_payers: ["d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32"], non_insurance_payers_info: [{ non_insurance_payer_id: "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32", member_id: "string", clinical_trial_info: [{ clinical_trial_id: "d5e9c84f-c2b2-4bf4-b4b0-7ffd7a9ffc32" }] }] },
2434
+ # rendering_provider: { npi: "string", taxonomy_code: "string", address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" }, first_name: "string", last_name: "string", organization_name: "string" },
2435
+ # service_facility: { organization_name: "Test Organization", address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" } },
2436
+ # supervising_provider: { npi: "string", taxonomy_code: "string", address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" }, first_name: "string", last_name: "string", organization_name: "string" },
2437
+ # billing_provider: { address: { address_1: "123 Main St", address_2: "Apt 1", city: "New York", state: NY, zip_code: "10001", zip_plus_four_code: "1234" }, tax_id: "string", npi: "string", taxonomy_code: "string", provider_commercial_license_type: LICENSED_CLINICAL_SOCIAL_WORKER, first_name: "string", last_name: "string", organization_name: "string" },
2409
2438
  # place_of_service_code_as_submitted: PHARMACY
2410
2439
  # )
2411
2440
  def update(encounter_id:, benefits_assigned_to_provider: nil, prior_authorization_number: nil,
2412
- external_id: nil, date_of_service: nil, tag_ids: nil, clinical_notes: nil, pay_to_address: nil, billable_status: nil, responsible_party: nil, provider_accepts_assignment: nil, synchronicity: nil, place_of_service_code: nil, appointment_type: nil, end_date_of_service: nil, subscriber_primary: nil, subscriber_secondary: nil, subscriber_tertiary: nil, additional_information: nil, service_authorization_exception_code: nil, admission_date: nil, discharge_date: nil, onset_of_current_illness_or_symptom_date: nil, last_menstrual_period_date: nil, delay_reason_code: nil, patient: nil, patient_authorized_release: nil, schema_instances: nil, vitals: nil, existing_medications: nil, rendering_provider: nil, service_facility: nil, guarantor: nil, billing_provider: nil, supervising_provider: nil, referring_provider: nil, initial_referring_provider: nil, referral_number: nil, epsdt_referral: nil, claim_supplemental_information: nil, additional_properties: nil, _field_set: nil, diagnosis_ids: nil, place_of_service_code_as_submitted: nil, request_options: nil)
2441
+ external_id: nil, date_of_service: nil, tag_ids: nil, clinical_notes: nil, billable_status: nil, responsible_party: nil, provider_accepts_assignment: nil, synchronicity: nil, place_of_service_code: nil, appointment_type: nil, end_date_of_service: nil, subscriber_primary: nil, subscriber_secondary: nil, subscriber_tertiary: nil, additional_information: nil, service_authorization_exception_code: nil, admission_date: nil, discharge_date: nil, onset_of_current_illness_or_symptom_date: nil, last_menstrual_period_date: nil, delay_reason_code: nil, patient_authorized_release: nil, schema_instances: nil, vitals: nil, existing_medications: nil, guarantor: nil, referral_number: nil, epsdt_referral: nil, claim_supplemental_information: nil, secondary_payer_carrier_code: nil, additional_properties: nil, _field_set: nil, pay_to_address: nil, diagnosis_ids: nil, initial_referring_provider: nil, referring_provider: nil, patient: nil, rendering_provider: nil, service_facility: nil, supervising_provider: nil, billing_provider: nil, place_of_service_code_as_submitted: nil, request_options: nil)
2413
2442
  Async do
2414
2443
  response = @request_client.conn.patch do |req|
2415
2444
  req.options.timeout = request_options.timeout_in_seconds unless request_options&.timeout_in_seconds.nil?
@@ -2427,7 +2456,6 @@ module CandidApiClient
2427
2456
  date_of_service: date_of_service,
2428
2457
  tag_ids: tag_ids,
2429
2458
  clinical_notes: clinical_notes,
2430
- pay_to_address: pay_to_address,
2431
2459
  billable_status: billable_status,
2432
2460
  responsible_party: responsible_party,
2433
2461
  provider_accepts_assignment: provider_accepts_assignment,
@@ -2445,24 +2473,26 @@ module CandidApiClient
2445
2473
  onset_of_current_illness_or_symptom_date: onset_of_current_illness_or_symptom_date,
2446
2474
  last_menstrual_period_date: last_menstrual_period_date,
2447
2475
  delay_reason_code: delay_reason_code,
2448
- patient: patient,
2449
2476
  patient_authorized_release: patient_authorized_release,
2450
2477
  schema_instances: schema_instances,
2451
2478
  vitals: vitals,
2452
2479
  existing_medications: existing_medications,
2453
- rendering_provider: rendering_provider,
2454
- service_facility: service_facility,
2455
2480
  guarantor: guarantor,
2456
- billing_provider: billing_provider,
2457
- supervising_provider: supervising_provider,
2458
- referring_provider: referring_provider,
2459
- initial_referring_provider: initial_referring_provider,
2460
2481
  referral_number: referral_number,
2461
2482
  epsdt_referral: epsdt_referral,
2462
2483
  claim_supplemental_information: claim_supplemental_information,
2484
+ secondary_payer_carrier_code: secondary_payer_carrier_code,
2463
2485
  additional_properties: additional_properties,
2464
2486
  _field_set: _field_set,
2487
+ pay_to_address: pay_to_address,
2465
2488
  diagnosis_ids: diagnosis_ids,
2489
+ initial_referring_provider: initial_referring_provider,
2490
+ referring_provider: referring_provider,
2491
+ patient: patient,
2492
+ rendering_provider: rendering_provider,
2493
+ service_facility: service_facility,
2494
+ supervising_provider: supervising_provider,
2495
+ billing_provider: billing_provider,
2466
2496
  place_of_service_code_as_submitted: place_of_service_code_as_submitted
2467
2497
  }.compact
2468
2498
  req.url "#{@request_client.get_url(environment: CandidApi,