@vbasoftware/vbapi-vbasoftware-typescript-axios 1.20230208.2 → 1.20230225.1
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.
- package/api/events-api.ts +87 -0
- package/models/claim-batch-detail.ts +145 -139
- package/models/claim-batch.ts +668 -446
- package/models/claim-detail.ts +130 -124
- package/models/claim-pre-batch-detail.ts +100 -94
- package/models/claim-pre-batch.ts +600 -378
- package/models/claim.ts +508 -280
- package/models/company-data.ts +421 -403
- package/models/cost-contain-zelis-ex-code.ts +6 -6
- package/models/groups.ts +18 -18
- package/models/idcard-request.ts +3 -3
- package/models/mem-enrollment-plan.ts +9 -9
- package/models/mem-enrollment-rider.ts +10 -10
- package/models/member-beneficiary.ts +3 -3
- package/models/member-language.ts +38 -2
- package/models/plan-benefit-cluster.ts +12 -12
- package/models/plan-benefit-rate.ts +5 -5
- package/models/plan-benefits.ts +57 -51
- package/models/plan-type.ts +21 -21
- package/models/plans.ts +41 -41
- package/models/prem-rate.ts +85 -85
- package/models/sub-enrollment-plan.ts +10 -10
- package/models/sub-enrollment-rider.ts +14 -14
- package/models/subscribers.ts +2 -2
- package/models/users.ts +8 -8
- package/package.json +1 -1
package/models/claim-detail.ts
CHANGED
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@@ -21,73 +21,73 @@
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*/
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export interface ClaimDetail {
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/**
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*
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* References the Claim.Claim_Number value on the parent record. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'claim_Number': number;
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/**
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*
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* In combination with Adjustment_Seq, creates a unique sequence for each service line on this claim.
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* @type {string}
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* @memberof ClaimDetail
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*/
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'claim_Seq': string;
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/**
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*
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* In combination with Claim_Seq, creates a unique sequence for each service line on this claim. Used to note adjustments, cascading, etc. when utlized.
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* @type {string}
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* @memberof ClaimDetail
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*/
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'adjustment_Seq': string;
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/**
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*
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* No longer in use.
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* @type {string}
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* @memberof ClaimDetail
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*/
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'ansI_Code'?: string | null;
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/**
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*
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* The APC code applied to this service if identified for calculation during adjudication.
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* @type {string}
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* @memberof ClaimDetail
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*/
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'apC_Code'?: string | null;
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/**
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*
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* For reference purposes, this hold the individual service line funding payor/account. If multiple payor/accounts are found on different service lines for the same claim, adjudication spits out an error.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'account_Key'?: number | null;
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/**
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*
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* Notes if this line was adjusted as part of an individual claim adjustment process. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
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* @type {boolean}
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* @memberof ClaimDetail
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*/
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'adjusted_Line': boolean;
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/**
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*
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* No longer in use. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'admin_Amt': number;
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/**
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*
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* The Auth Number for services that require authorization. References Auth.Auth_Number.
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* @type {string}
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* @memberof ClaimDetail
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*/
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'auth_Number'?: string | null;
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/**
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*
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* If an Auth Penalty is applied during adjudication, that is housed here.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'auth_Penalty'?: number | null;
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/**
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*
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* Notes that this service lines required authorization.
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* @type {string}
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* @memberof ClaimDetail
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*/
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'auth_Required'?: string | null;
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/**
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*
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* This is the benefit code assigned to this service line based on the Plan assigned on the Claim header. References BenefitCodes.Benefit_Code.
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* @type {string}
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* @memberof ClaimDetail
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*/
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@@ -97,675 +97,681 @@ export interface ClaimDetail {
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* @type {number}
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* @memberof ClaimDetail
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*/
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'benefit_Rate_Applied'?: number | null;
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/**
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* The billed charges assigned by the provider for this service. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'billed_Price': number;
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/**
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*
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* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
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* @type {string}
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* @memberof ClaimDetail
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*/
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'brand_Indicator'?: string | null;
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/**
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*
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* For dental claims, notes if this surface had services rendered. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
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* @type {boolean}
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* @memberof ClaimDetail
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*/
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'buccal': boolean;
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/**
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*
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* No longer in use.
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* @type {string}
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* @memberof ClaimDetail
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*/
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'cliA_Number'?: string | null;
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/**
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*
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* Holds the Other Insurance calculated amount that would affect the payable amount for this service (calculated from COB_Hold, COB_Mem_Resp, COB_Savings, and COB_Savings_Used). Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'coB_Amt': number;
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/**
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*
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* Used in COB calculations (Dupe or Non-Dupe) to determine the COB_Amt to be applied.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'coB_Hold'?: number | null;
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/**
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*
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* Used in COB calculations (Dupe or Non-Dupe) to determine the COB_Amt to be applied.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'coB_Mem_Resp'?: number | null;
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/**
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*
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* Used in COB calculations (Dupe or Non-Dupe) to determine the COB_Amt to be applied.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'coB_Savings'?: number | null;
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/**
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*
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* Used in COB calculations (Dupe or Non-Dupe) to determine the COB_Amt to be applied.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'coB_Savings_Used'?: number | null;
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/**
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* Used for Flex Claims to indicate the calendar year this claim applies.
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* @type {string}
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* @memberof ClaimDetail
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*/
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'calendar_Year'?: string | null;
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/**
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* Notes if this service line is captiated. If the Claim.Capitation_Claim value is flagged, it overrides this value and notes the entire claim and all service lines as capitated. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
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* @type {boolean}
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* @memberof ClaimDetail
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*/
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'capitation_Claim': boolean;
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/**
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* No longer in use.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'check_ID'?: number | null;
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/**
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* The co-insurance amount applied by adjudication based on benefit definition. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'co_Ins_Amt': number;
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/**
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* The co-pay amount applied by adjudication based on benefit definition. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'co_Pay_Amt': number;
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/**
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* For currency calculations, this holds the destination currency.
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* @type {string}
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* @memberof ClaimDetail
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*/
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'currency_ID'?: string | null;
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/**
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* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'days_Supply'?: number | null;
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/**
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* If the service is eligiblity for deductible credits, they would be stored here.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'ded_Credit_Amt'?: number | null;
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/**
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* The deductible amount applied by adjudication based on benefit definition. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'deductible_Amt': number;
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/**
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* The diagnosis pointer for this service line indicating which Diagnostic Codes from the Claim are applicable to this service.
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* @type {string}
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* @memberof ClaimDetail
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*/
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'diagnosis_Code'?: string | null;
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/**
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* The difference between Billed and Allowed is stored as the Discount Amount. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'discount_Amt': number;
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/**
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* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'dispense_As_Written'?: number | null;
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/**
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* For dental claims, notes if this surface had services rendered. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
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* @type {boolean}
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* @memberof ClaimDetail
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*/
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'distal': boolean;
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/**
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* For RX claims or medical claims that hold a drug code. References DrugCode.Drug_Code.
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* @type {string}
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* @memberof ClaimDetail
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'drug_Code'?: string | null;
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/**
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* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
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* @type {number}
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* @memberof ClaimDetail
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*/
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'drug_Quantity'?: number | null;
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/**
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* Date when the record was first added to the system.
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* @type {string}
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* @memberof ClaimDetail
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*/
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'entry_Date'?: string;
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/**
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* User that first added the record to the system.
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* @type {string}
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* @memberof ClaimDetail
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*/
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'entry_User'?: string | null;
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/**
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* A place for both user assigned reason codes applicable to this claim or for adjudication to automatically assign ex code. References ExplanationCodes.Ex_Code.
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* @type {string}
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'ex_Code'?: string | null;
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/**
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* A place for both user assigned reason codes applicable to this claim or for adjudication to automatically assign ex code. References ExplanationCodes.Ex_Code.
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'ex_Code2'?: string | null;
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/**
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*
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+
* A place for both user assigned reason codes applicable to this claim or for adjudication to automatically assign ex code. References ExplanationCodes.Ex_Code.
|
|
265
271
|
* @type {string}
|
|
266
272
|
* @memberof ClaimDetail
|
|
267
273
|
*/
|
|
268
274
|
'ex_Code3'?: string | null;
|
|
269
275
|
/**
|
|
270
|
-
*
|
|
276
|
+
* The FICA tax amount for disability claims. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
271
277
|
* @type {number}
|
|
272
278
|
* @memberof ClaimDetail
|
|
273
279
|
*/
|
|
274
280
|
'fica': number;
|
|
275
281
|
/**
|
|
276
|
-
*
|
|
282
|
+
* For dental claims, notes if this surface had services rendered. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
277
283
|
* @type {boolean}
|
|
278
284
|
* @memberof ClaimDetail
|
|
279
285
|
*/
|
|
280
286
|
'facial': boolean;
|
|
281
287
|
/**
|
|
282
|
-
*
|
|
288
|
+
* Based on taxable amount and various configurations, this holds the Federal \"To Tax\" amount for disability claim.
|
|
283
289
|
* @type {number}
|
|
284
290
|
* @memberof ClaimDetail
|
|
285
291
|
*/
|
|
286
292
|
'federal_Amount_To_Tax'?: number | null;
|
|
287
293
|
/**
|
|
288
|
-
*
|
|
294
|
+
* The calculated Federal tax amount based on the \"To Tax\" amount. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
289
295
|
* @type {number}
|
|
290
296
|
* @memberof ClaimDetail
|
|
291
297
|
*/
|
|
292
298
|
'federal_Tax': number;
|
|
293
299
|
/**
|
|
294
|
-
*
|
|
300
|
+
* A flat federal tax amount applied in addition to the calculated tax amount.
|
|
295
301
|
* @type {number}
|
|
296
302
|
* @memberof ClaimDetail
|
|
297
303
|
*/
|
|
298
304
|
'federal_Tax_Flat'?: number | null;
|
|
299
305
|
/**
|
|
300
|
-
*
|
|
306
|
+
* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
|
|
301
307
|
* @type {string}
|
|
302
308
|
* @memberof ClaimDetail
|
|
303
309
|
*/
|
|
304
310
|
'fill_Date'?: string | null;
|
|
305
311
|
/**
|
|
306
|
-
*
|
|
312
|
+
* Manually entered description of this flex claim.
|
|
307
313
|
* @type {string}
|
|
308
314
|
* @memberof ClaimDetail
|
|
309
315
|
*/
|
|
310
316
|
'flex_Description'?: string | null;
|
|
311
317
|
/**
|
|
312
|
-
*
|
|
318
|
+
* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
|
|
313
319
|
* @type {string}
|
|
314
320
|
* @memberof ClaimDetail
|
|
315
321
|
*/
|
|
316
322
|
'formulary_Indicator'?: string | null;
|
|
317
323
|
/**
|
|
318
|
-
*
|
|
324
|
+
* For dental claims, notes if this surface had services rendered. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
319
325
|
* @type {boolean}
|
|
320
326
|
* @memberof ClaimDetail
|
|
321
327
|
*/
|
|
322
328
|
'incisal': boolean;
|
|
323
329
|
/**
|
|
324
|
-
*
|
|
330
|
+
* If interest is calculated on a claim, it is stored here and applied to payable amount. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
325
331
|
* @type {number}
|
|
326
332
|
* @memberof ClaimDetail
|
|
327
333
|
*/
|
|
328
334
|
'interest': number;
|
|
329
335
|
/**
|
|
330
|
-
*
|
|
336
|
+
* For dental claims, notes if this surface had services rendered. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
331
337
|
* @type {boolean}
|
|
332
338
|
* @memberof ClaimDetail
|
|
333
339
|
*/
|
|
334
340
|
'labial': boolean;
|
|
335
341
|
/**
|
|
336
|
-
*
|
|
342
|
+
* The Life Benefit to be applied for Life claims processing.
|
|
337
343
|
* @type {string}
|
|
338
344
|
* @memberof ClaimDetail
|
|
339
345
|
*/
|
|
340
346
|
'life_Benefit'?: string | null;
|
|
341
347
|
/**
|
|
342
|
-
*
|
|
348
|
+
* The Life Benefit calculated volume based on benefit definition.
|
|
343
349
|
* @type {number}
|
|
344
350
|
* @memberof ClaimDetail
|
|
345
351
|
*/
|
|
346
352
|
'life_Benefit_Volume'?: number | null;
|
|
347
353
|
/**
|
|
348
|
-
*
|
|
354
|
+
* Number added manually to claims and from 837 files and sent outbound on 835 files.
|
|
349
355
|
* @type {string}
|
|
350
356
|
* @memberof ClaimDetail
|
|
351
357
|
*/
|
|
352
358
|
'line_Control_Number'?: string | null;
|
|
353
359
|
/**
|
|
354
|
-
*
|
|
360
|
+
* For dental claims, notes if this surface had services rendered. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
355
361
|
* @type {boolean}
|
|
356
362
|
* @memberof ClaimDetail
|
|
357
363
|
*/
|
|
358
364
|
'lingual': boolean;
|
|
359
365
|
/**
|
|
360
|
-
*
|
|
366
|
+
* If a locality tax is applicable it would be housed here.
|
|
361
367
|
* @type {number}
|
|
362
368
|
* @memberof ClaimDetail
|
|
363
369
|
*/
|
|
364
370
|
'local_Tax'?: number | null;
|
|
365
371
|
/**
|
|
366
|
-
*
|
|
372
|
+
* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
|
|
367
373
|
* @type {string}
|
|
368
374
|
* @memberof ClaimDetail
|
|
369
375
|
*/
|
|
370
376
|
'mail_Order_Indicator'?: string | null;
|
|
371
377
|
/**
|
|
372
|
-
*
|
|
378
|
+
* Based on taxable amount and various configurations, this holds the Medicare \"To Tax\" amount for disability claim.
|
|
373
379
|
* @type {number}
|
|
374
380
|
* @memberof ClaimDetail
|
|
375
381
|
*/
|
|
376
382
|
'medicare_Amount_To_Tax'?: number | null;
|
|
377
383
|
/**
|
|
378
|
-
*
|
|
384
|
+
* The calculated Medicare tax amount based on the \"To Tax\" amount.
|
|
379
385
|
* @type {number}
|
|
380
386
|
* @memberof ClaimDetail
|
|
381
387
|
*/
|
|
382
388
|
'medicare_Tax'?: number | null;
|
|
383
389
|
/**
|
|
384
|
-
*
|
|
390
|
+
* For dental claims, notes if this surface had services rendered. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
385
391
|
* @type {boolean}
|
|
386
392
|
* @memberof ClaimDetail
|
|
387
393
|
*/
|
|
388
394
|
'mesial': boolean;
|
|
389
395
|
/**
|
|
390
|
-
*
|
|
396
|
+
* The modifier applied to this service.
|
|
391
397
|
* @type {string}
|
|
392
398
|
* @memberof ClaimDetail
|
|
393
399
|
*/
|
|
394
400
|
'modifier'?: string | null;
|
|
395
401
|
/**
|
|
396
|
-
*
|
|
402
|
+
* The modifier applied to this service.
|
|
397
403
|
* @type {string}
|
|
398
404
|
* @memberof ClaimDetail
|
|
399
405
|
*/
|
|
400
406
|
'modifier_2'?: string | null;
|
|
401
407
|
/**
|
|
402
|
-
*
|
|
408
|
+
* The modifier applied to this service.
|
|
403
409
|
* @type {string}
|
|
404
410
|
* @memberof ClaimDetail
|
|
405
411
|
*/
|
|
406
412
|
'modifier_3'?: string | null;
|
|
407
413
|
/**
|
|
408
|
-
*
|
|
414
|
+
* The modifier applied to this service.
|
|
409
415
|
* @type {string}
|
|
410
416
|
* @memberof ClaimDetail
|
|
411
417
|
*/
|
|
412
418
|
'modifier_4'?: string | null;
|
|
413
419
|
/**
|
|
414
|
-
*
|
|
420
|
+
* For not covered services, or partially not covered services, this reflects that deduction. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
415
421
|
* @type {number}
|
|
416
422
|
* @memberof ClaimDetail
|
|
417
423
|
*/
|
|
418
424
|
'not_Covered_Amt': number;
|
|
419
425
|
/**
|
|
420
|
-
*
|
|
426
|
+
* For dental claims, notes if this surface had services rendered. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
421
427
|
* @type {boolean}
|
|
422
428
|
* @memberof ClaimDetail
|
|
423
429
|
*/
|
|
424
430
|
'occlusal': boolean;
|
|
425
431
|
/**
|
|
426
|
-
*
|
|
432
|
+
* For dental claims this holds the oral cavity designation sent on the 837D.
|
|
427
433
|
* @type {string}
|
|
428
434
|
* @memberof ClaimDetail
|
|
429
435
|
*/
|
|
430
436
|
'oral_Cavity_Designation_Code_1'?: string | null;
|
|
431
437
|
/**
|
|
432
|
-
*
|
|
438
|
+
* For dental claims this holds the oral cavity designation sent on the 837D.
|
|
433
439
|
* @type {string}
|
|
434
440
|
* @memberof ClaimDetail
|
|
435
441
|
*/
|
|
436
442
|
'oral_Cavity_Designation_Code_2'?: string | null;
|
|
437
443
|
/**
|
|
438
|
-
*
|
|
444
|
+
* For dental claims this holds the oral cavity designation sent on the 837D.
|
|
439
445
|
* @type {string}
|
|
440
446
|
* @memberof ClaimDetail
|
|
441
447
|
*/
|
|
442
448
|
'oral_Cavity_Designation_Code_3'?: string | null;
|
|
443
449
|
/**
|
|
444
|
-
*
|
|
450
|
+
* For dental claims this holds the oral cavity designation sent on the 837D.
|
|
445
451
|
* @type {string}
|
|
446
452
|
* @memberof ClaimDetail
|
|
447
453
|
*/
|
|
448
454
|
'oral_Cavity_Designation_Code_4'?: string | null;
|
|
449
455
|
/**
|
|
450
|
-
*
|
|
456
|
+
* For dental claims this holds the oral cavity designation sent on the 837D.
|
|
451
457
|
* @type {string}
|
|
452
458
|
* @memberof ClaimDetail
|
|
453
459
|
*/
|
|
454
460
|
'oral_Cavity_Designation_Code_5'?: string | null;
|
|
455
461
|
/**
|
|
456
|
-
*
|
|
462
|
+
* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
|
|
457
463
|
* @type {number}
|
|
458
464
|
* @memberof ClaimDetail
|
|
459
465
|
*/
|
|
460
466
|
'other_Deduction_Amount'?: number | null;
|
|
461
467
|
/**
|
|
462
|
-
*
|
|
468
|
+
* Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
463
469
|
* @type {boolean}
|
|
464
470
|
* @memberof ClaimDetail
|
|
465
471
|
*/
|
|
466
472
|
'override_COB_Amt': boolean;
|
|
467
473
|
/**
|
|
468
|
-
*
|
|
474
|
+
* Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
469
475
|
* @type {boolean}
|
|
470
476
|
* @memberof ClaimDetail
|
|
471
477
|
*/
|
|
472
478
|
'override_Co_Ins_Amt': boolean;
|
|
473
479
|
/**
|
|
474
|
-
*
|
|
480
|
+
* Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
475
481
|
* @type {boolean}
|
|
476
482
|
* @memberof ClaimDetail
|
|
477
483
|
*/
|
|
478
484
|
'override_Co_Pay_Amt': boolean;
|
|
479
485
|
/**
|
|
480
|
-
*
|
|
486
|
+
* Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
481
487
|
* @type {boolean}
|
|
482
488
|
* @memberof ClaimDetail
|
|
483
489
|
*/
|
|
484
490
|
'override_Ded_Credit_Amt': boolean;
|
|
485
491
|
/**
|
|
486
|
-
*
|
|
492
|
+
* Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
487
493
|
* @type {boolean}
|
|
488
494
|
* @memberof ClaimDetail
|
|
489
495
|
*/
|
|
490
496
|
'override_Deductible_Amt': boolean;
|
|
491
497
|
/**
|
|
492
|
-
*
|
|
498
|
+
* Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
493
499
|
* @type {boolean}
|
|
494
500
|
* @memberof ClaimDetail
|
|
495
501
|
*/
|
|
496
502
|
'override_Federal_Tax': boolean;
|
|
497
503
|
/**
|
|
498
|
-
*
|
|
504
|
+
* Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
499
505
|
* @type {boolean}
|
|
500
506
|
* @memberof ClaimDetail
|
|
501
507
|
*/
|
|
502
508
|
'override_Local_Tax': boolean;
|
|
503
509
|
/**
|
|
504
|
-
*
|
|
510
|
+
* Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
505
511
|
* @type {boolean}
|
|
506
512
|
* @memberof ClaimDetail
|
|
507
513
|
*/
|
|
508
514
|
'override_Medicare_Tax': boolean;
|
|
509
515
|
/**
|
|
510
|
-
*
|
|
516
|
+
* Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
511
517
|
* @type {boolean}
|
|
512
518
|
* @memberof ClaimDetail
|
|
513
519
|
*/
|
|
514
520
|
'override_Not_Covered_Amt': boolean;
|
|
515
521
|
/**
|
|
516
|
-
*
|
|
522
|
+
* Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
517
523
|
* @type {boolean}
|
|
518
524
|
* @memberof ClaimDetail
|
|
519
525
|
*/
|
|
520
526
|
'override_Plan_Price': boolean;
|
|
521
527
|
/**
|
|
522
|
-
*
|
|
528
|
+
* Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
523
529
|
* @type {boolean}
|
|
524
530
|
* @memberof ClaimDetail
|
|
525
531
|
*/
|
|
526
532
|
'override_Social_Security': boolean;
|
|
527
533
|
/**
|
|
528
|
-
*
|
|
534
|
+
* Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
529
535
|
* @type {boolean}
|
|
530
536
|
* @memberof ClaimDetail
|
|
531
537
|
*/
|
|
532
538
|
'override_State_Tax': boolean;
|
|
533
539
|
/**
|
|
534
|
-
*
|
|
540
|
+
* Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
535
541
|
* @type {boolean}
|
|
536
542
|
* @memberof ClaimDetail
|
|
537
543
|
*/
|
|
538
544
|
'override_With_Hold_Amt': boolean;
|
|
539
545
|
/**
|
|
540
|
-
*
|
|
546
|
+
* Information field used in custom processing and reporting.
|
|
541
547
|
* @type {number}
|
|
542
548
|
* @memberof ClaimDetail
|
|
543
549
|
*/
|
|
544
550
|
'ppO_Price_Plan_Price_Diff'?: number | null;
|
|
545
551
|
/**
|
|
546
|
-
*
|
|
552
|
+
* The final paid amount for this service line based on allowed amount (Plan_Price) minus all applicable deductions. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
547
553
|
* @type {number}
|
|
548
554
|
* @memberof ClaimDetail
|
|
549
555
|
*/
|
|
550
556
|
'paid_Amt': number;
|
|
551
557
|
/**
|
|
552
|
-
*
|
|
558
|
+
* The partial loss amount for disability claims. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
553
559
|
* @type {number}
|
|
554
560
|
* @memberof ClaimDetail
|
|
555
561
|
*/
|
|
556
562
|
'partial_Loss': number;
|
|
557
563
|
/**
|
|
558
|
-
*
|
|
564
|
+
* For reference purposes, this hold the individual service line funding payor/account. If multiple payor/accounts are found on different service lines for the same claim, adjudication spits out an error.
|
|
559
565
|
* @type {string}
|
|
560
566
|
* @memberof ClaimDetail
|
|
561
567
|
*/
|
|
562
568
|
'payor_ID'?: string | null;
|
|
563
569
|
/**
|
|
564
|
-
*
|
|
570
|
+
* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
|
|
565
571
|
* @type {string}
|
|
566
572
|
* @memberof ClaimDetail
|
|
567
573
|
*/
|
|
568
574
|
'pharmacy_Name'?: string | null;
|
|
569
575
|
/**
|
|
570
|
-
*
|
|
576
|
+
* The place of service for the services being rendered on this service line.
|
|
571
577
|
* @type {string}
|
|
572
578
|
* @memberof ClaimDetail
|
|
573
579
|
*/
|
|
574
580
|
'place_Of_Service'?: string | null;
|
|
575
581
|
/**
|
|
576
|
-
*
|
|
582
|
+
* The allowed amount for this service based on fee schedule, pricing, repricing, etc. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
577
583
|
* @type {number}
|
|
578
584
|
* @memberof ClaimDetail
|
|
579
585
|
*/
|
|
580
586
|
'plan_Price': number;
|
|
581
587
|
/**
|
|
582
|
-
*
|
|
588
|
+
* The premium deduction amount for disability claims. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
583
589
|
* @type {number}
|
|
584
590
|
* @memberof ClaimDetail
|
|
585
591
|
*/
|
|
586
592
|
'premium_Deduction': number;
|
|
587
593
|
/**
|
|
588
|
-
*
|
|
594
|
+
* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
|
|
589
595
|
* @type {string}
|
|
590
596
|
* @memberof ClaimDetail
|
|
591
597
|
*/
|
|
592
598
|
'prescriber_ID'?: string | null;
|
|
593
599
|
/**
|
|
594
|
-
*
|
|
600
|
+
* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
|
|
595
601
|
* @type {string}
|
|
596
602
|
* @memberof ClaimDetail
|
|
597
603
|
*/
|
|
598
604
|
'prescription_Date'?: string | null;
|
|
599
605
|
/**
|
|
600
|
-
*
|
|
606
|
+
* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
|
|
601
607
|
* @type {string}
|
|
602
608
|
* @memberof ClaimDetail
|
|
603
609
|
*/
|
|
604
610
|
'prescription_Number'?: string | null;
|
|
605
611
|
/**
|
|
606
|
-
*
|
|
612
|
+
* For reprice claims (typically submitted via 837), this notes the reprice method used to reprice this service line.
|
|
607
613
|
* @type {string}
|
|
608
614
|
* @memberof ClaimDetail
|
|
609
615
|
*/
|
|
610
616
|
'pricing_Method'?: string | null;
|
|
611
617
|
/**
|
|
612
|
-
*
|
|
618
|
+
* The rate associated with the reprice method (Pricing_Method).
|
|
613
619
|
* @type {number}
|
|
614
620
|
* @memberof ClaimDetail
|
|
615
621
|
*/
|
|
616
622
|
'pricing_Rate'?: number | null;
|
|
617
623
|
/**
|
|
618
|
-
*
|
|
624
|
+
* For life claims, this holds the principal amount for reporting. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
619
625
|
* @type {number}
|
|
620
626
|
* @memberof ClaimDetail
|
|
621
627
|
*/
|
|
622
628
|
'principal': number;
|
|
623
629
|
/**
|
|
624
|
-
*
|
|
630
|
+
* The service being rendered on this claim.
|
|
625
631
|
* @type {string}
|
|
626
632
|
* @memberof ClaimDetail
|
|
627
633
|
*/
|
|
628
634
|
'procedure_Code'?: string | null;
|
|
629
635
|
/**
|
|
630
|
-
*
|
|
636
|
+
* The secondary service being rendered on this claim.
|
|
631
637
|
* @type {string}
|
|
632
638
|
* @memberof ClaimDetail
|
|
633
639
|
*/
|
|
634
640
|
'procedure_Code2'?: string | null;
|
|
635
641
|
/**
|
|
636
|
-
*
|
|
642
|
+
* QPA (Qualified Payment Amount) values received in upcoming EDI transactions for the NSA (No Surprise Act) mandate.
|
|
637
643
|
* @type {number}
|
|
638
644
|
* @memberof ClaimDetail
|
|
639
645
|
*/
|
|
640
646
|
'qualifying_Payment_Amount'?: number | null;
|
|
641
647
|
/**
|
|
642
|
-
*
|
|
648
|
+
* No longer in use.
|
|
643
649
|
* @type {number}
|
|
644
650
|
* @memberof ClaimDetail
|
|
645
651
|
*/
|
|
646
652
|
'reason_Code'?: number | null;
|
|
647
653
|
/**
|
|
648
|
-
*
|
|
654
|
+
* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
|
|
649
655
|
* @type {number}
|
|
650
656
|
* @memberof ClaimDetail
|
|
651
657
|
*/
|
|
652
658
|
'refill_Indicator'?: number | null;
|
|
653
659
|
/**
|
|
654
|
-
*
|
|
660
|
+
* Holds the submitted reprice savings amount for services that include this amount in the pricing calculation.
|
|
655
661
|
* @type {number}
|
|
656
662
|
* @memberof ClaimDetail
|
|
657
663
|
*/
|
|
658
664
|
'repriced_Savings_Amount'?: number | null;
|
|
659
665
|
/**
|
|
660
|
-
*
|
|
666
|
+
* For dental claims, notes if this surface had services rendered. Note: The database will apply a default value of `False` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `False` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
661
667
|
* @type {boolean}
|
|
662
668
|
* @memberof ClaimDetail
|
|
663
669
|
*/
|
|
664
670
|
'root': boolean;
|
|
665
671
|
/**
|
|
666
|
-
*
|
|
672
|
+
* The start date of the services being rendered.
|
|
667
673
|
* @type {string}
|
|
668
674
|
* @memberof ClaimDetail
|
|
669
675
|
*/
|
|
670
676
|
'service_Date'?: string | null;
|
|
671
677
|
/**
|
|
672
|
-
*
|
|
678
|
+
* The end date of the services being rendered.
|
|
673
679
|
* @type {string}
|
|
674
680
|
* @memberof ClaimDetail
|
|
675
681
|
*/
|
|
676
682
|
'service_Thru'?: string | null;
|
|
677
683
|
/**
|
|
678
|
-
*
|
|
684
|
+
* Based on taxable amount and various configurations, this holds the Social Security \"To Tax\" amount for disability claim.
|
|
679
685
|
* @type {number}
|
|
680
686
|
* @memberof ClaimDetail
|
|
681
687
|
*/
|
|
682
688
|
'socSec_Amount_To_Tax'?: number | null;
|
|
683
689
|
/**
|
|
684
|
-
*
|
|
690
|
+
* The calculated Social Security tax amount based on the \"To Tax\" amount. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
685
691
|
* @type {number}
|
|
686
692
|
* @memberof ClaimDetail
|
|
687
693
|
*/
|
|
688
694
|
'social_Security': number;
|
|
689
695
|
/**
|
|
690
|
-
*
|
|
696
|
+
* Based on taxable amount and various configurations, this holds the State \"To Tax\" amount for disability claim.
|
|
691
697
|
* @type {number}
|
|
692
698
|
* @memberof ClaimDetail
|
|
693
699
|
*/
|
|
694
700
|
'state_Amount_To_Tax'?: number | null;
|
|
695
701
|
/**
|
|
696
|
-
*
|
|
702
|
+
* The calculated State tax amount based on the \"To Tax\" amount. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
697
703
|
* @type {number}
|
|
698
704
|
* @memberof ClaimDetail
|
|
699
705
|
*/
|
|
700
706
|
'state_Tax': number;
|
|
701
707
|
/**
|
|
702
|
-
*
|
|
708
|
+
* A flat state tax amount applied in addition to the calculated tax amount.
|
|
703
709
|
* @type {number}
|
|
704
710
|
* @memberof ClaimDetail
|
|
705
711
|
*/
|
|
706
712
|
'state_Tax_Flat'?: number | null;
|
|
707
713
|
/**
|
|
708
|
-
*
|
|
714
|
+
* When state taxes are calculated, this indicates the state the tax amount was calculated against.
|
|
709
715
|
* @type {string}
|
|
710
716
|
* @memberof ClaimDetail
|
|
711
717
|
*/
|
|
712
718
|
'state_Tax_State'?: string | null;
|
|
713
719
|
/**
|
|
714
|
-
*
|
|
720
|
+
* Holds the individaul status of this service line based on Ex Codes. A - Payable, D - Denied, E - Pended.
|
|
715
721
|
* @type {string}
|
|
716
722
|
* @memberof ClaimDetail
|
|
717
723
|
*/
|
|
718
724
|
'status_Code'?: string | null;
|
|
719
725
|
/**
|
|
720
|
-
*
|
|
726
|
+
* The units applied to this service.
|
|
721
727
|
* @type {number}
|
|
722
728
|
* @memberof ClaimDetail
|
|
723
729
|
*/
|
|
724
730
|
'svc_Count'?: number | null;
|
|
725
731
|
/**
|
|
726
|
-
*
|
|
732
|
+
* This holds the starting taxable amount based on pre-tax and pre-gross deductions applied to this service.
|
|
727
733
|
* @type {number}
|
|
728
734
|
* @memberof ClaimDetail
|
|
729
735
|
*/
|
|
730
736
|
'taxable_Amount'?: number | null;
|
|
731
737
|
/**
|
|
732
|
-
*
|
|
738
|
+
* For dental claims, this identifies the tooth, quadrant or arch being worked for this service.
|
|
733
739
|
* @type {number}
|
|
734
740
|
* @memberof ClaimDetail
|
|
735
741
|
*/
|
|
736
742
|
'tooth_Number'?: number | null;
|
|
737
743
|
/**
|
|
738
|
-
*
|
|
744
|
+
* No longer in use. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
739
745
|
* @type {number}
|
|
740
746
|
* @memberof ClaimDetail
|
|
741
747
|
*/
|
|
742
748
|
'ucR_Price': number;
|
|
743
749
|
/**
|
|
744
|
-
*
|
|
750
|
+
* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
|
|
745
751
|
* @type {number}
|
|
746
752
|
* @memberof ClaimDetail
|
|
747
753
|
*/
|
|
748
754
|
'unit_Dose'?: number | null;
|
|
749
755
|
/**
|
|
750
|
-
*
|
|
756
|
+
* Pharmacy claim information submitted via file submission and used in reporting and interfaces.
|
|
751
757
|
* @type {string}
|
|
752
758
|
* @memberof ClaimDetail
|
|
753
759
|
*/
|
|
754
760
|
'unit_Of_Measure'?: string | null;
|
|
755
761
|
/**
|
|
756
|
-
*
|
|
762
|
+
* Date when the record was last updated in the system.
|
|
757
763
|
* @type {string}
|
|
758
764
|
* @memberof ClaimDetail
|
|
759
765
|
*/
|
|
760
766
|
'update_Date'?: string;
|
|
761
767
|
/**
|
|
762
|
-
*
|
|
768
|
+
* User that last updated the record in the system.
|
|
763
769
|
* @type {string}
|
|
764
770
|
* @memberof ClaimDetail
|
|
765
771
|
*/
|
|
766
772
|
'update_User'?: string | null;
|
|
767
773
|
/**
|
|
768
|
-
*
|
|
774
|
+
* For plans that allow withhold, this amount is used to track that amount. Note: The database will apply a default value of `0` for this field if a value is not provided. This field is also marked as NOT NULL in the database and therefore required by the API. If you do not have a value for this field, supply the database default value of `0` to meet the API requirements and ensure that the functionality occurs as expected.
|
|
769
775
|
* @type {number}
|
|
770
776
|
* @memberof ClaimDetail
|
|
771
777
|
*/
|