samplehc 0.17.0__py3-none-any.whl → 0.19.0__py3-none-any.whl
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.
- samplehc/_base_client.py +5 -2
- samplehc/_client.py +1 -38
- samplehc/_compat.py +3 -3
- samplehc/_utils/_json.py +35 -0
- samplehc/_version.py +1 -1
- samplehc/resources/__init__.py +0 -14
- samplehc/resources/v2/__init__.py +0 -98
- samplehc/resources/v2/async_results.py +0 -79
- samplehc/resources/v2/documents/__init__.py +0 -14
- samplehc/resources/v2/documents/documents.py +44 -196
- samplehc/resources/v2/v2.py +0 -224
- samplehc/types/__init__.py +0 -5
- samplehc/types/v2/__init__.py +0 -53
- samplehc/types/v2/document_extract_params.py +20 -1
- samplehc/types/v2/documents/__init__.py +0 -3
- {samplehc-0.17.0.dist-info → samplehc-0.19.0.dist-info}/METADATA +22 -27
- samplehc-0.19.0.dist-info/RECORD +93 -0
- samplehc/resources/v1/__init__.py +0 -19
- samplehc/resources/v1/v1.py +0 -298
- samplehc/resources/v2/clearinghouse/__init__.py +0 -47
- samplehc/resources/v2/clearinghouse/claim.py +0 -407
- samplehc/resources/v2/clearinghouse/clearinghouse.py +0 -844
- samplehc/resources/v2/clearinghouse/payers.py +0 -224
- samplehc/resources/v2/documents/pdf_template.py +0 -165
- samplehc/resources/v2/hie/__init__.py +0 -47
- samplehc/resources/v2/hie/adt.py +0 -249
- samplehc/resources/v2/hie/documents.py +0 -390
- samplehc/resources/v2/hie/hie.py +0 -134
- samplehc/resources/v2/integrations/__init__.py +0 -131
- samplehc/resources/v2/integrations/bank/__init__.py +0 -33
- samplehc/resources/v2/integrations/bank/bank.py +0 -102
- samplehc/resources/v2/integrations/bank/transactions.py +0 -185
- samplehc/resources/v2/integrations/careviso.py +0 -372
- samplehc/resources/v2/integrations/glidian/__init__.py +0 -33
- samplehc/resources/v2/integrations/glidian/glidian.py +0 -425
- samplehc/resources/v2/integrations/glidian/prior_authorizations/__init__.py +0 -33
- samplehc/resources/v2/integrations/glidian/prior_authorizations/clinical_questions.py +0 -276
- samplehc/resources/v2/integrations/glidian/prior_authorizations/prior_authorizations.py +0 -527
- samplehc/resources/v2/integrations/integrations.py +0 -326
- samplehc/resources/v2/integrations/kno2/__init__.py +0 -33
- samplehc/resources/v2/integrations/kno2/kno2.py +0 -102
- samplehc/resources/v2/integrations/kno2/messages.py +0 -260
- samplehc/resources/v2/integrations/salesforce.py +0 -277
- samplehc/resources/v2/integrations/snowflake.py +0 -173
- samplehc/resources/v2/integrations/wellsky/__init__.py +0 -33
- samplehc/resources/v2/integrations/wellsky/patients.py +0 -324
- samplehc/resources/v2/integrations/wellsky/wellsky.py +0 -102
- samplehc/resources/v2/integrations/xcures.py +0 -197
- samplehc/resources/v2/policies.py +0 -655
- samplehc/resources/v2/tasks/__init__.py +0 -33
- samplehc/resources/v2/tasks/state.py +0 -266
- samplehc/resources/v2/tasks/tasks.py +0 -754
- samplehc/resources/v2/workflow_runs/__init__.py +0 -33
- samplehc/resources/v2/workflow_runs/step.py +0 -169
- samplehc/resources/v2/workflow_runs/workflow_runs.py +0 -479
- samplehc/resources/v2/workflows.py +0 -377
- samplehc/types/v1/__init__.py +0 -3
- samplehc/types/v1_query_audit_logs_params.py +0 -12
- samplehc/types/v1_query_audit_logs_response.py +0 -16
- samplehc/types/v1_sql_execute_params.py +0 -27
- samplehc/types/v1_sql_execute_response.py +0 -27
- samplehc/types/v2/async_result_retrieve_response.py +0 -18
- samplehc/types/v2/clearinghouse/__init__.py +0 -9
- samplehc/types/v2/clearinghouse/claim_submit_params.py +0 -2693
- samplehc/types/v2/clearinghouse/claim_submit_response.py +0 -23
- samplehc/types/v2/clearinghouse/payer_list_response.py +0 -27
- samplehc/types/v2/clearinghouse/payer_search_params.py +0 -12
- samplehc/types/v2/clearinghouse/payer_search_response.py +0 -33
- samplehc/types/v2/clearinghouse_calculate_patient_cost_params.py +0 -3129
- samplehc/types/v2/clearinghouse_check_claim_status_params.py +0 -41
- samplehc/types/v2/clearinghouse_check_eligibility_params.py +0 -36
- samplehc/types/v2/clearinghouse_check_eligibility_response.py +0 -15
- samplehc/types/v2/clearinghouse_coordination_of_benefits_params.py +0 -35
- samplehc/types/v2/clearinghouse_run_discovery_params.py +0 -59
- samplehc/types/v2/clearinghouse_run_discovery_response.py +0 -13
- samplehc/types/v2/document_unzip_async_response.py +0 -12
- samplehc/types/v2/document_unzip_response.py +0 -20
- samplehc/types/v2/documents/pdf_template_retrieve_metadata_response.py +0 -17
- samplehc/types/v2/hie/__init__.py +0 -8
- samplehc/types/v2/hie/adt_subscribe_params.py +0 -92
- samplehc/types/v2/hie/document_query_params.py +0 -92
- samplehc/types/v2/hie/document_query_response.py +0 -16
- samplehc/types/v2/hie/document_upload_params.py +0 -54
- samplehc/types/v2/integrations/__init__.py +0 -23
- samplehc/types/v2/integrations/bank/__init__.py +0 -6
- samplehc/types/v2/integrations/bank/transaction_sync_params.py +0 -15
- samplehc/types/v2/integrations/bank/transaction_sync_response.py +0 -26
- samplehc/types/v2/integrations/careviso_get_payers_response.py +0 -19
- samplehc/types/v2/integrations/careviso_submit_prior_authorization_params.py +0 -90
- samplehc/types/v2/integrations/glidian/__init__.py +0 -20
- samplehc/types/v2/integrations/glidian/prior_authorization_create_draft_params.py +0 -32
- samplehc/types/v2/integrations/glidian/prior_authorization_create_draft_response.py +0 -24
- samplehc/types/v2/integrations/glidian/prior_authorization_retrieve_record_response.py +0 -13
- samplehc/types/v2/integrations/glidian/prior_authorization_submit_response.py +0 -16
- samplehc/types/v2/integrations/glidian/prior_authorization_update_record_params.py +0 -20
- samplehc/types/v2/integrations/glidian/prior_authorization_update_record_response.py +0 -16
- samplehc/types/v2/integrations/glidian/prior_authorizations/__init__.py +0 -7
- samplehc/types/v2/integrations/glidian/prior_authorizations/clinical_question_list_response.py +0 -42
- samplehc/types/v2/integrations/glidian/prior_authorizations/clinical_question_update_params.py +0 -23
- samplehc/types/v2/integrations/glidian/prior_authorizations/clinical_question_update_response.py +0 -19
- samplehc/types/v2/integrations/glidian_get_submission_requirements_params.py +0 -17
- samplehc/types/v2/integrations/glidian_get_submission_requirements_response.py +0 -31
- samplehc/types/v2/integrations/glidian_list_payers_params.py +0 -11
- samplehc/types/v2/integrations/glidian_list_payers_response.py +0 -17
- samplehc/types/v2/integrations/glidian_list_services_params.py +0 -13
- samplehc/types/v2/integrations/glidian_list_services_response.py +0 -19
- samplehc/types/v2/integrations/kno2/__init__.py +0 -6
- samplehc/types/v2/integrations/kno2/message_get_attachment_response.py +0 -15
- samplehc/types/v2/integrations/kno2/message_retrieve_response.py +0 -13
- samplehc/types/v2/integrations/salesforce_run_crud_action_params.py +0 -22
- samplehc/types/v2/integrations/salesforce_run_soql_query_params.py +0 -11
- samplehc/types/v2/integrations/snowflake_query_params.py +0 -12
- samplehc/types/v2/integrations/snowflake_query_response.py +0 -8
- samplehc/types/v2/integrations/wellsky/__init__.py +0 -6
- samplehc/types/v2/integrations/wellsky/patient_add_params.py +0 -13
- samplehc/types/v2/integrations/wellsky/patient_search_params.py +0 -32
- samplehc/types/v2/integrations/xcure_make_request_params.py +0 -18
- samplehc/types/v2/ledger/__init__.py +0 -3
- samplehc/types/v2/policy_list_companies_params.py +0 -18
- samplehc/types/v2/policy_list_companies_response.py +0 -24
- samplehc/types/v2/policy_list_params.py +0 -47
- samplehc/types/v2/policy_list_plans_params.py +0 -18
- samplehc/types/v2/policy_list_plans_response.py +0 -30
- samplehc/types/v2/policy_list_response.py +0 -67
- samplehc/types/v2/policy_retrieve_presigned_url_response.py +0 -17
- samplehc/types/v2/policy_retrieve_text_response.py +0 -12
- samplehc/types/v2/task_cancel_response.py +0 -12
- samplehc/types/v2/task_complete_params.py +0 -12
- samplehc/types/v2/task_complete_response.py +0 -16
- samplehc/types/v2/task_get_suspended_payload_response.py +0 -8
- samplehc/types/v2/task_retrieve_response.py +0 -22
- samplehc/types/v2/task_retry_response.py +0 -10
- samplehc/types/v2/task_update_column_params.py +0 -19
- samplehc/types/v2/task_update_column_response.py +0 -9
- samplehc/types/v2/task_update_screen_time_params.py +0 -14
- samplehc/types/v2/task_update_screen_time_response.py +0 -8
- samplehc/types/v2/tasks/__init__.py +0 -7
- samplehc/types/v2/tasks/state_get_response.py +0 -8
- samplehc/types/v2/tasks/state_update_params.py +0 -13
- samplehc/types/v2/tasks/state_update_response.py +0 -9
- samplehc/types/v2/workflow_deploy_response.py +0 -12
- samplehc/types/v2/workflow_query_params.py +0 -12
- samplehc/types/v2/workflow_query_response.py +0 -8
- samplehc/types/v2/workflow_run_get_start_data_response.py +0 -14
- samplehc/types/v2/workflow_run_resume_when_complete_params.py +0 -14
- samplehc/types/v2/workflow_run_resume_when_complete_response.py +0 -12
- samplehc/types/v2/workflow_run_retrieve_response.py +0 -16
- samplehc/types/v2/workflow_runs/__init__.py +0 -5
- samplehc/types/v2/workflow_runs/step_get_output_response.py +0 -14
- samplehc/types/v2/workflow_start_params.py +0 -25
- samplehc/types/v2/workflow_start_response.py +0 -25
- samplehc-0.17.0.dist-info/RECORD +0 -226
- {samplehc-0.17.0.dist-info → samplehc-0.19.0.dist-info}/WHEEL +0 -0
- {samplehc-0.17.0.dist-info → samplehc-0.19.0.dist-info}/licenses/LICENSE +0 -0
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# File generated from our OpenAPI spec by Stainless. See CONTRIBUTING.md for details.
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from __future__ import annotations
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from typing import List, Iterable
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from typing_extensions import Literal, Required, Annotated, TypedDict
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from ...._types import SequenceNotStr
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from ...._utils import PropertyInfo
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__all__ = [
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"ClaimSubmitParams",
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"Billing",
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"BillingAddress",
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"BillingContactInformation",
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"ClaimInformation",
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"ClaimInformationHealthCareCodeInformation",
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"ClaimInformationServiceLine",
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"ClaimInformationServiceLineProfessionalService",
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"ClaimInformationServiceLineProfessionalServiceCompositeDiagnosisCodePointers",
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"ClaimInformationServiceLineAmbulanceCertification",
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"ClaimInformationServiceLineAmbulanceDropOffLocation",
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"ClaimInformationServiceLineAmbulancePickUpLocation",
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"ClaimInformationServiceLineAmbulanceTransportInformation",
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"ClaimInformationServiceLineConditionIndicatorDurableMedicalEquipment",
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"ClaimInformationServiceLineContractInformation",
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"ClaimInformationServiceLineDrugIdentification",
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"ClaimInformationServiceLineDurableMedicalEquipmentCertificateOfMedicalNecessity",
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"ClaimInformationServiceLineDurableMedicalEquipmentCertification",
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"ClaimInformationServiceLineDurableMedicalEquipmentService",
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"ClaimInformationServiceLineFormIdentification",
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"ClaimInformationServiceLineFormIdentificationSupportingDocumentation",
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"ClaimInformationServiceLineLineAdjudicationInformation",
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"ClaimInformationServiceLineLineAdjudicationInformationClaimAdjustmentInformation",
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"ClaimInformationServiceLineLineAdjudicationInformationClaimAdjustmentInformationAdjustmentDetail",
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"ClaimInformationServiceLineLinePricingRepricingInformation",
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"ClaimInformationServiceLineOrderingProvider",
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"ClaimInformationServiceLineOrderingProviderAddress",
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"ClaimInformationServiceLineOrderingProviderContactInformation",
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"ClaimInformationServiceLineOrderingProviderSecondaryIdentifier",
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"ClaimInformationServiceLinePurchasedServiceInformation",
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"ClaimInformationServiceLinePurchasedServiceProvider",
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"ClaimInformationServiceLinePurchasedServiceProviderAddress",
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"ClaimInformationServiceLinePurchasedServiceProviderContactInformation",
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"ClaimInformationServiceLinePurchasedServiceProviderSecondaryIdentifier",
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"ClaimInformationServiceLineReferringProvider",
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"ClaimInformationServiceLineReferringProviderAddress",
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"ClaimInformationServiceLineReferringProviderContactInformation",
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"ClaimInformationServiceLineReferringProviderSecondaryIdentifier",
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"ClaimInformationServiceLineRenderingProvider",
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"ClaimInformationServiceLineRenderingProviderAddress",
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"ClaimInformationServiceLineRenderingProviderContactInformation",
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"ClaimInformationServiceLineRenderingProviderSecondaryIdentifier",
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"ClaimInformationServiceLineServiceFacilityLocation",
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"ClaimInformationServiceLineServiceFacilityLocationAddress",
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"ClaimInformationServiceLineServiceFacilityLocationSecondaryIdentifier",
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"ClaimInformationServiceLineServiceLineDateInformation",
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"ClaimInformationServiceLineServiceLineReferenceInformation",
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"ClaimInformationServiceLineServiceLineReferenceInformationPriorAuthorization",
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"ClaimInformationServiceLineServiceLineSupplementalInformation",
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"ClaimInformationServiceLineSupervisingProvider",
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"ClaimInformationServiceLineSupervisingProviderAddress",
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"ClaimInformationServiceLineSupervisingProviderContactInformation",
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"ClaimInformationServiceLineSupervisingProviderSecondaryIdentifier",
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"ClaimInformationServiceLineTestResult",
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"ClaimInformationAmbulanceCertification",
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"ClaimInformationAmbulancePickUpLocation",
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"ClaimInformationAmbulanceTransportInformation",
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"ClaimInformationClaimPricingRepricingInformation",
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"ClaimInformationClaimSupplementalInformationReportInformation",
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"ClaimInformationConditionInformation",
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"ClaimInformationEpsdtReferral",
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"ClaimInformationOtherSubscriberInformation",
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"ClaimInformationOtherSubscriberInformationOtherPayerBillingProviderOtherPayerBillingProviderIdentifier",
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"ClaimInformationOtherSubscriberInformationOtherPayerRenderingProvider",
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"ClaimInformationOtherSubscriberInformationOtherPayerRenderingProviderOtherPayerRenderingProviderSecondaryIdentifier",
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"ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocation",
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"ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocationOtherPayerServiceFacilityLocationSecondaryIdentifier",
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"ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProvider",
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"ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProviderOtherPayerSupervisingProviderIdentifier",
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]
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class ClaimSubmitParams(TypedDict, total=False):
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billing: Required[Billing]
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claim_information: Required[Annotated[ClaimInformation, PropertyInfo(alias="claimInformation")]]
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is_testing: Required[Annotated[bool, PropertyInfo(alias="isTesting")]]
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receiver: Required[Receiver]
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submitter: Required[Submitter]
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subscriber: Required[Subscriber]
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trading_partner_service_id: Required[Annotated[str, PropertyInfo(alias="tradingPartnerServiceId")]]
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control_number: Annotated[str, PropertyInfo(alias="controlNumber")]
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dependent: Dependent
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ordering: Ordering
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payer_address: Annotated[PayerAddress, PropertyInfo(alias="payerAddress")]
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pay_to_address: Annotated[PayToAddress, PropertyInfo(alias="payToAddress")]
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pay_to_plan: Annotated[PayToPlan, PropertyInfo(alias="payToPlan")]
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providers: Iterable[Provider]
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referring: Referring
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rendering: Rendering
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165
|
-
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|
166
|
-
supervising: Supervising
|
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167
|
-
|
|
168
|
-
trading_partner_name: Annotated[str, PropertyInfo(alias="tradingPartnerName")]
|
|
169
|
-
|
|
170
|
-
|
|
171
|
-
class BillingAddress(TypedDict, total=False):
|
|
172
|
-
address1: Required[str]
|
|
173
|
-
|
|
174
|
-
city: Required[str]
|
|
175
|
-
|
|
176
|
-
address2: str
|
|
177
|
-
|
|
178
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
179
|
-
|
|
180
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
181
|
-
|
|
182
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
183
|
-
|
|
184
|
-
state: str
|
|
185
|
-
|
|
186
|
-
|
|
187
|
-
class BillingContactInformation(TypedDict, total=False):
|
|
188
|
-
email: str
|
|
189
|
-
|
|
190
|
-
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
191
|
-
|
|
192
|
-
name: str
|
|
193
|
-
|
|
194
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
195
|
-
|
|
196
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
197
|
-
|
|
198
|
-
|
|
199
|
-
class Billing(TypedDict, total=False):
|
|
200
|
-
address: BillingAddress
|
|
201
|
-
|
|
202
|
-
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
203
|
-
|
|
204
|
-
contact_information: Annotated[BillingContactInformation, PropertyInfo(alias="contactInformation")]
|
|
205
|
-
|
|
206
|
-
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
207
|
-
|
|
208
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
209
|
-
|
|
210
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
211
|
-
|
|
212
|
-
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
213
|
-
|
|
214
|
-
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
215
|
-
|
|
216
|
-
npi: str
|
|
217
|
-
|
|
218
|
-
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
219
|
-
|
|
220
|
-
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
221
|
-
|
|
222
|
-
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
223
|
-
|
|
224
|
-
ssn: str
|
|
225
|
-
|
|
226
|
-
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
227
|
-
|
|
228
|
-
suffix: str
|
|
229
|
-
|
|
230
|
-
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
231
|
-
|
|
232
|
-
|
|
233
|
-
class ClaimInformationHealthCareCodeInformation(TypedDict, total=False):
|
|
234
|
-
diagnosis_code: Required[Annotated[str, PropertyInfo(alias="diagnosisCode")]]
|
|
235
|
-
|
|
236
|
-
diagnosis_type_code: Required[Annotated[Literal["BK", "ABK", "BF", "ABF"], PropertyInfo(alias="diagnosisTypeCode")]]
|
|
237
|
-
|
|
238
|
-
|
|
239
|
-
class ClaimInformationServiceLineProfessionalServiceCompositeDiagnosisCodePointers(TypedDict, total=False):
|
|
240
|
-
diagnosis_code_pointers: Required[Annotated[SequenceNotStr[str], PropertyInfo(alias="diagnosisCodePointers")]]
|
|
241
|
-
|
|
242
|
-
|
|
243
|
-
class ClaimInformationServiceLineProfessionalService(TypedDict, total=False):
|
|
244
|
-
composite_diagnosis_code_pointers: Required[
|
|
245
|
-
Annotated[
|
|
246
|
-
ClaimInformationServiceLineProfessionalServiceCompositeDiagnosisCodePointers,
|
|
247
|
-
PropertyInfo(alias="compositeDiagnosisCodePointers"),
|
|
248
|
-
]
|
|
249
|
-
]
|
|
250
|
-
|
|
251
|
-
line_item_charge_amount: Required[Annotated[str, PropertyInfo(alias="lineItemChargeAmount")]]
|
|
252
|
-
|
|
253
|
-
measurement_unit: Required[Annotated[Literal["MJ", "UN"], PropertyInfo(alias="measurementUnit")]]
|
|
254
|
-
|
|
255
|
-
procedure_code: Required[Annotated[str, PropertyInfo(alias="procedureCode")]]
|
|
256
|
-
|
|
257
|
-
procedure_identifier: Required[
|
|
258
|
-
Annotated[Literal["ER", "HC", "IV", "WK"], PropertyInfo(alias="procedureIdentifier")]
|
|
259
|
-
]
|
|
260
|
-
|
|
261
|
-
service_unit_count: Required[Annotated[str, PropertyInfo(alias="serviceUnitCount")]]
|
|
262
|
-
|
|
263
|
-
copay_status_code: Annotated[Literal["0"], PropertyInfo(alias="copayStatusCode")]
|
|
264
|
-
|
|
265
|
-
description: str
|
|
266
|
-
|
|
267
|
-
emergency_indicator: Annotated[Literal["Y"], PropertyInfo(alias="emergencyIndicator")]
|
|
268
|
-
|
|
269
|
-
epsdt_indicator: Annotated[Literal["Y"], PropertyInfo(alias="epsdtIndicator")]
|
|
270
|
-
|
|
271
|
-
family_planning_indicator: Annotated[Literal["Y"], PropertyInfo(alias="familyPlanningIndicator")]
|
|
272
|
-
|
|
273
|
-
place_of_service_code: Annotated[str, PropertyInfo(alias="placeOfServiceCode")]
|
|
274
|
-
|
|
275
|
-
procedure_modifiers: Annotated[SequenceNotStr[str], PropertyInfo(alias="procedureModifiers")]
|
|
276
|
-
|
|
277
|
-
|
|
278
|
-
class ClaimInformationServiceLineAmbulanceCertification(TypedDict, total=False):
|
|
279
|
-
certification_condition_indicator: Required[
|
|
280
|
-
Annotated[Literal["N", "Y"], PropertyInfo(alias="certificationConditionIndicator")]
|
|
281
|
-
]
|
|
282
|
-
|
|
283
|
-
condition_codes: Required[
|
|
284
|
-
Annotated[List[Literal["01", "04", "05", "06", "07", "08", "09", "12"]], PropertyInfo(alias="conditionCodes")]
|
|
285
|
-
]
|
|
286
|
-
|
|
287
|
-
|
|
288
|
-
class ClaimInformationServiceLineAmbulanceDropOffLocation(TypedDict, total=False):
|
|
289
|
-
address1: Required[str]
|
|
290
|
-
|
|
291
|
-
city: Required[str]
|
|
292
|
-
|
|
293
|
-
address2: str
|
|
294
|
-
|
|
295
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
296
|
-
|
|
297
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
298
|
-
|
|
299
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
300
|
-
|
|
301
|
-
state: str
|
|
302
|
-
|
|
303
|
-
|
|
304
|
-
class ClaimInformationServiceLineAmbulancePickUpLocation(TypedDict, total=False):
|
|
305
|
-
address1: Required[str]
|
|
306
|
-
|
|
307
|
-
city: Required[str]
|
|
308
|
-
|
|
309
|
-
address2: str
|
|
310
|
-
|
|
311
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
312
|
-
|
|
313
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
314
|
-
|
|
315
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
316
|
-
|
|
317
|
-
state: str
|
|
318
|
-
|
|
319
|
-
|
|
320
|
-
class ClaimInformationServiceLineAmbulanceTransportInformation(TypedDict, total=False):
|
|
321
|
-
ambulance_transport_reason_code: Required[
|
|
322
|
-
Annotated[Literal["A", "B", "C", "D", "E"], PropertyInfo(alias="ambulanceTransportReasonCode")]
|
|
323
|
-
]
|
|
324
|
-
|
|
325
|
-
transport_distance_in_miles: Required[Annotated[str, PropertyInfo(alias="transportDistanceInMiles")]]
|
|
326
|
-
|
|
327
|
-
patient_weight_in_pounds: Annotated[str, PropertyInfo(alias="patientWeightInPounds")]
|
|
328
|
-
|
|
329
|
-
round_trip_purpose_description: Annotated[str, PropertyInfo(alias="roundTripPurposeDescription")]
|
|
330
|
-
|
|
331
|
-
stretcher_purpose_description: Annotated[str, PropertyInfo(alias="stretcherPurposeDescription")]
|
|
332
|
-
|
|
333
|
-
|
|
334
|
-
class ClaimInformationServiceLineConditionIndicatorDurableMedicalEquipment(TypedDict, total=False):
|
|
335
|
-
certification_condition_indicator: Required[
|
|
336
|
-
Annotated[Literal["Y", "N"], PropertyInfo(alias="certificationConditionIndicator")]
|
|
337
|
-
]
|
|
338
|
-
|
|
339
|
-
condition_indicator: Required[Annotated[Literal["38", "ZV"], PropertyInfo(alias="conditionIndicator")]]
|
|
340
|
-
|
|
341
|
-
condition_indicator_code: Annotated[Literal["38", "ZV"], PropertyInfo(alias="conditionIndicatorCode")]
|
|
342
|
-
|
|
343
|
-
|
|
344
|
-
class ClaimInformationServiceLineContractInformation(TypedDict, total=False):
|
|
345
|
-
contract_type_code: Required[
|
|
346
|
-
Annotated[Literal["01", "02", "03", "04", "05", "06", "09"], PropertyInfo(alias="contractTypeCode")]
|
|
347
|
-
]
|
|
348
|
-
|
|
349
|
-
contract_amount: Annotated[str, PropertyInfo(alias="contractAmount")]
|
|
350
|
-
|
|
351
|
-
contract_code: Annotated[str, PropertyInfo(alias="contractCode")]
|
|
352
|
-
|
|
353
|
-
contract_percentage: Annotated[str, PropertyInfo(alias="contractPercentage")]
|
|
354
|
-
|
|
355
|
-
contract_version_identifier: Annotated[str, PropertyInfo(alias="contractVersionIdentifier")]
|
|
356
|
-
|
|
357
|
-
terms_discount_percentage: Annotated[str, PropertyInfo(alias="termsDiscountPercentage")]
|
|
358
|
-
|
|
359
|
-
|
|
360
|
-
class ClaimInformationServiceLineDrugIdentification(TypedDict, total=False):
|
|
361
|
-
measurement_unit_code: Required[
|
|
362
|
-
Annotated[Literal["F2", "GR", "ME", "ML", "UN"], PropertyInfo(alias="measurementUnitCode")]
|
|
363
|
-
]
|
|
364
|
-
|
|
365
|
-
national_drug_code: Required[Annotated[str, PropertyInfo(alias="nationalDrugCode")]]
|
|
366
|
-
|
|
367
|
-
national_drug_unit_count: Required[Annotated[str, PropertyInfo(alias="nationalDrugUnitCount")]]
|
|
368
|
-
|
|
369
|
-
service_id_qualifier: Required[
|
|
370
|
-
Annotated[Literal["EN", "EO", "HI", "N4", "ON", "UK", "UP"], PropertyInfo(alias="serviceIdQualifier")]
|
|
371
|
-
]
|
|
372
|
-
|
|
373
|
-
link_sequence_number: Annotated[str, PropertyInfo(alias="linkSequenceNumber")]
|
|
374
|
-
|
|
375
|
-
pharmacy_prescription_number: Annotated[str, PropertyInfo(alias="pharmacyPrescriptionNumber")]
|
|
376
|
-
|
|
377
|
-
|
|
378
|
-
class ClaimInformationServiceLineDurableMedicalEquipmentCertificateOfMedicalNecessity(TypedDict, total=False):
|
|
379
|
-
attachment_transmission_code: Required[
|
|
380
|
-
Annotated[Literal["AB", "AD", "AF", "AG", "NS"], PropertyInfo(alias="attachmentTransmissionCode")]
|
|
381
|
-
]
|
|
382
|
-
|
|
383
|
-
|
|
384
|
-
class ClaimInformationServiceLineDurableMedicalEquipmentCertification(TypedDict, total=False):
|
|
385
|
-
certification_type_code: Required[Annotated[Literal["I", "R", "S"], PropertyInfo(alias="certificationTypeCode")]]
|
|
386
|
-
|
|
387
|
-
durable_medical_equipment_duration_in_months: Required[
|
|
388
|
-
Annotated[str, PropertyInfo(alias="durableMedicalEquipmentDurationInMonths")]
|
|
389
|
-
]
|
|
390
|
-
|
|
391
|
-
|
|
392
|
-
class ClaimInformationServiceLineDurableMedicalEquipmentService(TypedDict, total=False):
|
|
393
|
-
days: Required[str]
|
|
394
|
-
|
|
395
|
-
frequency_code: Required[Annotated[Literal["1", "4", "6"], PropertyInfo(alias="frequencyCode")]]
|
|
396
|
-
|
|
397
|
-
purchase_price: Required[Annotated[str, PropertyInfo(alias="purchasePrice")]]
|
|
398
|
-
|
|
399
|
-
rental_price: Required[Annotated[str, PropertyInfo(alias="rentalPrice")]]
|
|
400
|
-
|
|
401
|
-
|
|
402
|
-
class ClaimInformationServiceLineFormIdentificationSupportingDocumentation(TypedDict, total=False):
|
|
403
|
-
question_number: Required[Annotated[str, PropertyInfo(alias="questionNumber")]]
|
|
404
|
-
|
|
405
|
-
question_response: Annotated[str, PropertyInfo(alias="questionResponse")]
|
|
406
|
-
|
|
407
|
-
question_response_as_date: Annotated[str, PropertyInfo(alias="questionResponseAsDate")]
|
|
408
|
-
|
|
409
|
-
question_response_as_percent: Annotated[str, PropertyInfo(alias="questionResponseAsPercent")]
|
|
410
|
-
|
|
411
|
-
question_response_code: Annotated[Literal["N", "W", "Y"], PropertyInfo(alias="questionResponseCode")]
|
|
412
|
-
|
|
413
|
-
|
|
414
|
-
class ClaimInformationServiceLineFormIdentification(TypedDict, total=False):
|
|
415
|
-
form_identifier: Required[Annotated[str, PropertyInfo(alias="formIdentifier")]]
|
|
416
|
-
|
|
417
|
-
form_type_code: Required[Annotated[Literal["AS", "UT"], PropertyInfo(alias="formTypeCode")]]
|
|
418
|
-
|
|
419
|
-
supporting_documentation: Annotated[
|
|
420
|
-
Iterable[ClaimInformationServiceLineFormIdentificationSupportingDocumentation],
|
|
421
|
-
PropertyInfo(alias="supportingDocumentation"),
|
|
422
|
-
]
|
|
423
|
-
|
|
424
|
-
|
|
425
|
-
class ClaimInformationServiceLineLineAdjudicationInformationClaimAdjustmentInformationAdjustmentDetail(
|
|
426
|
-
TypedDict, total=False
|
|
427
|
-
):
|
|
428
|
-
adjustment_amount: Required[Annotated[str, PropertyInfo(alias="adjustmentAmount")]]
|
|
429
|
-
|
|
430
|
-
adjustment_reason_code: Required[Annotated[str, PropertyInfo(alias="adjustmentReasonCode")]]
|
|
431
|
-
|
|
432
|
-
adjustment_quantity: Annotated[str, PropertyInfo(alias="adjustmentQuantity")]
|
|
433
|
-
|
|
434
|
-
|
|
435
|
-
class ClaimInformationServiceLineLineAdjudicationInformationClaimAdjustmentInformation(TypedDict, total=False):
|
|
436
|
-
adjustment_details: Required[
|
|
437
|
-
Annotated[
|
|
438
|
-
Iterable[ClaimInformationServiceLineLineAdjudicationInformationClaimAdjustmentInformationAdjustmentDetail],
|
|
439
|
-
PropertyInfo(alias="adjustmentDetails"),
|
|
440
|
-
]
|
|
441
|
-
]
|
|
442
|
-
|
|
443
|
-
adjustment_group_code: Required[
|
|
444
|
-
Annotated[Literal["CO", "CR", "OA", "PI", "PR"], PropertyInfo(alias="adjustmentGroupCode")]
|
|
445
|
-
]
|
|
446
|
-
|
|
447
|
-
|
|
448
|
-
class ClaimInformationServiceLineLineAdjudicationInformation(TypedDict, total=False):
|
|
449
|
-
adjudication_or_payment_date: Required[Annotated[str, PropertyInfo(alias="adjudicationOrPaymentDate")]]
|
|
450
|
-
|
|
451
|
-
other_payer_primary_identifier: Required[Annotated[str, PropertyInfo(alias="otherPayerPrimaryIdentifier")]]
|
|
452
|
-
|
|
453
|
-
paid_service_unit_count: Required[Annotated[str, PropertyInfo(alias="paidServiceUnitCount")]]
|
|
454
|
-
|
|
455
|
-
procedure_code: Required[Annotated[str, PropertyInfo(alias="procedureCode")]]
|
|
456
|
-
|
|
457
|
-
service_id_qualifier: Required[
|
|
458
|
-
Annotated[Literal["ER", "HC", "HP", "IV", "WK"], PropertyInfo(alias="serviceIdQualifier")]
|
|
459
|
-
]
|
|
460
|
-
|
|
461
|
-
service_line_paid_amount: Required[Annotated[str, PropertyInfo(alias="serviceLinePaidAmount")]]
|
|
462
|
-
|
|
463
|
-
bundled_or_unbundled_line_number: Annotated[str, PropertyInfo(alias="bundledOrUnbundledLineNumber")]
|
|
464
|
-
|
|
465
|
-
claim_adjustment_information: Annotated[
|
|
466
|
-
Iterable[ClaimInformationServiceLineLineAdjudicationInformationClaimAdjustmentInformation],
|
|
467
|
-
PropertyInfo(alias="claimAdjustmentInformation"),
|
|
468
|
-
]
|
|
469
|
-
|
|
470
|
-
procedure_code_description: Annotated[str, PropertyInfo(alias="procedureCodeDescription")]
|
|
471
|
-
|
|
472
|
-
procedure_modifier: Annotated[SequenceNotStr[str], PropertyInfo(alias="procedureModifier")]
|
|
473
|
-
|
|
474
|
-
remaining_patient_liability: Annotated[str, PropertyInfo(alias="remainingPatientLiability")]
|
|
475
|
-
|
|
476
|
-
|
|
477
|
-
class ClaimInformationServiceLineLinePricingRepricingInformation(TypedDict, total=False):
|
|
478
|
-
pricing_methodology_code: Required[
|
|
479
|
-
Annotated[
|
|
480
|
-
Literal["00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14"],
|
|
481
|
-
PropertyInfo(alias="pricingMethodologyCode"),
|
|
482
|
-
]
|
|
483
|
-
]
|
|
484
|
-
|
|
485
|
-
repriced_allowed_amount: Required[Annotated[str, PropertyInfo(alias="repricedAllowedAmount")]]
|
|
486
|
-
|
|
487
|
-
exception_code: Annotated[Literal["1", "2", "3", "4", "5", "6"], PropertyInfo(alias="exceptionCode")]
|
|
488
|
-
|
|
489
|
-
policy_compliance_code: Annotated[Literal["1", "2", "3", "4", "5"], PropertyInfo(alias="policyComplianceCode")]
|
|
490
|
-
|
|
491
|
-
reject_reason_code: Annotated[Literal["T1", "T2", "T3", "T4", "T5", "T6"], PropertyInfo(alias="rejectReasonCode")]
|
|
492
|
-
|
|
493
|
-
repriced_approved_ambulatory_patient_group_amount: Annotated[
|
|
494
|
-
str, PropertyInfo(alias="repricedApprovedAmbulatoryPatientGroupAmount")
|
|
495
|
-
]
|
|
496
|
-
|
|
497
|
-
repriced_approved_ambulatory_patient_group_code: Annotated[
|
|
498
|
-
str, PropertyInfo(alias="repricedApprovedAmbulatoryPatientGroupCode")
|
|
499
|
-
]
|
|
500
|
-
|
|
501
|
-
repriced_saving_amount: Annotated[str, PropertyInfo(alias="repricedSavingAmount")]
|
|
502
|
-
|
|
503
|
-
repricing_organization_identifier: Annotated[str, PropertyInfo(alias="repricingOrganizationIdentifier")]
|
|
504
|
-
|
|
505
|
-
repricing_per_diem_or_flat_rate_amount: Annotated[str, PropertyInfo(alias="repricingPerDiemOrFlatRateAmount")]
|
|
506
|
-
|
|
507
|
-
|
|
508
|
-
class ClaimInformationServiceLineOrderingProviderAddress(TypedDict, total=False):
|
|
509
|
-
address1: Required[str]
|
|
510
|
-
|
|
511
|
-
city: Required[str]
|
|
512
|
-
|
|
513
|
-
address2: str
|
|
514
|
-
|
|
515
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
516
|
-
|
|
517
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
518
|
-
|
|
519
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
520
|
-
|
|
521
|
-
state: str
|
|
522
|
-
|
|
523
|
-
|
|
524
|
-
class ClaimInformationServiceLineOrderingProviderContactInformation(TypedDict, total=False):
|
|
525
|
-
name: Required[str]
|
|
526
|
-
|
|
527
|
-
email: str
|
|
528
|
-
|
|
529
|
-
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
530
|
-
|
|
531
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
532
|
-
|
|
533
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
534
|
-
|
|
535
|
-
|
|
536
|
-
class ClaimInformationServiceLineOrderingProviderSecondaryIdentifier(TypedDict, total=False):
|
|
537
|
-
identifier: Required[str]
|
|
538
|
-
|
|
539
|
-
qualifier: Required[str]
|
|
540
|
-
|
|
541
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
542
|
-
|
|
543
|
-
|
|
544
|
-
class ClaimInformationServiceLineOrderingProvider(TypedDict, total=False):
|
|
545
|
-
address: ClaimInformationServiceLineOrderingProviderAddress
|
|
546
|
-
|
|
547
|
-
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
548
|
-
|
|
549
|
-
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
550
|
-
|
|
551
|
-
contact_information: Annotated[
|
|
552
|
-
ClaimInformationServiceLineOrderingProviderContactInformation, PropertyInfo(alias="contactInformation")
|
|
553
|
-
]
|
|
554
|
-
|
|
555
|
-
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
556
|
-
|
|
557
|
-
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
558
|
-
|
|
559
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
560
|
-
|
|
561
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
562
|
-
|
|
563
|
-
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
564
|
-
|
|
565
|
-
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
566
|
-
|
|
567
|
-
naic: str
|
|
568
|
-
|
|
569
|
-
npi: str
|
|
570
|
-
|
|
571
|
-
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
572
|
-
|
|
573
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
574
|
-
|
|
575
|
-
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
576
|
-
|
|
577
|
-
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
578
|
-
|
|
579
|
-
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
580
|
-
|
|
581
|
-
secondary_identifier: Annotated[
|
|
582
|
-
Iterable[ClaimInformationServiceLineOrderingProviderSecondaryIdentifier],
|
|
583
|
-
PropertyInfo(alias="secondaryIdentifier"),
|
|
584
|
-
]
|
|
585
|
-
|
|
586
|
-
ssn: str
|
|
587
|
-
|
|
588
|
-
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
589
|
-
|
|
590
|
-
suffix: str
|
|
591
|
-
|
|
592
|
-
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
593
|
-
|
|
594
|
-
|
|
595
|
-
class ClaimInformationServiceLinePurchasedServiceInformation(TypedDict, total=False):
|
|
596
|
-
purchased_service_charge_amount: Required[Annotated[str, PropertyInfo(alias="purchasedServiceChargeAmount")]]
|
|
597
|
-
|
|
598
|
-
purchased_service_provider_identifier: Required[
|
|
599
|
-
Annotated[str, PropertyInfo(alias="purchasedServiceProviderIdentifier")]
|
|
600
|
-
]
|
|
601
|
-
|
|
602
|
-
|
|
603
|
-
class ClaimInformationServiceLinePurchasedServiceProviderAddress(TypedDict, total=False):
|
|
604
|
-
address1: Required[str]
|
|
605
|
-
|
|
606
|
-
city: Required[str]
|
|
607
|
-
|
|
608
|
-
address2: str
|
|
609
|
-
|
|
610
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
611
|
-
|
|
612
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
613
|
-
|
|
614
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
615
|
-
|
|
616
|
-
state: str
|
|
617
|
-
|
|
618
|
-
|
|
619
|
-
class ClaimInformationServiceLinePurchasedServiceProviderContactInformation(TypedDict, total=False):
|
|
620
|
-
email: str
|
|
621
|
-
|
|
622
|
-
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
623
|
-
|
|
624
|
-
name: str
|
|
625
|
-
|
|
626
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
627
|
-
|
|
628
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
629
|
-
|
|
630
|
-
|
|
631
|
-
class ClaimInformationServiceLinePurchasedServiceProviderSecondaryIdentifier(TypedDict, total=False):
|
|
632
|
-
identifier: Required[str]
|
|
633
|
-
|
|
634
|
-
qualifier: Required[str]
|
|
635
|
-
|
|
636
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
637
|
-
|
|
638
|
-
|
|
639
|
-
class ClaimInformationServiceLinePurchasedServiceProvider(TypedDict, total=False):
|
|
640
|
-
address: ClaimInformationServiceLinePurchasedServiceProviderAddress
|
|
641
|
-
|
|
642
|
-
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
643
|
-
|
|
644
|
-
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
645
|
-
|
|
646
|
-
contact_information: Annotated[
|
|
647
|
-
ClaimInformationServiceLinePurchasedServiceProviderContactInformation, PropertyInfo(alias="contactInformation")
|
|
648
|
-
]
|
|
649
|
-
|
|
650
|
-
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
651
|
-
|
|
652
|
-
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
653
|
-
|
|
654
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
655
|
-
|
|
656
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
657
|
-
|
|
658
|
-
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
659
|
-
|
|
660
|
-
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
661
|
-
|
|
662
|
-
naic: str
|
|
663
|
-
|
|
664
|
-
npi: str
|
|
665
|
-
|
|
666
|
-
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
667
|
-
|
|
668
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
669
|
-
|
|
670
|
-
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
671
|
-
|
|
672
|
-
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
673
|
-
|
|
674
|
-
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
675
|
-
|
|
676
|
-
secondary_identifier: Annotated[
|
|
677
|
-
Iterable[ClaimInformationServiceLinePurchasedServiceProviderSecondaryIdentifier],
|
|
678
|
-
PropertyInfo(alias="secondaryIdentifier"),
|
|
679
|
-
]
|
|
680
|
-
|
|
681
|
-
ssn: str
|
|
682
|
-
|
|
683
|
-
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
684
|
-
|
|
685
|
-
suffix: str
|
|
686
|
-
|
|
687
|
-
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
688
|
-
|
|
689
|
-
|
|
690
|
-
class ClaimInformationServiceLineReferringProviderAddress(TypedDict, total=False):
|
|
691
|
-
address1: Required[str]
|
|
692
|
-
|
|
693
|
-
city: Required[str]
|
|
694
|
-
|
|
695
|
-
address2: str
|
|
696
|
-
|
|
697
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
698
|
-
|
|
699
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
700
|
-
|
|
701
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
702
|
-
|
|
703
|
-
state: str
|
|
704
|
-
|
|
705
|
-
|
|
706
|
-
class ClaimInformationServiceLineReferringProviderContactInformation(TypedDict, total=False):
|
|
707
|
-
email: str
|
|
708
|
-
|
|
709
|
-
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
710
|
-
|
|
711
|
-
name: str
|
|
712
|
-
|
|
713
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
714
|
-
|
|
715
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
716
|
-
|
|
717
|
-
|
|
718
|
-
class ClaimInformationServiceLineReferringProviderSecondaryIdentifier(TypedDict, total=False):
|
|
719
|
-
identifier: Required[str]
|
|
720
|
-
|
|
721
|
-
qualifier: Required[str]
|
|
722
|
-
|
|
723
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
724
|
-
|
|
725
|
-
|
|
726
|
-
class ClaimInformationServiceLineReferringProvider(TypedDict, total=False):
|
|
727
|
-
provider_type: Required[Annotated[str, PropertyInfo(alias="providerType")]]
|
|
728
|
-
|
|
729
|
-
address: ClaimInformationServiceLineReferringProviderAddress
|
|
730
|
-
|
|
731
|
-
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
732
|
-
|
|
733
|
-
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
734
|
-
|
|
735
|
-
contact_information: Annotated[
|
|
736
|
-
ClaimInformationServiceLineReferringProviderContactInformation, PropertyInfo(alias="contactInformation")
|
|
737
|
-
]
|
|
738
|
-
|
|
739
|
-
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
740
|
-
|
|
741
|
-
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
742
|
-
|
|
743
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
744
|
-
|
|
745
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
746
|
-
|
|
747
|
-
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
748
|
-
|
|
749
|
-
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
750
|
-
|
|
751
|
-
naic: str
|
|
752
|
-
|
|
753
|
-
npi: str
|
|
754
|
-
|
|
755
|
-
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
756
|
-
|
|
757
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
758
|
-
|
|
759
|
-
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
760
|
-
|
|
761
|
-
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
762
|
-
|
|
763
|
-
secondary_identifier: Annotated[
|
|
764
|
-
Iterable[ClaimInformationServiceLineReferringProviderSecondaryIdentifier],
|
|
765
|
-
PropertyInfo(alias="secondaryIdentifier"),
|
|
766
|
-
]
|
|
767
|
-
|
|
768
|
-
ssn: str
|
|
769
|
-
|
|
770
|
-
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
771
|
-
|
|
772
|
-
suffix: str
|
|
773
|
-
|
|
774
|
-
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
775
|
-
|
|
776
|
-
|
|
777
|
-
class ClaimInformationServiceLineRenderingProviderAddress(TypedDict, total=False):
|
|
778
|
-
address1: Required[str]
|
|
779
|
-
|
|
780
|
-
city: Required[str]
|
|
781
|
-
|
|
782
|
-
address2: str
|
|
783
|
-
|
|
784
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
785
|
-
|
|
786
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
787
|
-
|
|
788
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
789
|
-
|
|
790
|
-
state: str
|
|
791
|
-
|
|
792
|
-
|
|
793
|
-
class ClaimInformationServiceLineRenderingProviderContactInformation(TypedDict, total=False):
|
|
794
|
-
email: str
|
|
795
|
-
|
|
796
|
-
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
797
|
-
|
|
798
|
-
name: str
|
|
799
|
-
|
|
800
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
801
|
-
|
|
802
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
803
|
-
|
|
804
|
-
|
|
805
|
-
class ClaimInformationServiceLineRenderingProviderSecondaryIdentifier(TypedDict, total=False):
|
|
806
|
-
identifier: Required[str]
|
|
807
|
-
|
|
808
|
-
qualifier: Required[str]
|
|
809
|
-
|
|
810
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
811
|
-
|
|
812
|
-
|
|
813
|
-
class ClaimInformationServiceLineRenderingProvider(TypedDict, total=False):
|
|
814
|
-
provider_type: Required[Annotated[str, PropertyInfo(alias="providerType")]]
|
|
815
|
-
|
|
816
|
-
address: ClaimInformationServiceLineRenderingProviderAddress
|
|
817
|
-
|
|
818
|
-
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
819
|
-
|
|
820
|
-
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
821
|
-
|
|
822
|
-
contact_information: Annotated[
|
|
823
|
-
ClaimInformationServiceLineRenderingProviderContactInformation, PropertyInfo(alias="contactInformation")
|
|
824
|
-
]
|
|
825
|
-
|
|
826
|
-
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
827
|
-
|
|
828
|
-
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
829
|
-
|
|
830
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
831
|
-
|
|
832
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
833
|
-
|
|
834
|
-
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
835
|
-
|
|
836
|
-
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
837
|
-
|
|
838
|
-
naic: str
|
|
839
|
-
|
|
840
|
-
npi: str
|
|
841
|
-
|
|
842
|
-
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
843
|
-
|
|
844
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
845
|
-
|
|
846
|
-
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
847
|
-
|
|
848
|
-
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
849
|
-
|
|
850
|
-
secondary_identifier: Annotated[
|
|
851
|
-
Iterable[ClaimInformationServiceLineRenderingProviderSecondaryIdentifier],
|
|
852
|
-
PropertyInfo(alias="secondaryIdentifier"),
|
|
853
|
-
]
|
|
854
|
-
|
|
855
|
-
ssn: str
|
|
856
|
-
|
|
857
|
-
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
858
|
-
|
|
859
|
-
suffix: str
|
|
860
|
-
|
|
861
|
-
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
862
|
-
|
|
863
|
-
|
|
864
|
-
class ClaimInformationServiceLineServiceFacilityLocationAddress(TypedDict, total=False):
|
|
865
|
-
address1: Required[str]
|
|
866
|
-
|
|
867
|
-
city: Required[str]
|
|
868
|
-
|
|
869
|
-
address2: str
|
|
870
|
-
|
|
871
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
872
|
-
|
|
873
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
874
|
-
|
|
875
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
876
|
-
|
|
877
|
-
state: str
|
|
878
|
-
|
|
879
|
-
|
|
880
|
-
class ClaimInformationServiceLineServiceFacilityLocationSecondaryIdentifier(TypedDict, total=False):
|
|
881
|
-
identifier: Required[str]
|
|
882
|
-
|
|
883
|
-
qualifier: Required[str]
|
|
884
|
-
|
|
885
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
886
|
-
|
|
887
|
-
|
|
888
|
-
class ClaimInformationServiceLineServiceFacilityLocation(TypedDict, total=False):
|
|
889
|
-
address: Required[ClaimInformationServiceLineServiceFacilityLocationAddress]
|
|
890
|
-
|
|
891
|
-
organization_name: Required[Annotated[str, PropertyInfo(alias="organizationName")]]
|
|
892
|
-
|
|
893
|
-
npi: str
|
|
894
|
-
|
|
895
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
896
|
-
|
|
897
|
-
phone_name: Annotated[str, PropertyInfo(alias="phoneName")]
|
|
898
|
-
|
|
899
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
900
|
-
|
|
901
|
-
secondary_identifier: Annotated[
|
|
902
|
-
Iterable[ClaimInformationServiceLineServiceFacilityLocationSecondaryIdentifier],
|
|
903
|
-
PropertyInfo(alias="secondaryIdentifier"),
|
|
904
|
-
]
|
|
905
|
-
|
|
906
|
-
|
|
907
|
-
class ClaimInformationServiceLineServiceLineDateInformation(TypedDict, total=False):
|
|
908
|
-
begin_therapy_date: Annotated[str, PropertyInfo(alias="beginTherapyDate")]
|
|
909
|
-
|
|
910
|
-
certification_revision_or_recertification_date: Annotated[
|
|
911
|
-
str, PropertyInfo(alias="certificationRevisionOrRecertificationDate")
|
|
912
|
-
]
|
|
913
|
-
|
|
914
|
-
hemoglobin_test_date: Annotated[str, PropertyInfo(alias="hemoglobinTestDate")]
|
|
915
|
-
|
|
916
|
-
initial_treatment_date: Annotated[str, PropertyInfo(alias="initialTreatmentDate")]
|
|
917
|
-
|
|
918
|
-
last_certification_date: Annotated[str, PropertyInfo(alias="lastCertificationDate")]
|
|
919
|
-
|
|
920
|
-
last_x_ray_date: Annotated[str, PropertyInfo(alias="lastXRayDate")]
|
|
921
|
-
|
|
922
|
-
prescription_date: Annotated[str, PropertyInfo(alias="prescriptionDate")]
|
|
923
|
-
|
|
924
|
-
serum_creatine_test_date: Annotated[str, PropertyInfo(alias="serumCreatineTestDate")]
|
|
925
|
-
|
|
926
|
-
shipped_date: Annotated[str, PropertyInfo(alias="shippedDate")]
|
|
927
|
-
|
|
928
|
-
treatment_or_therapy_date: Annotated[str, PropertyInfo(alias="treatmentOrTherapyDate")]
|
|
929
|
-
|
|
930
|
-
|
|
931
|
-
class ClaimInformationServiceLineServiceLineReferenceInformationPriorAuthorization(TypedDict, total=False):
|
|
932
|
-
prior_authorization_or_referral_number: Required[
|
|
933
|
-
Annotated[str, PropertyInfo(alias="priorAuthorizationOrReferralNumber")]
|
|
934
|
-
]
|
|
935
|
-
|
|
936
|
-
other_payer_primary_identifier: Annotated[str, PropertyInfo(alias="otherPayerPrimaryIdentifier")]
|
|
937
|
-
|
|
938
|
-
|
|
939
|
-
class ClaimInformationServiceLineServiceLineReferenceInformation(TypedDict, total=False):
|
|
940
|
-
adjusted_repriced_line_item_reference_number: Annotated[
|
|
941
|
-
str, PropertyInfo(alias="adjustedRepricedLineItemReferenceNumber")
|
|
942
|
-
]
|
|
943
|
-
|
|
944
|
-
clinical_laboratory_improvement_amendment_number: Annotated[
|
|
945
|
-
str, PropertyInfo(alias="clinicalLaboratoryImprovementAmendmentNumber")
|
|
946
|
-
]
|
|
947
|
-
|
|
948
|
-
immunization_batch_number: Annotated[str, PropertyInfo(alias="immunizationBatchNumber")]
|
|
949
|
-
|
|
950
|
-
mammography_certification_number: Annotated[str, PropertyInfo(alias="mammographyCertificationNumber")]
|
|
951
|
-
|
|
952
|
-
prior_authorization: Annotated[
|
|
953
|
-
Iterable[ClaimInformationServiceLineServiceLineReferenceInformationPriorAuthorization],
|
|
954
|
-
PropertyInfo(alias="priorAuthorization"),
|
|
955
|
-
]
|
|
956
|
-
|
|
957
|
-
referral_number: Annotated[SequenceNotStr[str], PropertyInfo(alias="referralNumber")]
|
|
958
|
-
|
|
959
|
-
referring_clia_number: Annotated[str, PropertyInfo(alias="referringCliaNumber")]
|
|
960
|
-
|
|
961
|
-
repriced_line_item_reference_number: Annotated[str, PropertyInfo(alias="repricedLineItemReferenceNumber")]
|
|
962
|
-
|
|
963
|
-
|
|
964
|
-
class ClaimInformationServiceLineServiceLineSupplementalInformation(TypedDict, total=False):
|
|
965
|
-
attachment_report_type_code: Required[
|
|
966
|
-
Annotated[
|
|
967
|
-
Literal[
|
|
968
|
-
"03",
|
|
969
|
-
"04",
|
|
970
|
-
"05",
|
|
971
|
-
"06",
|
|
972
|
-
"07",
|
|
973
|
-
"08",
|
|
974
|
-
"09",
|
|
975
|
-
"10",
|
|
976
|
-
"11",
|
|
977
|
-
"13",
|
|
978
|
-
"15",
|
|
979
|
-
"21",
|
|
980
|
-
"A3",
|
|
981
|
-
"A4",
|
|
982
|
-
"AM",
|
|
983
|
-
"AS",
|
|
984
|
-
"B2",
|
|
985
|
-
"B3",
|
|
986
|
-
"B4",
|
|
987
|
-
"BR",
|
|
988
|
-
"BS",
|
|
989
|
-
"BT",
|
|
990
|
-
"CB",
|
|
991
|
-
"CK",
|
|
992
|
-
"CT",
|
|
993
|
-
"D2",
|
|
994
|
-
"DA",
|
|
995
|
-
"DB",
|
|
996
|
-
"DG",
|
|
997
|
-
"DJ",
|
|
998
|
-
"DS",
|
|
999
|
-
"EB",
|
|
1000
|
-
"HC",
|
|
1001
|
-
"HR",
|
|
1002
|
-
"I5",
|
|
1003
|
-
"IR",
|
|
1004
|
-
"LA",
|
|
1005
|
-
"M1",
|
|
1006
|
-
"MT",
|
|
1007
|
-
"NM",
|
|
1008
|
-
"OB",
|
|
1009
|
-
"OC",
|
|
1010
|
-
"OD",
|
|
1011
|
-
"OE",
|
|
1012
|
-
"OX",
|
|
1013
|
-
"OZ",
|
|
1014
|
-
"P4",
|
|
1015
|
-
"P5",
|
|
1016
|
-
"PE",
|
|
1017
|
-
"PN",
|
|
1018
|
-
"PO",
|
|
1019
|
-
"PQ",
|
|
1020
|
-
"PY",
|
|
1021
|
-
"PZ",
|
|
1022
|
-
"RB",
|
|
1023
|
-
"RR",
|
|
1024
|
-
"RT",
|
|
1025
|
-
"RX",
|
|
1026
|
-
"SG",
|
|
1027
|
-
"V5",
|
|
1028
|
-
"XP",
|
|
1029
|
-
],
|
|
1030
|
-
PropertyInfo(alias="attachmentReportTypeCode"),
|
|
1031
|
-
]
|
|
1032
|
-
]
|
|
1033
|
-
|
|
1034
|
-
attachment_transmission_code: Required[
|
|
1035
|
-
Annotated[Literal["AA", "BM", "EL", "EM", "FT", "FX"], PropertyInfo(alias="attachmentTransmissionCode")]
|
|
1036
|
-
]
|
|
1037
|
-
|
|
1038
|
-
attachment_control_number: Annotated[str, PropertyInfo(alias="attachmentControlNumber")]
|
|
1039
|
-
|
|
1040
|
-
|
|
1041
|
-
class ClaimInformationServiceLineSupervisingProviderAddress(TypedDict, total=False):
|
|
1042
|
-
address1: Required[str]
|
|
1043
|
-
|
|
1044
|
-
city: Required[str]
|
|
1045
|
-
|
|
1046
|
-
address2: str
|
|
1047
|
-
|
|
1048
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
1049
|
-
|
|
1050
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
1051
|
-
|
|
1052
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
1053
|
-
|
|
1054
|
-
state: str
|
|
1055
|
-
|
|
1056
|
-
|
|
1057
|
-
class ClaimInformationServiceLineSupervisingProviderContactInformation(TypedDict, total=False):
|
|
1058
|
-
email: str
|
|
1059
|
-
|
|
1060
|
-
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
1061
|
-
|
|
1062
|
-
name: str
|
|
1063
|
-
|
|
1064
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
1065
|
-
|
|
1066
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
1067
|
-
|
|
1068
|
-
|
|
1069
|
-
class ClaimInformationServiceLineSupervisingProviderSecondaryIdentifier(TypedDict, total=False):
|
|
1070
|
-
identifier: Required[str]
|
|
1071
|
-
|
|
1072
|
-
qualifier: Required[str]
|
|
1073
|
-
|
|
1074
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1075
|
-
|
|
1076
|
-
|
|
1077
|
-
class ClaimInformationServiceLineSupervisingProvider(TypedDict, total=False):
|
|
1078
|
-
provider_type: Required[Annotated[str, PropertyInfo(alias="providerType")]]
|
|
1079
|
-
|
|
1080
|
-
address: ClaimInformationServiceLineSupervisingProviderAddress
|
|
1081
|
-
|
|
1082
|
-
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
1083
|
-
|
|
1084
|
-
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
1085
|
-
|
|
1086
|
-
contact_information: Annotated[
|
|
1087
|
-
ClaimInformationServiceLineSupervisingProviderContactInformation, PropertyInfo(alias="contactInformation")
|
|
1088
|
-
]
|
|
1089
|
-
|
|
1090
|
-
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
1091
|
-
|
|
1092
|
-
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
1093
|
-
|
|
1094
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
1095
|
-
|
|
1096
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
1097
|
-
|
|
1098
|
-
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
1099
|
-
|
|
1100
|
-
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
1101
|
-
|
|
1102
|
-
naic: str
|
|
1103
|
-
|
|
1104
|
-
npi: str
|
|
1105
|
-
|
|
1106
|
-
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
1107
|
-
|
|
1108
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1109
|
-
|
|
1110
|
-
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
1111
|
-
|
|
1112
|
-
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
1113
|
-
|
|
1114
|
-
secondary_identifier: Annotated[
|
|
1115
|
-
Iterable[ClaimInformationServiceLineSupervisingProviderSecondaryIdentifier],
|
|
1116
|
-
PropertyInfo(alias="secondaryIdentifier"),
|
|
1117
|
-
]
|
|
1118
|
-
|
|
1119
|
-
ssn: str
|
|
1120
|
-
|
|
1121
|
-
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
1122
|
-
|
|
1123
|
-
suffix: str
|
|
1124
|
-
|
|
1125
|
-
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
1126
|
-
|
|
1127
|
-
|
|
1128
|
-
class ClaimInformationServiceLineTestResult(TypedDict, total=False):
|
|
1129
|
-
measurement_qualifier: Required[
|
|
1130
|
-
Annotated[Literal["HT", "R1", "R2", "R3", "R4"], PropertyInfo(alias="measurementQualifier")]
|
|
1131
|
-
]
|
|
1132
|
-
|
|
1133
|
-
measurement_reference_identification_code: Required[
|
|
1134
|
-
Annotated[Literal["OG", "TR"], PropertyInfo(alias="measurementReferenceIdentificationCode")]
|
|
1135
|
-
]
|
|
1136
|
-
|
|
1137
|
-
test_results: Required[Annotated[str, PropertyInfo(alias="testResults")]]
|
|
1138
|
-
|
|
1139
|
-
|
|
1140
|
-
class ClaimInformationServiceLine(TypedDict, total=False):
|
|
1141
|
-
professional_service: Required[
|
|
1142
|
-
Annotated[ClaimInformationServiceLineProfessionalService, PropertyInfo(alias="professionalService")]
|
|
1143
|
-
]
|
|
1144
|
-
|
|
1145
|
-
service_date: Required[Annotated[str, PropertyInfo(alias="serviceDate")]]
|
|
1146
|
-
|
|
1147
|
-
additional_notes: Annotated[str, PropertyInfo(alias="additionalNotes")]
|
|
1148
|
-
|
|
1149
|
-
ambulance_certification: Annotated[
|
|
1150
|
-
Iterable[ClaimInformationServiceLineAmbulanceCertification], PropertyInfo(alias="ambulanceCertification")
|
|
1151
|
-
]
|
|
1152
|
-
|
|
1153
|
-
ambulance_drop_off_location: Annotated[
|
|
1154
|
-
ClaimInformationServiceLineAmbulanceDropOffLocation, PropertyInfo(alias="ambulanceDropOffLocation")
|
|
1155
|
-
]
|
|
1156
|
-
|
|
1157
|
-
ambulance_patient_count: Annotated[float, PropertyInfo(alias="ambulancePatientCount")]
|
|
1158
|
-
|
|
1159
|
-
ambulance_pick_up_location: Annotated[
|
|
1160
|
-
ClaimInformationServiceLineAmbulancePickUpLocation, PropertyInfo(alias="ambulancePickUpLocation")
|
|
1161
|
-
]
|
|
1162
|
-
|
|
1163
|
-
ambulance_transport_information: Annotated[
|
|
1164
|
-
ClaimInformationServiceLineAmbulanceTransportInformation, PropertyInfo(alias="ambulanceTransportInformation")
|
|
1165
|
-
]
|
|
1166
|
-
|
|
1167
|
-
assigned_number: Annotated[str, PropertyInfo(alias="assignedNumber")]
|
|
1168
|
-
|
|
1169
|
-
condition_indicator_durable_medical_equipment: Annotated[
|
|
1170
|
-
ClaimInformationServiceLineConditionIndicatorDurableMedicalEquipment,
|
|
1171
|
-
PropertyInfo(alias="conditionIndicatorDurableMedicalEquipment"),
|
|
1172
|
-
]
|
|
1173
|
-
|
|
1174
|
-
contract_information: Annotated[
|
|
1175
|
-
ClaimInformationServiceLineContractInformation, PropertyInfo(alias="contractInformation")
|
|
1176
|
-
]
|
|
1177
|
-
|
|
1178
|
-
drug_identification: Annotated[
|
|
1179
|
-
ClaimInformationServiceLineDrugIdentification, PropertyInfo(alias="drugIdentification")
|
|
1180
|
-
]
|
|
1181
|
-
|
|
1182
|
-
durable_medical_equipment_certificate_of_medical_necessity: Annotated[
|
|
1183
|
-
ClaimInformationServiceLineDurableMedicalEquipmentCertificateOfMedicalNecessity,
|
|
1184
|
-
PropertyInfo(alias="durableMedicalEquipmentCertificateOfMedicalNecessity"),
|
|
1185
|
-
]
|
|
1186
|
-
|
|
1187
|
-
durable_medical_equipment_certification: Annotated[
|
|
1188
|
-
ClaimInformationServiceLineDurableMedicalEquipmentCertification,
|
|
1189
|
-
PropertyInfo(alias="durableMedicalEquipmentCertification"),
|
|
1190
|
-
]
|
|
1191
|
-
|
|
1192
|
-
durable_medical_equipment_service: Annotated[
|
|
1193
|
-
ClaimInformationServiceLineDurableMedicalEquipmentService, PropertyInfo(alias="durableMedicalEquipmentService")
|
|
1194
|
-
]
|
|
1195
|
-
|
|
1196
|
-
file_information: Annotated[SequenceNotStr[str], PropertyInfo(alias="fileInformation")]
|
|
1197
|
-
|
|
1198
|
-
form_identification: Annotated[
|
|
1199
|
-
Iterable[ClaimInformationServiceLineFormIdentification], PropertyInfo(alias="formIdentification")
|
|
1200
|
-
]
|
|
1201
|
-
|
|
1202
|
-
goal_rehab_or_discharge_plans: Annotated[str, PropertyInfo(alias="goalRehabOrDischargePlans")]
|
|
1203
|
-
|
|
1204
|
-
hospice_employee_indicator: Annotated[bool, PropertyInfo(alias="hospiceEmployeeIndicator")]
|
|
1205
|
-
|
|
1206
|
-
line_adjudication_information: Annotated[
|
|
1207
|
-
Iterable[ClaimInformationServiceLineLineAdjudicationInformation],
|
|
1208
|
-
PropertyInfo(alias="lineAdjudicationInformation"),
|
|
1209
|
-
]
|
|
1210
|
-
|
|
1211
|
-
line_pricing_repricing_information: Annotated[
|
|
1212
|
-
ClaimInformationServiceLineLinePricingRepricingInformation,
|
|
1213
|
-
PropertyInfo(alias="linePricingRepricingInformation"),
|
|
1214
|
-
]
|
|
1215
|
-
|
|
1216
|
-
obstetric_anesthesia_additional_units: Annotated[float, PropertyInfo(alias="obstetricAnesthesiaAdditionalUnits")]
|
|
1217
|
-
|
|
1218
|
-
ordering_provider: Annotated[ClaimInformationServiceLineOrderingProvider, PropertyInfo(alias="orderingProvider")]
|
|
1219
|
-
|
|
1220
|
-
postage_tax_amount: Annotated[str, PropertyInfo(alias="postageTaxAmount")]
|
|
1221
|
-
|
|
1222
|
-
purchased_service_information: Annotated[
|
|
1223
|
-
ClaimInformationServiceLinePurchasedServiceInformation, PropertyInfo(alias="purchasedServiceInformation")
|
|
1224
|
-
]
|
|
1225
|
-
|
|
1226
|
-
purchased_service_provider: Annotated[
|
|
1227
|
-
ClaimInformationServiceLinePurchasedServiceProvider, PropertyInfo(alias="purchasedServiceProvider")
|
|
1228
|
-
]
|
|
1229
|
-
|
|
1230
|
-
referring_provider: Annotated[ClaimInformationServiceLineReferringProvider, PropertyInfo(alias="referringProvider")]
|
|
1231
|
-
|
|
1232
|
-
rendering_provider: Annotated[ClaimInformationServiceLineRenderingProvider, PropertyInfo(alias="renderingProvider")]
|
|
1233
|
-
|
|
1234
|
-
sales_tax_amount: Annotated[str, PropertyInfo(alias="salesTaxAmount")]
|
|
1235
|
-
|
|
1236
|
-
service_date_end: Annotated[str, PropertyInfo(alias="serviceDateEnd")]
|
|
1237
|
-
|
|
1238
|
-
service_facility_location: Annotated[
|
|
1239
|
-
ClaimInformationServiceLineServiceFacilityLocation, PropertyInfo(alias="serviceFacilityLocation")
|
|
1240
|
-
]
|
|
1241
|
-
|
|
1242
|
-
service_line_date_information: Annotated[
|
|
1243
|
-
ClaimInformationServiceLineServiceLineDateInformation, PropertyInfo(alias="serviceLineDateInformation")
|
|
1244
|
-
]
|
|
1245
|
-
|
|
1246
|
-
service_line_reference_information: Annotated[
|
|
1247
|
-
ClaimInformationServiceLineServiceLineReferenceInformation,
|
|
1248
|
-
PropertyInfo(alias="serviceLineReferenceInformation"),
|
|
1249
|
-
]
|
|
1250
|
-
|
|
1251
|
-
service_line_supplemental_information: Annotated[
|
|
1252
|
-
Iterable[ClaimInformationServiceLineServiceLineSupplementalInformation],
|
|
1253
|
-
PropertyInfo(alias="serviceLineSupplementalInformation"),
|
|
1254
|
-
]
|
|
1255
|
-
|
|
1256
|
-
supervising_provider: Annotated[
|
|
1257
|
-
ClaimInformationServiceLineSupervisingProvider, PropertyInfo(alias="supervisingProvider")
|
|
1258
|
-
]
|
|
1259
|
-
|
|
1260
|
-
test_results: Annotated[Iterable[ClaimInformationServiceLineTestResult], PropertyInfo(alias="testResults")]
|
|
1261
|
-
|
|
1262
|
-
third_party_organization_notes: Annotated[str, PropertyInfo(alias="thirdPartyOrganizationNotes")]
|
|
1263
|
-
|
|
1264
|
-
|
|
1265
|
-
class ClaimInformationAmbulanceCertification(TypedDict, total=False):
|
|
1266
|
-
certification_condition_indicator: Required[
|
|
1267
|
-
Annotated[Literal["N", "Y"], PropertyInfo(alias="certificationConditionIndicator")]
|
|
1268
|
-
]
|
|
1269
|
-
|
|
1270
|
-
condition_codes: Required[
|
|
1271
|
-
Annotated[List[Literal["01", "04", "05", "06", "07", "08", "09", "12"]], PropertyInfo(alias="conditionCodes")]
|
|
1272
|
-
]
|
|
1273
|
-
|
|
1274
|
-
|
|
1275
|
-
class ClaimInformationAmbulanceDropOffLocation(TypedDict, total=False):
|
|
1276
|
-
address1: Required[str]
|
|
1277
|
-
|
|
1278
|
-
city: Required[str]
|
|
1279
|
-
|
|
1280
|
-
address2: str
|
|
1281
|
-
|
|
1282
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
1283
|
-
|
|
1284
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
1285
|
-
|
|
1286
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
1287
|
-
|
|
1288
|
-
state: str
|
|
1289
|
-
|
|
1290
|
-
|
|
1291
|
-
class ClaimInformationAmbulancePickUpLocation(TypedDict, total=False):
|
|
1292
|
-
address1: Required[str]
|
|
1293
|
-
|
|
1294
|
-
city: Required[str]
|
|
1295
|
-
|
|
1296
|
-
address2: str
|
|
1297
|
-
|
|
1298
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
1299
|
-
|
|
1300
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
1301
|
-
|
|
1302
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
1303
|
-
|
|
1304
|
-
state: str
|
|
1305
|
-
|
|
1306
|
-
|
|
1307
|
-
class ClaimInformationAmbulanceTransportInformation(TypedDict, total=False):
|
|
1308
|
-
ambulance_transport_reason_code: Required[
|
|
1309
|
-
Annotated[Literal["A", "B", "C", "D", "E"], PropertyInfo(alias="ambulanceTransportReasonCode")]
|
|
1310
|
-
]
|
|
1311
|
-
|
|
1312
|
-
transport_distance_in_miles: Required[Annotated[str, PropertyInfo(alias="transportDistanceInMiles")]]
|
|
1313
|
-
|
|
1314
|
-
patient_weight_in_pounds: Annotated[str, PropertyInfo(alias="patientWeightInPounds")]
|
|
1315
|
-
|
|
1316
|
-
round_trip_purpose_description: Annotated[str, PropertyInfo(alias="roundTripPurposeDescription")]
|
|
1317
|
-
|
|
1318
|
-
stretcher_purpose_description: Annotated[str, PropertyInfo(alias="stretcherPurposeDescription")]
|
|
1319
|
-
|
|
1320
|
-
|
|
1321
|
-
class ClaimInformationClaimContractInformation(TypedDict, total=False):
|
|
1322
|
-
contract_type_code: Required[
|
|
1323
|
-
Annotated[Literal["01", "02", "03", "04", "05", "06", "09"], PropertyInfo(alias="contractTypeCode")]
|
|
1324
|
-
]
|
|
1325
|
-
|
|
1326
|
-
contract_amount: Annotated[str, PropertyInfo(alias="contractAmount")]
|
|
1327
|
-
|
|
1328
|
-
contract_code: Annotated[str, PropertyInfo(alias="contractCode")]
|
|
1329
|
-
|
|
1330
|
-
contract_percentage: Annotated[str, PropertyInfo(alias="contractPercentage")]
|
|
1331
|
-
|
|
1332
|
-
contract_version_identifier: Annotated[str, PropertyInfo(alias="contractVersionIdentifier")]
|
|
1333
|
-
|
|
1334
|
-
terms_discount_percentage: Annotated[str, PropertyInfo(alias="termsDiscountPercentage")]
|
|
1335
|
-
|
|
1336
|
-
|
|
1337
|
-
class ClaimInformationClaimDateInformation(TypedDict, total=False):
|
|
1338
|
-
accident_date: Annotated[str, PropertyInfo(alias="accidentDate")]
|
|
1339
|
-
|
|
1340
|
-
acute_manifestation_date: Annotated[str, PropertyInfo(alias="acuteManifestationDate")]
|
|
1341
|
-
|
|
1342
|
-
admission_date: Annotated[str, PropertyInfo(alias="admissionDate")]
|
|
1343
|
-
|
|
1344
|
-
assumed_and_relinquished_care_begin_date: Annotated[str, PropertyInfo(alias="assumedAndRelinquishedCareBeginDate")]
|
|
1345
|
-
|
|
1346
|
-
assumed_and_relinquished_care_end_date: Annotated[str, PropertyInfo(alias="assumedAndRelinquishedCareEndDate")]
|
|
1347
|
-
|
|
1348
|
-
authorized_return_to_work_date: Annotated[str, PropertyInfo(alias="authorizedReturnToWorkDate")]
|
|
1349
|
-
|
|
1350
|
-
disability_begin_date: Annotated[str, PropertyInfo(alias="disabilityBeginDate")]
|
|
1351
|
-
|
|
1352
|
-
disability_end_date: Annotated[str, PropertyInfo(alias="disabilityEndDate")]
|
|
1353
|
-
|
|
1354
|
-
discharge_date: Annotated[str, PropertyInfo(alias="dischargeDate")]
|
|
1355
|
-
|
|
1356
|
-
first_contact_date: Annotated[str, PropertyInfo(alias="firstContactDate")]
|
|
1357
|
-
|
|
1358
|
-
hearing_and_vision_prescription_date: Annotated[str, PropertyInfo(alias="hearingAndVisionPrescriptionDate")]
|
|
1359
|
-
|
|
1360
|
-
initial_treatment_date: Annotated[str, PropertyInfo(alias="initialTreatmentDate")]
|
|
1361
|
-
|
|
1362
|
-
last_menstrual_period_date: Annotated[str, PropertyInfo(alias="lastMenstrualPeriodDate")]
|
|
1363
|
-
|
|
1364
|
-
last_seen_date: Annotated[str, PropertyInfo(alias="lastSeenDate")]
|
|
1365
|
-
|
|
1366
|
-
last_worked_date: Annotated[str, PropertyInfo(alias="lastWorkedDate")]
|
|
1367
|
-
|
|
1368
|
-
last_x_ray_date: Annotated[str, PropertyInfo(alias="lastXRayDate")]
|
|
1369
|
-
|
|
1370
|
-
repricer_received_date: Annotated[str, PropertyInfo(alias="repricerReceivedDate")]
|
|
1371
|
-
|
|
1372
|
-
symptom_date: Annotated[str, PropertyInfo(alias="symptomDate")]
|
|
1373
|
-
|
|
1374
|
-
|
|
1375
|
-
class ClaimInformationClaimNote(TypedDict, total=False):
|
|
1376
|
-
additional_information: Annotated[str, PropertyInfo(alias="additionalInformation")]
|
|
1377
|
-
|
|
1378
|
-
certification_narrative: Annotated[str, PropertyInfo(alias="certificationNarrative")]
|
|
1379
|
-
|
|
1380
|
-
diagnosis_description: Annotated[str, PropertyInfo(alias="diagnosisDescription")]
|
|
1381
|
-
|
|
1382
|
-
goal_rehab_or_discharge_plans: Annotated[str, PropertyInfo(alias="goalRehabOrDischargePlans")]
|
|
1383
|
-
|
|
1384
|
-
third_part_org_notes: Annotated[str, PropertyInfo(alias="thirdPartOrgNotes")]
|
|
1385
|
-
|
|
1386
|
-
|
|
1387
|
-
class ClaimInformationClaimPricingRepricingInformation(TypedDict, total=False):
|
|
1388
|
-
pricing_methodology_code: Required[
|
|
1389
|
-
Annotated[
|
|
1390
|
-
Literal["00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14"],
|
|
1391
|
-
PropertyInfo(alias="pricingMethodologyCode"),
|
|
1392
|
-
]
|
|
1393
|
-
]
|
|
1394
|
-
|
|
1395
|
-
repriced_allowed_amount: Required[Annotated[str, PropertyInfo(alias="repricedAllowedAmount")]]
|
|
1396
|
-
|
|
1397
|
-
exception_code: Annotated[Literal["1", "2", "3", "4", "5", "6"], PropertyInfo(alias="exceptionCode")]
|
|
1398
|
-
|
|
1399
|
-
policy_compliance_code: Annotated[Literal["1", "2", "3", "4", "5"], PropertyInfo(alias="policyComplianceCode")]
|
|
1400
|
-
|
|
1401
|
-
reject_reason_code: Annotated[Literal["T1", "T2", "T3", "T4", "T5", "T6"], PropertyInfo(alias="rejectReasonCode")]
|
|
1402
|
-
|
|
1403
|
-
repriced_approved_ambulatory_patient_group_amount: Annotated[
|
|
1404
|
-
str, PropertyInfo(alias="repricedApprovedAmbulatoryPatientGroupAmount")
|
|
1405
|
-
]
|
|
1406
|
-
|
|
1407
|
-
repriced_approved_ambulatory_patient_group_code: Annotated[
|
|
1408
|
-
str, PropertyInfo(alias="repricedApprovedAmbulatoryPatientGroupCode")
|
|
1409
|
-
]
|
|
1410
|
-
|
|
1411
|
-
repriced_saving_amount: Annotated[str, PropertyInfo(alias="repricedSavingAmount")]
|
|
1412
|
-
|
|
1413
|
-
repricing_organization_identifier: Annotated[str, PropertyInfo(alias="repricingOrganizationIdentifier")]
|
|
1414
|
-
|
|
1415
|
-
repricing_per_diem_or_flat_rate_amount: Annotated[str, PropertyInfo(alias="repricingPerDiemOrFlatRateAmount")]
|
|
1416
|
-
|
|
1417
|
-
|
|
1418
|
-
class ClaimInformationClaimSupplementalInformationReportInformation(TypedDict, total=False):
|
|
1419
|
-
attachment_report_type_code: Required[
|
|
1420
|
-
Annotated[
|
|
1421
|
-
Literal[
|
|
1422
|
-
"03",
|
|
1423
|
-
"04",
|
|
1424
|
-
"05",
|
|
1425
|
-
"06",
|
|
1426
|
-
"07",
|
|
1427
|
-
"08",
|
|
1428
|
-
"09",
|
|
1429
|
-
"10",
|
|
1430
|
-
"11",
|
|
1431
|
-
"13",
|
|
1432
|
-
"15",
|
|
1433
|
-
"21",
|
|
1434
|
-
"A3",
|
|
1435
|
-
"A4",
|
|
1436
|
-
"AM",
|
|
1437
|
-
"AS",
|
|
1438
|
-
"B2",
|
|
1439
|
-
"B3",
|
|
1440
|
-
"B4",
|
|
1441
|
-
"BR",
|
|
1442
|
-
"BS",
|
|
1443
|
-
"BT",
|
|
1444
|
-
"CB",
|
|
1445
|
-
"CK",
|
|
1446
|
-
"CT",
|
|
1447
|
-
"D2",
|
|
1448
|
-
"DA",
|
|
1449
|
-
"DB",
|
|
1450
|
-
"DG",
|
|
1451
|
-
"DJ",
|
|
1452
|
-
"DS",
|
|
1453
|
-
"EB",
|
|
1454
|
-
"HC",
|
|
1455
|
-
"HR",
|
|
1456
|
-
"I5",
|
|
1457
|
-
"IR",
|
|
1458
|
-
"LA",
|
|
1459
|
-
"M1",
|
|
1460
|
-
"MT",
|
|
1461
|
-
"NM",
|
|
1462
|
-
"OB",
|
|
1463
|
-
"OC",
|
|
1464
|
-
"OD",
|
|
1465
|
-
"OE",
|
|
1466
|
-
"OX",
|
|
1467
|
-
"OZ",
|
|
1468
|
-
"P4",
|
|
1469
|
-
"P5",
|
|
1470
|
-
"PE",
|
|
1471
|
-
"PN",
|
|
1472
|
-
"PO",
|
|
1473
|
-
"PQ",
|
|
1474
|
-
"PY",
|
|
1475
|
-
"PZ",
|
|
1476
|
-
"RB",
|
|
1477
|
-
"RR",
|
|
1478
|
-
"RT",
|
|
1479
|
-
"RX",
|
|
1480
|
-
"SG",
|
|
1481
|
-
"V5",
|
|
1482
|
-
"XP",
|
|
1483
|
-
],
|
|
1484
|
-
PropertyInfo(alias="attachmentReportTypeCode"),
|
|
1485
|
-
]
|
|
1486
|
-
]
|
|
1487
|
-
|
|
1488
|
-
attachment_transmission_code: Required[
|
|
1489
|
-
Annotated[Literal["AA", "BM", "EL", "EM", "FT", "FX"], PropertyInfo(alias="attachmentTransmissionCode")]
|
|
1490
|
-
]
|
|
1491
|
-
|
|
1492
|
-
attachment_control_number: Annotated[str, PropertyInfo(alias="attachmentControlNumber")]
|
|
1493
|
-
|
|
1494
|
-
|
|
1495
|
-
class ClaimInformationClaimSupplementalInformation(TypedDict, total=False):
|
|
1496
|
-
adjusted_repriced_claim_number: Annotated[str, PropertyInfo(alias="adjustedRepricedClaimNumber")]
|
|
1497
|
-
|
|
1498
|
-
care_plan_oversight_number: Annotated[str, PropertyInfo(alias="carePlanOversightNumber")]
|
|
1499
|
-
|
|
1500
|
-
claim_control_number: Annotated[str, PropertyInfo(alias="claimControlNumber")]
|
|
1501
|
-
|
|
1502
|
-
claim_number: Annotated[str, PropertyInfo(alias="claimNumber")]
|
|
1503
|
-
|
|
1504
|
-
clia_number: Annotated[str, PropertyInfo(alias="cliaNumber")]
|
|
1505
|
-
|
|
1506
|
-
demo_project_identifier: Annotated[str, PropertyInfo(alias="demoProjectIdentifier")]
|
|
1507
|
-
|
|
1508
|
-
investigational_device_exemption_number: Annotated[str, PropertyInfo(alias="investigationalDeviceExemptionNumber")]
|
|
1509
|
-
|
|
1510
|
-
mammography_certification_number: Annotated[str, PropertyInfo(alias="mammographyCertificationNumber")]
|
|
1511
|
-
|
|
1512
|
-
medical_record_number: Annotated[str, PropertyInfo(alias="medicalRecordNumber")]
|
|
1513
|
-
|
|
1514
|
-
medicare_crossover_reference_id: Annotated[str, PropertyInfo(alias="medicareCrossoverReferenceId")]
|
|
1515
|
-
|
|
1516
|
-
prior_authorization_number: Annotated[str, PropertyInfo(alias="priorAuthorizationNumber")]
|
|
1517
|
-
|
|
1518
|
-
referral_number: Annotated[str, PropertyInfo(alias="referralNumber")]
|
|
1519
|
-
|
|
1520
|
-
report_information: Annotated[
|
|
1521
|
-
ClaimInformationClaimSupplementalInformationReportInformation, PropertyInfo(alias="reportInformation")
|
|
1522
|
-
]
|
|
1523
|
-
|
|
1524
|
-
report_informations: Annotated[
|
|
1525
|
-
Iterable[ClaimInformationClaimSupplementalInformationReportInformation],
|
|
1526
|
-
PropertyInfo(alias="reportInformations"),
|
|
1527
|
-
]
|
|
1528
|
-
|
|
1529
|
-
repriced_claim_number: Annotated[str, PropertyInfo(alias="repricedClaimNumber")]
|
|
1530
|
-
|
|
1531
|
-
service_authorization_exception_code: Annotated[
|
|
1532
|
-
Literal["1", "2", "3", "4", "5", "6", "7"], PropertyInfo(alias="serviceAuthorizationExceptionCode")
|
|
1533
|
-
]
|
|
1534
|
-
|
|
1535
|
-
|
|
1536
|
-
class ClaimInformationConditionInformation(TypedDict, total=False):
|
|
1537
|
-
condition_codes: Required[Annotated[SequenceNotStr[str], PropertyInfo(alias="conditionCodes")]]
|
|
1538
|
-
|
|
1539
|
-
|
|
1540
|
-
class ClaimInformationEpsdtReferral(TypedDict, total=False):
|
|
1541
|
-
certification_condition_code_applies_indicator: Required[
|
|
1542
|
-
Annotated[Literal["N", "Y"], PropertyInfo(alias="certificationConditionCodeAppliesIndicator")]
|
|
1543
|
-
]
|
|
1544
|
-
|
|
1545
|
-
condition_codes: Required[Annotated[List[Literal["AV", "NU", "S2", "ST"]], PropertyInfo(alias="conditionCodes")]]
|
|
1546
|
-
|
|
1547
|
-
|
|
1548
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerNameOtherPayerAddress(TypedDict, total=False):
|
|
1549
|
-
address1: Required[str]
|
|
1550
|
-
|
|
1551
|
-
city: Required[str]
|
|
1552
|
-
|
|
1553
|
-
address2: str
|
|
1554
|
-
|
|
1555
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
1556
|
-
|
|
1557
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
1558
|
-
|
|
1559
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
1560
|
-
|
|
1561
|
-
state: str
|
|
1562
|
-
|
|
1563
|
-
|
|
1564
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerNameOtherPayerSecondaryIdentifier(TypedDict, total=False):
|
|
1565
|
-
identifier: Required[str]
|
|
1566
|
-
|
|
1567
|
-
qualifier: Required[str]
|
|
1568
|
-
|
|
1569
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1570
|
-
|
|
1571
|
-
|
|
1572
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerName(TypedDict, total=False):
|
|
1573
|
-
other_payer_identifier: Required[Annotated[str, PropertyInfo(alias="otherPayerIdentifier")]]
|
|
1574
|
-
|
|
1575
|
-
other_payer_identifier_type_code: Required[
|
|
1576
|
-
Annotated[Literal["PI", "XV"], PropertyInfo(alias="otherPayerIdentifierTypeCode")]
|
|
1577
|
-
]
|
|
1578
|
-
|
|
1579
|
-
other_payer_organization_name: Required[Annotated[str, PropertyInfo(alias="otherPayerOrganizationName")]]
|
|
1580
|
-
|
|
1581
|
-
other_payer_address: Annotated[
|
|
1582
|
-
ClaimInformationOtherSubscriberInformationOtherPayerNameOtherPayerAddress,
|
|
1583
|
-
PropertyInfo(alias="otherPayerAddress"),
|
|
1584
|
-
]
|
|
1585
|
-
|
|
1586
|
-
other_payer_adjudication_or_payment_date: Annotated[str, PropertyInfo(alias="otherPayerAdjudicationOrPaymentDate")]
|
|
1587
|
-
|
|
1588
|
-
other_payer_claim_adjustment_indicator: Annotated[bool, PropertyInfo(alias="otherPayerClaimAdjustmentIndicator")]
|
|
1589
|
-
|
|
1590
|
-
other_payer_claim_control_number: Annotated[str, PropertyInfo(alias="otherPayerClaimControlNumber")]
|
|
1591
|
-
|
|
1592
|
-
other_payer_prior_authorization_number: Annotated[str, PropertyInfo(alias="otherPayerPriorAuthorizationNumber")]
|
|
1593
|
-
|
|
1594
|
-
other_payer_prior_authorization_or_referral_number: Annotated[
|
|
1595
|
-
str, PropertyInfo(alias="otherPayerPriorAuthorizationOrReferralNumber")
|
|
1596
|
-
]
|
|
1597
|
-
|
|
1598
|
-
other_payer_secondary_identifier: Annotated[
|
|
1599
|
-
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerNameOtherPayerSecondaryIdentifier],
|
|
1600
|
-
PropertyInfo(alias="otherPayerSecondaryIdentifier"),
|
|
1601
|
-
]
|
|
1602
|
-
|
|
1603
|
-
|
|
1604
|
-
class ClaimInformationOtherSubscriberInformationOtherSubscriberNameOtherInsuredAddress(TypedDict, total=False):
|
|
1605
|
-
address1: Required[str]
|
|
1606
|
-
|
|
1607
|
-
city: Required[str]
|
|
1608
|
-
|
|
1609
|
-
address2: str
|
|
1610
|
-
|
|
1611
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
1612
|
-
|
|
1613
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
1614
|
-
|
|
1615
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
1616
|
-
|
|
1617
|
-
state: str
|
|
1618
|
-
|
|
1619
|
-
|
|
1620
|
-
class ClaimInformationOtherSubscriberInformationOtherSubscriberName(TypedDict, total=False):
|
|
1621
|
-
other_insured_identifier: Required[Annotated[str, PropertyInfo(alias="otherInsuredIdentifier")]]
|
|
1622
|
-
|
|
1623
|
-
other_insured_identifier_type_code: Required[
|
|
1624
|
-
Annotated[Literal["II", "MI"], PropertyInfo(alias="otherInsuredIdentifierTypeCode")]
|
|
1625
|
-
]
|
|
1626
|
-
|
|
1627
|
-
other_insured_last_name: Required[Annotated[str, PropertyInfo(alias="otherInsuredLastName")]]
|
|
1628
|
-
|
|
1629
|
-
other_insured_qualifier: Required[Annotated[Literal["1", "2"], PropertyInfo(alias="otherInsuredQualifier")]]
|
|
1630
|
-
|
|
1631
|
-
other_insured_additional_identifier: Annotated[str, PropertyInfo(alias="otherInsuredAdditionalIdentifier")]
|
|
1632
|
-
|
|
1633
|
-
other_insured_address: Annotated[
|
|
1634
|
-
ClaimInformationOtherSubscriberInformationOtherSubscriberNameOtherInsuredAddress,
|
|
1635
|
-
PropertyInfo(alias="otherInsuredAddress"),
|
|
1636
|
-
]
|
|
1637
|
-
|
|
1638
|
-
other_insured_first_name: Annotated[str, PropertyInfo(alias="otherInsuredFirstName")]
|
|
1639
|
-
|
|
1640
|
-
other_insured_middle_name: Annotated[str, PropertyInfo(alias="otherInsuredMiddleName")]
|
|
1641
|
-
|
|
1642
|
-
other_insured_name_suffix: Annotated[str, PropertyInfo(alias="otherInsuredNameSuffix")]
|
|
1643
|
-
|
|
1644
|
-
|
|
1645
|
-
class ClaimInformationOtherSubscriberInformationClaimLevelAdjustmentAdjustmentDetail(TypedDict, total=False):
|
|
1646
|
-
adjustment_amount: Required[Annotated[str, PropertyInfo(alias="adjustmentAmount")]]
|
|
1647
|
-
|
|
1648
|
-
adjustment_reason_code: Required[Annotated[str, PropertyInfo(alias="adjustmentReasonCode")]]
|
|
1649
|
-
|
|
1650
|
-
adjustment_quantity: Annotated[str, PropertyInfo(alias="adjustmentQuantity")]
|
|
1651
|
-
|
|
1652
|
-
|
|
1653
|
-
class ClaimInformationOtherSubscriberInformationClaimLevelAdjustment(TypedDict, total=False):
|
|
1654
|
-
adjustment_details: Required[
|
|
1655
|
-
Annotated[
|
|
1656
|
-
Iterable[ClaimInformationOtherSubscriberInformationClaimLevelAdjustmentAdjustmentDetail],
|
|
1657
|
-
PropertyInfo(alias="adjustmentDetails"),
|
|
1658
|
-
]
|
|
1659
|
-
]
|
|
1660
|
-
|
|
1661
|
-
adjustment_group_code: Required[
|
|
1662
|
-
Annotated[Literal["CO", "CR", "OA", "PI", "PR"], PropertyInfo(alias="adjustmentGroupCode")]
|
|
1663
|
-
]
|
|
1664
|
-
|
|
1665
|
-
|
|
1666
|
-
class ClaimInformationOtherSubscriberInformationMedicareOutpatientAdjudication(TypedDict, total=False):
|
|
1667
|
-
claim_payment_remark_code: Annotated[SequenceNotStr[str], PropertyInfo(alias="claimPaymentRemarkCode")]
|
|
1668
|
-
|
|
1669
|
-
end_stage_renal_disease_payment_amount: Annotated[str, PropertyInfo(alias="endStageRenalDiseasePaymentAmount")]
|
|
1670
|
-
|
|
1671
|
-
hcpcs_payable_amount: Annotated[str, PropertyInfo(alias="hcpcsPayableAmount")]
|
|
1672
|
-
|
|
1673
|
-
non_payable_professional_component_billed_amount: Annotated[
|
|
1674
|
-
str, PropertyInfo(alias="nonPayableProfessionalComponentBilledAmount")
|
|
1675
|
-
]
|
|
1676
|
-
|
|
1677
|
-
reimbursement_rate: Annotated[str, PropertyInfo(alias="reimbursementRate")]
|
|
1678
|
-
|
|
1679
|
-
|
|
1680
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerBillingProviderOtherPayerBillingProviderIdentifier(
|
|
1681
|
-
TypedDict, total=False
|
|
1682
|
-
):
|
|
1683
|
-
identifier: Required[str]
|
|
1684
|
-
|
|
1685
|
-
qualifier: Required[str]
|
|
1686
|
-
|
|
1687
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1688
|
-
|
|
1689
|
-
|
|
1690
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerBillingProvider(TypedDict, total=False):
|
|
1691
|
-
entity_type_qualifier: Required[Annotated[Literal["1", "2"], PropertyInfo(alias="entityTypeQualifier")]]
|
|
1692
|
-
|
|
1693
|
-
other_payer_billing_provider_identifier: Required[
|
|
1694
|
-
Annotated[
|
|
1695
|
-
Iterable[
|
|
1696
|
-
ClaimInformationOtherSubscriberInformationOtherPayerBillingProviderOtherPayerBillingProviderIdentifier
|
|
1697
|
-
],
|
|
1698
|
-
PropertyInfo(alias="otherPayerBillingProviderIdentifier"),
|
|
1699
|
-
]
|
|
1700
|
-
]
|
|
1701
|
-
|
|
1702
|
-
|
|
1703
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerReferringProviderOtherPayerReferringProviderIdentifier(
|
|
1704
|
-
TypedDict, total=False
|
|
1705
|
-
):
|
|
1706
|
-
identifier: Required[str]
|
|
1707
|
-
|
|
1708
|
-
qualifier: Required[str]
|
|
1709
|
-
|
|
1710
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1711
|
-
|
|
1712
|
-
|
|
1713
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerReferringProvider(TypedDict, total=False):
|
|
1714
|
-
other_payer_referring_provider_identifier: Required[
|
|
1715
|
-
Annotated[
|
|
1716
|
-
Iterable[
|
|
1717
|
-
ClaimInformationOtherSubscriberInformationOtherPayerReferringProviderOtherPayerReferringProviderIdentifier
|
|
1718
|
-
],
|
|
1719
|
-
PropertyInfo(alias="otherPayerReferringProviderIdentifier"),
|
|
1720
|
-
]
|
|
1721
|
-
]
|
|
1722
|
-
|
|
1723
|
-
|
|
1724
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerRenderingProviderOtherPayerRenderingProviderSecondaryIdentifier(
|
|
1725
|
-
TypedDict, total=False
|
|
1726
|
-
):
|
|
1727
|
-
identifier: Required[str]
|
|
1728
|
-
|
|
1729
|
-
qualifier: Required[str]
|
|
1730
|
-
|
|
1731
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1732
|
-
|
|
1733
|
-
|
|
1734
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerRenderingProvider(TypedDict, total=False):
|
|
1735
|
-
entity_type_qualifier: Required[Annotated[Literal["1", "2"], PropertyInfo(alias="entityTypeQualifier")]]
|
|
1736
|
-
|
|
1737
|
-
other_payer_rendering_provider_secondary_identifier: Annotated[
|
|
1738
|
-
Iterable[
|
|
1739
|
-
ClaimInformationOtherSubscriberInformationOtherPayerRenderingProviderOtherPayerRenderingProviderSecondaryIdentifier
|
|
1740
|
-
],
|
|
1741
|
-
PropertyInfo(alias="otherPayerRenderingProviderSecondaryIdentifier"),
|
|
1742
|
-
]
|
|
1743
|
-
|
|
1744
|
-
|
|
1745
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocationOtherPayerServiceFacilityLocationSecondaryIdentifier(
|
|
1746
|
-
TypedDict, total=False
|
|
1747
|
-
):
|
|
1748
|
-
identifier: Required[str]
|
|
1749
|
-
|
|
1750
|
-
qualifier: Required[str]
|
|
1751
|
-
|
|
1752
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1753
|
-
|
|
1754
|
-
|
|
1755
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocation(TypedDict, total=False):
|
|
1756
|
-
other_payer_service_facility_location_secondary_identifier: Required[
|
|
1757
|
-
Annotated[
|
|
1758
|
-
Iterable[
|
|
1759
|
-
ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocationOtherPayerServiceFacilityLocationSecondaryIdentifier
|
|
1760
|
-
],
|
|
1761
|
-
PropertyInfo(alias="otherPayerServiceFacilityLocationSecondaryIdentifier"),
|
|
1762
|
-
]
|
|
1763
|
-
]
|
|
1764
|
-
|
|
1765
|
-
|
|
1766
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProviderOtherPayerSupervisingProviderIdentifier(
|
|
1767
|
-
TypedDict, total=False
|
|
1768
|
-
):
|
|
1769
|
-
identifier: Required[str]
|
|
1770
|
-
|
|
1771
|
-
qualifier: Required[str]
|
|
1772
|
-
|
|
1773
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1774
|
-
|
|
1775
|
-
|
|
1776
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProvider(TypedDict, total=False):
|
|
1777
|
-
other_payer_supervising_provider_identifier: Required[
|
|
1778
|
-
Annotated[
|
|
1779
|
-
Iterable[
|
|
1780
|
-
ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProviderOtherPayerSupervisingProviderIdentifier
|
|
1781
|
-
],
|
|
1782
|
-
PropertyInfo(alias="otherPayerSupervisingProviderIdentifier"),
|
|
1783
|
-
]
|
|
1784
|
-
]
|
|
1785
|
-
|
|
1786
|
-
|
|
1787
|
-
class ClaimInformationOtherSubscriberInformation(TypedDict, total=False):
|
|
1788
|
-
benefits_assignment_certification_indicator: Required[
|
|
1789
|
-
Annotated[Literal["N", "W", "Y"], PropertyInfo(alias="benefitsAssignmentCertificationIndicator")]
|
|
1790
|
-
]
|
|
1791
|
-
|
|
1792
|
-
claim_filing_indicator_code: Required[
|
|
1793
|
-
Annotated[
|
|
1794
|
-
Literal[
|
|
1795
|
-
"11",
|
|
1796
|
-
"12",
|
|
1797
|
-
"13",
|
|
1798
|
-
"14",
|
|
1799
|
-
"15",
|
|
1800
|
-
"16",
|
|
1801
|
-
"17",
|
|
1802
|
-
"AM",
|
|
1803
|
-
"BL",
|
|
1804
|
-
"CH",
|
|
1805
|
-
"CI",
|
|
1806
|
-
"DS",
|
|
1807
|
-
"FI",
|
|
1808
|
-
"HM",
|
|
1809
|
-
"LM",
|
|
1810
|
-
"MA",
|
|
1811
|
-
"MB",
|
|
1812
|
-
"MC",
|
|
1813
|
-
"OF",
|
|
1814
|
-
"TV",
|
|
1815
|
-
"VA",
|
|
1816
|
-
"WC",
|
|
1817
|
-
"ZZ",
|
|
1818
|
-
],
|
|
1819
|
-
PropertyInfo(alias="claimFilingIndicatorCode"),
|
|
1820
|
-
]
|
|
1821
|
-
]
|
|
1822
|
-
|
|
1823
|
-
individual_relationship_code: Required[
|
|
1824
|
-
Annotated[
|
|
1825
|
-
Literal["01", "18", "19", "20", "21", "39", "40", "53", "G8"],
|
|
1826
|
-
PropertyInfo(alias="individualRelationshipCode"),
|
|
1827
|
-
]
|
|
1828
|
-
]
|
|
1829
|
-
|
|
1830
|
-
other_payer_name: Required[
|
|
1831
|
-
Annotated[ClaimInformationOtherSubscriberInformationOtherPayerName, PropertyInfo(alias="otherPayerName")]
|
|
1832
|
-
]
|
|
1833
|
-
|
|
1834
|
-
other_subscriber_name: Required[
|
|
1835
|
-
Annotated[
|
|
1836
|
-
ClaimInformationOtherSubscriberInformationOtherSubscriberName, PropertyInfo(alias="otherSubscriberName")
|
|
1837
|
-
]
|
|
1838
|
-
]
|
|
1839
|
-
|
|
1840
|
-
payment_responsibility_level_code: Required[
|
|
1841
|
-
Annotated[
|
|
1842
|
-
Literal["A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U"],
|
|
1843
|
-
PropertyInfo(alias="paymentResponsibilityLevelCode"),
|
|
1844
|
-
]
|
|
1845
|
-
]
|
|
1846
|
-
|
|
1847
|
-
release_of_information_code: Required[Annotated[Literal["I", "Y"], PropertyInfo(alias="releaseOfInformationCode")]]
|
|
1848
|
-
|
|
1849
|
-
claim_level_adjustments: Annotated[
|
|
1850
|
-
Iterable[ClaimInformationOtherSubscriberInformationClaimLevelAdjustment],
|
|
1851
|
-
PropertyInfo(alias="claimLevelAdjustments"),
|
|
1852
|
-
]
|
|
1853
|
-
|
|
1854
|
-
insurance_group_or_policy_number: Annotated[str, PropertyInfo(alias="insuranceGroupOrPolicyNumber")]
|
|
1855
|
-
|
|
1856
|
-
insurance_type_code: Annotated[
|
|
1857
|
-
Literal["12", "13", "14", "15", "16", "41", "42", "43", "47"], PropertyInfo(alias="insuranceTypeCode")
|
|
1858
|
-
]
|
|
1859
|
-
|
|
1860
|
-
medicare_outpatient_adjudication: Annotated[
|
|
1861
|
-
ClaimInformationOtherSubscriberInformationMedicareOutpatientAdjudication,
|
|
1862
|
-
PropertyInfo(alias="medicareOutpatientAdjudication"),
|
|
1863
|
-
]
|
|
1864
|
-
|
|
1865
|
-
non_covered_charge_amount: Annotated[str, PropertyInfo(alias="nonCoveredChargeAmount")]
|
|
1866
|
-
|
|
1867
|
-
other_insured_group_name: Annotated[str, PropertyInfo(alias="otherInsuredGroupName")]
|
|
1868
|
-
|
|
1869
|
-
other_payer_billing_provider: Annotated[
|
|
1870
|
-
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerBillingProvider],
|
|
1871
|
-
PropertyInfo(alias="otherPayerBillingProvider"),
|
|
1872
|
-
]
|
|
1873
|
-
|
|
1874
|
-
other_payer_referring_provider: Annotated[
|
|
1875
|
-
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerReferringProvider],
|
|
1876
|
-
PropertyInfo(alias="otherPayerReferringProvider"),
|
|
1877
|
-
]
|
|
1878
|
-
|
|
1879
|
-
other_payer_rendering_provider: Annotated[
|
|
1880
|
-
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerRenderingProvider],
|
|
1881
|
-
PropertyInfo(alias="otherPayerRenderingProvider"),
|
|
1882
|
-
]
|
|
1883
|
-
|
|
1884
|
-
other_payer_service_facility_location: Annotated[
|
|
1885
|
-
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocation],
|
|
1886
|
-
PropertyInfo(alias="otherPayerServiceFacilityLocation"),
|
|
1887
|
-
]
|
|
1888
|
-
|
|
1889
|
-
other_payer_supervising_provider: Annotated[
|
|
1890
|
-
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProvider],
|
|
1891
|
-
PropertyInfo(alias="otherPayerSupervisingProvider"),
|
|
1892
|
-
]
|
|
1893
|
-
|
|
1894
|
-
patient_signature_generated_for_patient: Annotated[bool, PropertyInfo(alias="patientSignatureGeneratedForPatient")]
|
|
1895
|
-
|
|
1896
|
-
payer_paid_amount: Annotated[str, PropertyInfo(alias="payerPaidAmount")]
|
|
1897
|
-
|
|
1898
|
-
remaining_patient_liability: Annotated[str, PropertyInfo(alias="remainingPatientLiability")]
|
|
1899
|
-
|
|
1900
|
-
|
|
1901
|
-
class ClaimInformationPatientConditionInformationVision(TypedDict, total=False):
|
|
1902
|
-
certification_condition_indicator: Required[
|
|
1903
|
-
Annotated[Literal["N", "Y"], PropertyInfo(alias="certificationConditionIndicator")]
|
|
1904
|
-
]
|
|
1905
|
-
|
|
1906
|
-
code_category: Required[Annotated[Literal["E1", "E2", "E3"], PropertyInfo(alias="codeCategory")]]
|
|
1907
|
-
|
|
1908
|
-
condition_codes: Required[
|
|
1909
|
-
Annotated[List[Literal["L1", "L2", "L3", "L4", "L5"]], PropertyInfo(alias="conditionCodes")]
|
|
1910
|
-
]
|
|
1911
|
-
|
|
1912
|
-
|
|
1913
|
-
class ClaimInformationServiceFacilityLocationAddress(TypedDict, total=False):
|
|
1914
|
-
address1: Required[str]
|
|
1915
|
-
|
|
1916
|
-
city: Required[str]
|
|
1917
|
-
|
|
1918
|
-
address2: str
|
|
1919
|
-
|
|
1920
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
1921
|
-
|
|
1922
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
1923
|
-
|
|
1924
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
1925
|
-
|
|
1926
|
-
state: str
|
|
1927
|
-
|
|
1928
|
-
|
|
1929
|
-
class ClaimInformationServiceFacilityLocationSecondaryIdentifier(TypedDict, total=False):
|
|
1930
|
-
identifier: Required[str]
|
|
1931
|
-
|
|
1932
|
-
qualifier: Required[str]
|
|
1933
|
-
|
|
1934
|
-
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1935
|
-
|
|
1936
|
-
|
|
1937
|
-
class ClaimInformationServiceFacilityLocation(TypedDict, total=False):
|
|
1938
|
-
address: Required[ClaimInformationServiceFacilityLocationAddress]
|
|
1939
|
-
|
|
1940
|
-
organization_name: Required[Annotated[str, PropertyInfo(alias="organizationName")]]
|
|
1941
|
-
|
|
1942
|
-
npi: str
|
|
1943
|
-
|
|
1944
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
1945
|
-
|
|
1946
|
-
phone_name: Annotated[str, PropertyInfo(alias="phoneName")]
|
|
1947
|
-
|
|
1948
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
1949
|
-
|
|
1950
|
-
secondary_identifier: Annotated[
|
|
1951
|
-
Iterable[ClaimInformationServiceFacilityLocationSecondaryIdentifier], PropertyInfo(alias="secondaryIdentifier")
|
|
1952
|
-
]
|
|
1953
|
-
|
|
1954
|
-
|
|
1955
|
-
class ClaimInformationSpinalManipulationServiceInformation(TypedDict, total=False):
|
|
1956
|
-
patient_condition_code: Required[Annotated[str, PropertyInfo(alias="patientConditionCode")]]
|
|
1957
|
-
|
|
1958
|
-
patient_condition_description1: Annotated[
|
|
1959
|
-
Literal["A", "C", "D", "E", "F", "G", "M"], PropertyInfo(alias="patientConditionDescription1")
|
|
1960
|
-
]
|
|
1961
|
-
|
|
1962
|
-
patient_condition_description2: Annotated[str, PropertyInfo(alias="patientConditionDescription2")]
|
|
1963
|
-
|
|
1964
|
-
|
|
1965
|
-
class ClaimInformation(TypedDict, total=False):
|
|
1966
|
-
benefits_assignment_certification_indicator: Required[
|
|
1967
|
-
Annotated[Literal["N", "W", "Y"], PropertyInfo(alias="benefitsAssignmentCertificationIndicator")]
|
|
1968
|
-
]
|
|
1969
|
-
|
|
1970
|
-
claim_charge_amount: Required[Annotated[str, PropertyInfo(alias="claimChargeAmount")]]
|
|
1971
|
-
|
|
1972
|
-
claim_filing_code: Required[
|
|
1973
|
-
Annotated[
|
|
1974
|
-
Literal[
|
|
1975
|
-
"11",
|
|
1976
|
-
"12",
|
|
1977
|
-
"13",
|
|
1978
|
-
"14",
|
|
1979
|
-
"15",
|
|
1980
|
-
"16",
|
|
1981
|
-
"17",
|
|
1982
|
-
"AM",
|
|
1983
|
-
"BL",
|
|
1984
|
-
"CH",
|
|
1985
|
-
"CI",
|
|
1986
|
-
"DS",
|
|
1987
|
-
"FI",
|
|
1988
|
-
"HM",
|
|
1989
|
-
"LM",
|
|
1990
|
-
"MA",
|
|
1991
|
-
"MB",
|
|
1992
|
-
"MC",
|
|
1993
|
-
"OF",
|
|
1994
|
-
"TV",
|
|
1995
|
-
"VA",
|
|
1996
|
-
"WC",
|
|
1997
|
-
"ZZ",
|
|
1998
|
-
],
|
|
1999
|
-
PropertyInfo(alias="claimFilingCode"),
|
|
2000
|
-
]
|
|
2001
|
-
]
|
|
2002
|
-
|
|
2003
|
-
claim_frequency_code: Required[Annotated[Literal["1", "7", "8"], PropertyInfo(alias="claimFrequencyCode")]]
|
|
2004
|
-
|
|
2005
|
-
health_care_code_information: Required[
|
|
2006
|
-
Annotated[Iterable[ClaimInformationHealthCareCodeInformation], PropertyInfo(alias="healthCareCodeInformation")]
|
|
2007
|
-
]
|
|
2008
|
-
|
|
2009
|
-
place_of_service_code: Required[
|
|
2010
|
-
Annotated[
|
|
2011
|
-
Literal[
|
|
2012
|
-
"01",
|
|
2013
|
-
"02",
|
|
2014
|
-
"03",
|
|
2015
|
-
"04",
|
|
2016
|
-
"05",
|
|
2017
|
-
"06",
|
|
2018
|
-
"07",
|
|
2019
|
-
"08",
|
|
2020
|
-
"09",
|
|
2021
|
-
"10",
|
|
2022
|
-
"11",
|
|
2023
|
-
"12",
|
|
2024
|
-
"13",
|
|
2025
|
-
"14",
|
|
2026
|
-
"15",
|
|
2027
|
-
"16",
|
|
2028
|
-
"17",
|
|
2029
|
-
"18",
|
|
2030
|
-
"19",
|
|
2031
|
-
"20",
|
|
2032
|
-
"21",
|
|
2033
|
-
"22",
|
|
2034
|
-
"23",
|
|
2035
|
-
"24",
|
|
2036
|
-
"25",
|
|
2037
|
-
"26",
|
|
2038
|
-
"27",
|
|
2039
|
-
"31",
|
|
2040
|
-
"32",
|
|
2041
|
-
"33",
|
|
2042
|
-
"34",
|
|
2043
|
-
"41",
|
|
2044
|
-
"42",
|
|
2045
|
-
"49",
|
|
2046
|
-
"50",
|
|
2047
|
-
"51",
|
|
2048
|
-
"52",
|
|
2049
|
-
"53",
|
|
2050
|
-
"54",
|
|
2051
|
-
"55",
|
|
2052
|
-
"56",
|
|
2053
|
-
"57",
|
|
2054
|
-
"58",
|
|
2055
|
-
"60",
|
|
2056
|
-
"61",
|
|
2057
|
-
"62",
|
|
2058
|
-
"65",
|
|
2059
|
-
"66",
|
|
2060
|
-
"71",
|
|
2061
|
-
"72",
|
|
2062
|
-
"81",
|
|
2063
|
-
"99",
|
|
2064
|
-
],
|
|
2065
|
-
PropertyInfo(alias="placeOfServiceCode"),
|
|
2066
|
-
]
|
|
2067
|
-
]
|
|
2068
|
-
|
|
2069
|
-
plan_participation_code: Required[Annotated[Literal["A", "B", "C"], PropertyInfo(alias="planParticipationCode")]]
|
|
2070
|
-
|
|
2071
|
-
release_information_code: Required[Annotated[Literal["I", "Y"], PropertyInfo(alias="releaseInformationCode")]]
|
|
2072
|
-
|
|
2073
|
-
service_lines: Required[Annotated[Iterable[ClaimInformationServiceLine], PropertyInfo(alias="serviceLines")]]
|
|
2074
|
-
|
|
2075
|
-
signature_indicator: Required[Annotated[Literal["N", "Y"], PropertyInfo(alias="signatureIndicator")]]
|
|
2076
|
-
|
|
2077
|
-
ambulance_certification: Annotated[
|
|
2078
|
-
Iterable[ClaimInformationAmbulanceCertification], PropertyInfo(alias="ambulanceCertification")
|
|
2079
|
-
]
|
|
2080
|
-
|
|
2081
|
-
ambulance_drop_off_location: Annotated[
|
|
2082
|
-
ClaimInformationAmbulanceDropOffLocation, PropertyInfo(alias="ambulanceDropOffLocation")
|
|
2083
|
-
]
|
|
2084
|
-
|
|
2085
|
-
ambulance_pick_up_location: Annotated[
|
|
2086
|
-
ClaimInformationAmbulancePickUpLocation, PropertyInfo(alias="ambulancePickUpLocation")
|
|
2087
|
-
]
|
|
2088
|
-
|
|
2089
|
-
ambulance_transport_information: Annotated[
|
|
2090
|
-
ClaimInformationAmbulanceTransportInformation, PropertyInfo(alias="ambulanceTransportInformation")
|
|
2091
|
-
]
|
|
2092
|
-
|
|
2093
|
-
anesthesia_related_surgical_procedure: Annotated[
|
|
2094
|
-
SequenceNotStr[str], PropertyInfo(alias="anesthesiaRelatedSurgicalProcedure")
|
|
2095
|
-
]
|
|
2096
|
-
|
|
2097
|
-
auto_accident_country_code: Annotated[str, PropertyInfo(alias="autoAccidentCountryCode")]
|
|
2098
|
-
|
|
2099
|
-
auto_accident_state_code: Annotated[str, PropertyInfo(alias="autoAccidentStateCode")]
|
|
2100
|
-
|
|
2101
|
-
claim_contract_information: Annotated[
|
|
2102
|
-
ClaimInformationClaimContractInformation, PropertyInfo(alias="claimContractInformation")
|
|
2103
|
-
]
|
|
2104
|
-
|
|
2105
|
-
claim_date_information: Annotated[ClaimInformationClaimDateInformation, PropertyInfo(alias="claimDateInformation")]
|
|
2106
|
-
|
|
2107
|
-
claim_note: Annotated[ClaimInformationClaimNote, PropertyInfo(alias="claimNote")]
|
|
2108
|
-
|
|
2109
|
-
claim_pricing_repricing_information: Annotated[
|
|
2110
|
-
ClaimInformationClaimPricingRepricingInformation, PropertyInfo(alias="claimPricingRepricingInformation")
|
|
2111
|
-
]
|
|
2112
|
-
|
|
2113
|
-
claim_supplemental_information: Annotated[
|
|
2114
|
-
ClaimInformationClaimSupplementalInformation, PropertyInfo(alias="claimSupplementalInformation")
|
|
2115
|
-
]
|
|
2116
|
-
|
|
2117
|
-
condition_information: Annotated[
|
|
2118
|
-
Iterable[ClaimInformationConditionInformation], PropertyInfo(alias="conditionInformation")
|
|
2119
|
-
]
|
|
2120
|
-
|
|
2121
|
-
death_date: Annotated[str, PropertyInfo(alias="deathDate")]
|
|
2122
|
-
|
|
2123
|
-
delay_reason_code: Annotated[
|
|
2124
|
-
Literal["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "15"], PropertyInfo(alias="delayReasonCode")
|
|
2125
|
-
]
|
|
2126
|
-
|
|
2127
|
-
epsdt_referral: Annotated[ClaimInformationEpsdtReferral, PropertyInfo(alias="epsdtReferral")]
|
|
2128
|
-
|
|
2129
|
-
file_information: Annotated[str, PropertyInfo(alias="fileInformation")]
|
|
2130
|
-
|
|
2131
|
-
file_information_list: Annotated[SequenceNotStr[str], PropertyInfo(alias="fileInformationList")]
|
|
2132
|
-
|
|
2133
|
-
homebound_indicator: Annotated[bool, PropertyInfo(alias="homeboundIndicator")]
|
|
2134
|
-
|
|
2135
|
-
other_subscriber_information: Annotated[
|
|
2136
|
-
Iterable[ClaimInformationOtherSubscriberInformation], PropertyInfo(alias="otherSubscriberInformation")
|
|
2137
|
-
]
|
|
2138
|
-
|
|
2139
|
-
patient_amount_paid: Annotated[str, PropertyInfo(alias="patientAmountPaid")]
|
|
2140
|
-
|
|
2141
|
-
patient_condition_information_vision: Annotated[
|
|
2142
|
-
Iterable[ClaimInformationPatientConditionInformationVision],
|
|
2143
|
-
PropertyInfo(alias="patientConditionInformationVision"),
|
|
2144
|
-
]
|
|
2145
|
-
|
|
2146
|
-
patient_signature_source_code: Annotated[bool, PropertyInfo(alias="patientSignatureSourceCode")]
|
|
2147
|
-
|
|
2148
|
-
patient_weight: Annotated[str, PropertyInfo(alias="patientWeight")]
|
|
2149
|
-
|
|
2150
|
-
pregnancy_indicator: Annotated[Literal["Y"], PropertyInfo(alias="pregnancyIndicator")]
|
|
2151
|
-
|
|
2152
|
-
property_casualty_claim_number: Annotated[str, PropertyInfo(alias="propertyCasualtyClaimNumber")]
|
|
2153
|
-
|
|
2154
|
-
related_causes_code: Annotated[List[Literal["AA", "EM", "OA"]], PropertyInfo(alias="relatedCausesCode")]
|
|
2155
|
-
|
|
2156
|
-
service_facility_location: Annotated[
|
|
2157
|
-
ClaimInformationServiceFacilityLocation, PropertyInfo(alias="serviceFacilityLocation")
|
|
2158
|
-
]
|
|
2159
|
-
|
|
2160
|
-
special_program_code: Annotated[Literal["02", "03", "05", "09"], PropertyInfo(alias="specialProgramCode")]
|
|
2161
|
-
|
|
2162
|
-
spinal_manipulation_service_information: Annotated[
|
|
2163
|
-
ClaimInformationSpinalManipulationServiceInformation, PropertyInfo(alias="spinalManipulationServiceInformation")
|
|
2164
|
-
]
|
|
2165
|
-
|
|
2166
|
-
|
|
2167
|
-
class Receiver(TypedDict, total=False):
|
|
2168
|
-
organization_name: Required[Annotated[str, PropertyInfo(alias="organizationName")]]
|
|
2169
|
-
|
|
2170
|
-
|
|
2171
|
-
class SubmitterContactInformation(TypedDict, total=False):
|
|
2172
|
-
email: str
|
|
2173
|
-
|
|
2174
|
-
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2175
|
-
|
|
2176
|
-
name: str
|
|
2177
|
-
|
|
2178
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2179
|
-
|
|
2180
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2181
|
-
|
|
2182
|
-
|
|
2183
|
-
class Submitter(TypedDict, total=False):
|
|
2184
|
-
contact_information: Required[Annotated[SubmitterContactInformation, PropertyInfo(alias="contactInformation")]]
|
|
2185
|
-
|
|
2186
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2187
|
-
|
|
2188
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2189
|
-
|
|
2190
|
-
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
2191
|
-
|
|
2192
|
-
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2193
|
-
|
|
2194
|
-
submitter_identification: Annotated[str, PropertyInfo(alias="submitterIdentification")]
|
|
2195
|
-
|
|
2196
|
-
|
|
2197
|
-
class SubscriberAddress(TypedDict, total=False):
|
|
2198
|
-
address1: Required[str]
|
|
2199
|
-
|
|
2200
|
-
city: Required[str]
|
|
2201
|
-
|
|
2202
|
-
address2: str
|
|
2203
|
-
|
|
2204
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
2205
|
-
|
|
2206
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
2207
|
-
|
|
2208
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
2209
|
-
|
|
2210
|
-
state: str
|
|
2211
|
-
|
|
2212
|
-
|
|
2213
|
-
class SubscriberContactInformation(TypedDict, total=False):
|
|
2214
|
-
name: Required[str]
|
|
2215
|
-
|
|
2216
|
-
email: str
|
|
2217
|
-
|
|
2218
|
-
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2219
|
-
|
|
2220
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2221
|
-
|
|
2222
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2223
|
-
|
|
2224
|
-
|
|
2225
|
-
class Subscriber(TypedDict, total=False):
|
|
2226
|
-
address: SubscriberAddress
|
|
2227
|
-
|
|
2228
|
-
contact_information: Annotated[SubscriberContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2229
|
-
|
|
2230
|
-
date_of_birth: Annotated[str, PropertyInfo(alias="dateOfBirth")]
|
|
2231
|
-
|
|
2232
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2233
|
-
|
|
2234
|
-
gender: Literal["M", "F", "U"]
|
|
2235
|
-
|
|
2236
|
-
group_number: Annotated[str, PropertyInfo(alias="groupNumber")]
|
|
2237
|
-
|
|
2238
|
-
insurance_type_code: Annotated[
|
|
2239
|
-
Literal["12", "13", "14", "15", "16", "41", "42", "43", "47"], PropertyInfo(alias="insuranceTypeCode")
|
|
2240
|
-
]
|
|
2241
|
-
|
|
2242
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2243
|
-
|
|
2244
|
-
member_id: Annotated[str, PropertyInfo(alias="memberId")]
|
|
2245
|
-
|
|
2246
|
-
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
2247
|
-
|
|
2248
|
-
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2249
|
-
|
|
2250
|
-
payment_responsibility_level_code: Annotated[
|
|
2251
|
-
Literal["A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U"],
|
|
2252
|
-
PropertyInfo(alias="paymentResponsibilityLevelCode"),
|
|
2253
|
-
]
|
|
2254
|
-
|
|
2255
|
-
policy_number: Annotated[str, PropertyInfo(alias="policyNumber")]
|
|
2256
|
-
|
|
2257
|
-
ssn: str
|
|
2258
|
-
|
|
2259
|
-
subscriber_group_name: Annotated[str, PropertyInfo(alias="subscriberGroupName")]
|
|
2260
|
-
|
|
2261
|
-
suffix: str
|
|
2262
|
-
|
|
2263
|
-
|
|
2264
|
-
class DependentAddress(TypedDict, total=False):
|
|
2265
|
-
address1: Required[str]
|
|
2266
|
-
|
|
2267
|
-
city: Required[str]
|
|
2268
|
-
|
|
2269
|
-
address2: str
|
|
2270
|
-
|
|
2271
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
2272
|
-
|
|
2273
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
2274
|
-
|
|
2275
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
2276
|
-
|
|
2277
|
-
state: str
|
|
2278
|
-
|
|
2279
|
-
|
|
2280
|
-
class DependentContactInformation(TypedDict, total=False):
|
|
2281
|
-
name: Required[str]
|
|
2282
|
-
|
|
2283
|
-
email: str
|
|
2284
|
-
|
|
2285
|
-
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2286
|
-
|
|
2287
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2288
|
-
|
|
2289
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2290
|
-
|
|
2291
|
-
|
|
2292
|
-
class Dependent(TypedDict, total=False):
|
|
2293
|
-
date_of_birth: Required[Annotated[str, PropertyInfo(alias="dateOfBirth")]]
|
|
2294
|
-
|
|
2295
|
-
first_name: Required[Annotated[str, PropertyInfo(alias="firstName")]]
|
|
2296
|
-
|
|
2297
|
-
gender: Required[Literal["M", "F", "U"]]
|
|
2298
|
-
|
|
2299
|
-
last_name: Required[Annotated[str, PropertyInfo(alias="lastName")]]
|
|
2300
|
-
|
|
2301
|
-
relationship_to_subscriber_code: Required[
|
|
2302
|
-
Annotated[
|
|
2303
|
-
Literal["01", "19", "20", "21", "39", "40", "53", "G8"], PropertyInfo(alias="relationshipToSubscriberCode")
|
|
2304
|
-
]
|
|
2305
|
-
]
|
|
2306
|
-
|
|
2307
|
-
address: DependentAddress
|
|
2308
|
-
|
|
2309
|
-
contact_information: Annotated[DependentContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2310
|
-
|
|
2311
|
-
member_id: Annotated[str, PropertyInfo(alias="memberId")]
|
|
2312
|
-
|
|
2313
|
-
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
2314
|
-
|
|
2315
|
-
ssn: str
|
|
2316
|
-
|
|
2317
|
-
suffix: str
|
|
2318
|
-
|
|
2319
|
-
|
|
2320
|
-
class OrderingAddress(TypedDict, total=False):
|
|
2321
|
-
address1: Required[str]
|
|
2322
|
-
|
|
2323
|
-
city: Required[str]
|
|
2324
|
-
|
|
2325
|
-
address2: str
|
|
2326
|
-
|
|
2327
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
2328
|
-
|
|
2329
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
2330
|
-
|
|
2331
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
2332
|
-
|
|
2333
|
-
state: str
|
|
2334
|
-
|
|
2335
|
-
|
|
2336
|
-
class OrderingContactInformation(TypedDict, total=False):
|
|
2337
|
-
email: str
|
|
2338
|
-
|
|
2339
|
-
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2340
|
-
|
|
2341
|
-
name: str
|
|
2342
|
-
|
|
2343
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2344
|
-
|
|
2345
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2346
|
-
|
|
2347
|
-
|
|
2348
|
-
class Ordering(TypedDict, total=False):
|
|
2349
|
-
address: OrderingAddress
|
|
2350
|
-
|
|
2351
|
-
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
2352
|
-
|
|
2353
|
-
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
2354
|
-
|
|
2355
|
-
contact_information: Annotated[OrderingContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2356
|
-
|
|
2357
|
-
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
2358
|
-
|
|
2359
|
-
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
2360
|
-
|
|
2361
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2362
|
-
|
|
2363
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2364
|
-
|
|
2365
|
-
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
2366
|
-
|
|
2367
|
-
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
2368
|
-
|
|
2369
|
-
naic: str
|
|
2370
|
-
|
|
2371
|
-
npi: str
|
|
2372
|
-
|
|
2373
|
-
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2374
|
-
|
|
2375
|
-
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
2376
|
-
|
|
2377
|
-
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
2378
|
-
|
|
2379
|
-
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
2380
|
-
|
|
2381
|
-
ssn: str
|
|
2382
|
-
|
|
2383
|
-
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2384
|
-
|
|
2385
|
-
suffix: str
|
|
2386
|
-
|
|
2387
|
-
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
2388
|
-
|
|
2389
|
-
|
|
2390
|
-
class PayerAddress(TypedDict, total=False):
|
|
2391
|
-
address1: Required[str]
|
|
2392
|
-
|
|
2393
|
-
city: Required[str]
|
|
2394
|
-
|
|
2395
|
-
address2: str
|
|
2396
|
-
|
|
2397
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
2398
|
-
|
|
2399
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
2400
|
-
|
|
2401
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
2402
|
-
|
|
2403
|
-
state: str
|
|
2404
|
-
|
|
2405
|
-
|
|
2406
|
-
class PayToAddress(TypedDict, total=False):
|
|
2407
|
-
address1: Required[str]
|
|
2408
|
-
|
|
2409
|
-
city: Required[str]
|
|
2410
|
-
|
|
2411
|
-
address2: str
|
|
2412
|
-
|
|
2413
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
2414
|
-
|
|
2415
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
2416
|
-
|
|
2417
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
2418
|
-
|
|
2419
|
-
state: str
|
|
2420
|
-
|
|
2421
|
-
|
|
2422
|
-
class PayToPlanAddress(TypedDict, total=False):
|
|
2423
|
-
address1: Required[str]
|
|
2424
|
-
|
|
2425
|
-
city: Required[str]
|
|
2426
|
-
|
|
2427
|
-
address2: str
|
|
2428
|
-
|
|
2429
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
2430
|
-
|
|
2431
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
2432
|
-
|
|
2433
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
2434
|
-
|
|
2435
|
-
state: str
|
|
2436
|
-
|
|
2437
|
-
|
|
2438
|
-
class PayToPlan(TypedDict, total=False):
|
|
2439
|
-
address: Required[PayToPlanAddress]
|
|
2440
|
-
|
|
2441
|
-
organization_name: Required[Annotated[str, PropertyInfo(alias="organizationName")]]
|
|
2442
|
-
|
|
2443
|
-
primary_identifier: Required[Annotated[str, PropertyInfo(alias="primaryIdentifier")]]
|
|
2444
|
-
|
|
2445
|
-
primary_identifier_type_code: Required[
|
|
2446
|
-
Annotated[Literal["PI", "XV"], PropertyInfo(alias="primaryIdentifierTypeCode")]
|
|
2447
|
-
]
|
|
2448
|
-
|
|
2449
|
-
tax_identification_number: Required[Annotated[str, PropertyInfo(alias="taxIdentificationNumber")]]
|
|
2450
|
-
|
|
2451
|
-
secondary_identifier: Annotated[str, PropertyInfo(alias="secondaryIdentifier")]
|
|
2452
|
-
|
|
2453
|
-
secondary_identifier_type_code: Annotated[
|
|
2454
|
-
Literal["2U", "FY", "NF"], PropertyInfo(alias="secondaryIdentifierTypeCode")
|
|
2455
|
-
]
|
|
2456
|
-
|
|
2457
|
-
|
|
2458
|
-
class ProviderAddress(TypedDict, total=False):
|
|
2459
|
-
address1: Required[str]
|
|
2460
|
-
|
|
2461
|
-
city: Required[str]
|
|
2462
|
-
|
|
2463
|
-
address2: str
|
|
2464
|
-
|
|
2465
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
2466
|
-
|
|
2467
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
2468
|
-
|
|
2469
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
2470
|
-
|
|
2471
|
-
state: str
|
|
2472
|
-
|
|
2473
|
-
|
|
2474
|
-
class ProviderContactInformation(TypedDict, total=False):
|
|
2475
|
-
email: str
|
|
2476
|
-
|
|
2477
|
-
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2478
|
-
|
|
2479
|
-
name: str
|
|
2480
|
-
|
|
2481
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2482
|
-
|
|
2483
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2484
|
-
|
|
2485
|
-
|
|
2486
|
-
class Provider(TypedDict, total=False):
|
|
2487
|
-
address: ProviderAddress
|
|
2488
|
-
|
|
2489
|
-
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
2490
|
-
|
|
2491
|
-
contact_information: Annotated[ProviderContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2492
|
-
|
|
2493
|
-
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
2494
|
-
|
|
2495
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2496
|
-
|
|
2497
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2498
|
-
|
|
2499
|
-
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
2500
|
-
|
|
2501
|
-
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
2502
|
-
|
|
2503
|
-
npi: str
|
|
2504
|
-
|
|
2505
|
-
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2506
|
-
|
|
2507
|
-
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
2508
|
-
|
|
2509
|
-
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
2510
|
-
|
|
2511
|
-
ssn: str
|
|
2512
|
-
|
|
2513
|
-
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2514
|
-
|
|
2515
|
-
suffix: str
|
|
2516
|
-
|
|
2517
|
-
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
2518
|
-
|
|
2519
|
-
|
|
2520
|
-
class ReferringAddress(TypedDict, total=False):
|
|
2521
|
-
address1: Required[str]
|
|
2522
|
-
|
|
2523
|
-
city: Required[str]
|
|
2524
|
-
|
|
2525
|
-
address2: str
|
|
2526
|
-
|
|
2527
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
2528
|
-
|
|
2529
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
2530
|
-
|
|
2531
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
2532
|
-
|
|
2533
|
-
state: str
|
|
2534
|
-
|
|
2535
|
-
|
|
2536
|
-
class ReferringContactInformation(TypedDict, total=False):
|
|
2537
|
-
email: str
|
|
2538
|
-
|
|
2539
|
-
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2540
|
-
|
|
2541
|
-
name: str
|
|
2542
|
-
|
|
2543
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2544
|
-
|
|
2545
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2546
|
-
|
|
2547
|
-
|
|
2548
|
-
class Referring(TypedDict, total=False):
|
|
2549
|
-
address: ReferringAddress
|
|
2550
|
-
|
|
2551
|
-
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
2552
|
-
|
|
2553
|
-
contact_information: Annotated[ReferringContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2554
|
-
|
|
2555
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2556
|
-
|
|
2557
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2558
|
-
|
|
2559
|
-
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
2560
|
-
|
|
2561
|
-
npi: str
|
|
2562
|
-
|
|
2563
|
-
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2564
|
-
|
|
2565
|
-
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
2566
|
-
|
|
2567
|
-
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
2568
|
-
|
|
2569
|
-
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2570
|
-
|
|
2571
|
-
suffix: str
|
|
2572
|
-
|
|
2573
|
-
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
2574
|
-
|
|
2575
|
-
|
|
2576
|
-
class RenderingAddress(TypedDict, total=False):
|
|
2577
|
-
address1: Required[str]
|
|
2578
|
-
|
|
2579
|
-
city: Required[str]
|
|
2580
|
-
|
|
2581
|
-
address2: str
|
|
2582
|
-
|
|
2583
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
2584
|
-
|
|
2585
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
2586
|
-
|
|
2587
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
2588
|
-
|
|
2589
|
-
state: str
|
|
2590
|
-
|
|
2591
|
-
|
|
2592
|
-
class RenderingContactInformation(TypedDict, total=False):
|
|
2593
|
-
email: str
|
|
2594
|
-
|
|
2595
|
-
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2596
|
-
|
|
2597
|
-
name: str
|
|
2598
|
-
|
|
2599
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2600
|
-
|
|
2601
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2602
|
-
|
|
2603
|
-
|
|
2604
|
-
class Rendering(TypedDict, total=False):
|
|
2605
|
-
address: RenderingAddress
|
|
2606
|
-
|
|
2607
|
-
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
2608
|
-
|
|
2609
|
-
contact_information: Annotated[RenderingContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2610
|
-
|
|
2611
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2612
|
-
|
|
2613
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2614
|
-
|
|
2615
|
-
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
2616
|
-
|
|
2617
|
-
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
2618
|
-
|
|
2619
|
-
npi: str
|
|
2620
|
-
|
|
2621
|
-
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2622
|
-
|
|
2623
|
-
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
2624
|
-
|
|
2625
|
-
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
2626
|
-
|
|
2627
|
-
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2628
|
-
|
|
2629
|
-
suffix: str
|
|
2630
|
-
|
|
2631
|
-
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
2632
|
-
|
|
2633
|
-
|
|
2634
|
-
class SupervisingAddress(TypedDict, total=False):
|
|
2635
|
-
address1: Required[str]
|
|
2636
|
-
|
|
2637
|
-
city: Required[str]
|
|
2638
|
-
|
|
2639
|
-
address2: str
|
|
2640
|
-
|
|
2641
|
-
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
2642
|
-
|
|
2643
|
-
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
2644
|
-
|
|
2645
|
-
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
2646
|
-
|
|
2647
|
-
state: str
|
|
2648
|
-
|
|
2649
|
-
|
|
2650
|
-
class SupervisingContactInformation(TypedDict, total=False):
|
|
2651
|
-
email: str
|
|
2652
|
-
|
|
2653
|
-
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2654
|
-
|
|
2655
|
-
name: str
|
|
2656
|
-
|
|
2657
|
-
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2658
|
-
|
|
2659
|
-
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2660
|
-
|
|
2661
|
-
|
|
2662
|
-
class Supervising(TypedDict, total=False):
|
|
2663
|
-
address: SupervisingAddress
|
|
2664
|
-
|
|
2665
|
-
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
2666
|
-
|
|
2667
|
-
contact_information: Annotated[SupervisingContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2668
|
-
|
|
2669
|
-
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
2670
|
-
|
|
2671
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2672
|
-
|
|
2673
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2674
|
-
|
|
2675
|
-
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
2676
|
-
|
|
2677
|
-
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
2678
|
-
|
|
2679
|
-
npi: str
|
|
2680
|
-
|
|
2681
|
-
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2682
|
-
|
|
2683
|
-
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
2684
|
-
|
|
2685
|
-
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
2686
|
-
|
|
2687
|
-
ssn: str
|
|
2688
|
-
|
|
2689
|
-
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2690
|
-
|
|
2691
|
-
suffix: str
|
|
2692
|
-
|
|
2693
|
-
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|