samplehc 0.5.0__py3-none-any.whl → 0.6.0__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/_version.py +1 -1
- samplehc/resources/v2/__init__.py +14 -0
- samplehc/resources/v2/browser_agents.py +177 -0
- samplehc/resources/v2/clearinghouse/claim.py +20 -32
- samplehc/resources/v2/communication.py +8 -0
- samplehc/resources/v2/database.py +19 -9
- samplehc/resources/v2/events.py +2 -2
- samplehc/resources/v2/integrations/__init__.py +14 -0
- samplehc/resources/v2/integrations/glidian/__init__.py +33 -0
- samplehc/resources/v2/integrations/glidian/glidian.py +425 -0
- samplehc/resources/v2/integrations/glidian/prior_authorizations/__init__.py +33 -0
- samplehc/resources/v2/integrations/glidian/prior_authorizations/clinical_questions.py +276 -0
- samplehc/resources/v2/integrations/glidian/prior_authorizations/prior_authorizations.py +527 -0
- samplehc/resources/v2/integrations/integrations.py +32 -0
- samplehc/resources/v2/v2.py +32 -0
- samplehc/types/v2/__init__.py +2 -0
- samplehc/types/v2/browser_agent_invoke_params.py +13 -0
- samplehc/types/v2/browser_agent_invoke_response.py +12 -0
- samplehc/types/v2/clearinghouse/claim_submit_params.py +1214 -882
- samplehc/types/v2/clearinghouse/claim_submit_response.py +10 -1
- samplehc/types/v2/communication_send_email_params.py +3 -0
- samplehc/types/v2/database_execute_sql_params.py +5 -3
- samplehc/types/v2/event_emit_params.py +1 -1
- samplehc/types/v2/integrations/__init__.py +10 -0
- samplehc/types/v2/integrations/glidian/__init__.py +20 -0
- samplehc/types/v2/integrations/glidian/prior_authorization_create_draft_params.py +32 -0
- samplehc/types/v2/integrations/glidian/prior_authorization_create_draft_response.py +22 -0
- samplehc/types/v2/integrations/glidian/prior_authorization_retrieve_record_response.py +11 -0
- samplehc/types/v2/integrations/glidian/prior_authorization_submit_response.py +14 -0
- samplehc/types/v2/integrations/glidian/prior_authorization_update_record_params.py +20 -0
- samplehc/types/v2/integrations/glidian/prior_authorization_update_record_response.py +14 -0
- samplehc/types/v2/integrations/glidian/prior_authorizations/__init__.py +7 -0
- samplehc/types/v2/integrations/glidian/prior_authorizations/clinical_question_list_response.py +40 -0
- samplehc/types/v2/integrations/glidian/prior_authorizations/clinical_question_update_params.py +22 -0
- samplehc/types/v2/integrations/glidian/prior_authorizations/clinical_question_update_response.py +17 -0
- samplehc/types/v2/integrations/glidian_get_submission_requirements_params.py +17 -0
- samplehc/types/v2/integrations/glidian_get_submission_requirements_response.py +31 -0
- samplehc/types/v2/integrations/glidian_list_payers_params.py +11 -0
- samplehc/types/v2/integrations/glidian_list_payers_response.py +17 -0
- samplehc/types/v2/integrations/glidian_list_services_params.py +13 -0
- samplehc/types/v2/integrations/glidian_list_services_response.py +19 -0
- {samplehc-0.5.0.dist-info → samplehc-0.6.0.dist-info}/METADATA +1 -1
- {samplehc-0.5.0.dist-info → samplehc-0.6.0.dist-info}/RECORD +45 -20
- {samplehc-0.5.0.dist-info → samplehc-0.6.0.dist-info}/WHEEL +0 -0
- {samplehc-0.5.0.dist-info → samplehc-0.6.0.dist-info}/licenses/LICENSE +0 -0
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from __future__ import annotations
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from typing import List,
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from typing_extensions import Literal, Required, Annotated,
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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 ...._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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"ClaimInformationClaimDateInformation",
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"ClaimInformationPrincipalDiagnosis",
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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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"ClaimInformationServiceLineServiceLineReferenceInformationRepricedLineItemRefNumber",
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"ClaimInformationServiceLineServiceLineReferenceInformationAdjustedRepricedLineItemRefNumber",
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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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"ClaimInformationAmbulanceDropOffLocation",
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"ClaimInformationAmbulancePickUpLocation",
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"ClaimInformationAmbulanceTransportInformation",
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"ClaimInformationClaimContractInformation",
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"ClaimInformationClaimDateInformation",
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"ClaimInformationClaimNote",
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"ClaimInformationClaimPricingRepricingInformation",
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"ClaimInformationClaimSupplementalInformation",
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"ClaimInformationClaimSupplementalInformationReportInformation",
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"ClaimInformationDiagnosisRelatedGroupInformation",
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"ClaimInformationConditionInformation",
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"ClaimInformationEpsdtReferral",
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"ClaimInformationExternalCauseOfInjury",
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"ClaimInformationOccurrenceInformationList",
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"ClaimInformationOccurrenceSpanInformation",
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"ClaimInformationOtherDiagnosisInformationList",
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"ClaimInformationOtherProcedureInformationList",
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"ClaimInformationOtherSubscriberInformation",
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"ClaimInformationOtherSubscriberInformationOtherPayerName",
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"ClaimInformationOtherSubscriberInformationOtherPayerNameOtherPayerAddress",
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"ClaimInformationOtherSubscriberInformationOtherPayerNameOtherPayerSecondaryIdentifier",
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"ClaimInformationOtherSubscriberInformationOtherSubscriberName",
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"ClaimInformationOtherSubscriberInformationOtherSubscriberNameOtherInsuredAddress",
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"ClaimInformationOtherSubscriberInformationClaimLevelAdjustment",
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"ClaimInformationOtherSubscriberInformationMedicareInpatientAdjudication",
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"ClaimInformationOtherSubscriberInformationClaimLevelAdjustmentAdjustmentDetail",
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"ClaimInformationOtherSubscriberInformationMedicareOutpatientAdjudication",
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"ClaimInformationOtherSubscriberInformationOtherPayerAttendingProvider",
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"ClaimInformationOtherSubscriberInformationOtherPayerAttendingProviderOtherPayerAttendingProviderIdentifier",
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"ClaimInformationOtherSubscriberInformationOtherPayerBillingProvider",
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"ClaimInformationOtherSubscriberInformationOtherPayerBillingProviderOtherPayerBillingProviderIdentifier",
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"ClaimInformationOtherSubscriberInformationOtherPayerOperatingPhysician",
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"ClaimInformationOtherSubscriberInformationOtherPayerOperatingPhysicianOtherPayerOperatingPhysicianIdentifier",
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"ClaimInformationOtherSubscriberInformationOtherPayerOtherOperatingPhysician",
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"ClaimInformationOtherSubscriberInformationOtherPayerOtherOperatingPhysicianOtherPayerOtherOperatingPhysicianIdentifier",
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"ClaimInformationOtherSubscriberInformationOtherPayerReferringProvider",
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"ClaimInformationOtherSubscriberInformationOtherPayerReferringProviderOtherPayerReferringProviderIdentifier",
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"ClaimInformationOtherSubscriberInformationOtherPayerRenderingProvider",
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"ClaimInformationOtherSubscriberInformationOtherPayerRenderingProviderOtherPayerRenderingProviderSecondaryIdentifier",
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"ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocationOtherPayerServiceFacilityLocationSecondaryIdentifier",
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"ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProvider",
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"ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProviderOtherPayerSupervisingProviderIdentifier",
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"ClaimInformationPatientConditionInformationVision",
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"ClaimInformationServiceFacilityLocation",
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"ClaimInformationServiceFacilityLocationSecondaryIdentifier",
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"ClaimInformationSpinalManipulationServiceInformation",
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"Receiver",
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"Submitter",
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"BillingAddress",
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"BillingPayToPlanNameAddress",
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"SubscriberContactInformation",
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"Dependent",
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"DependentContactInformation",
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"OrderingAddress",
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"OrderingContactInformation",
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"PayToAddress",
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"PayToPlan",
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"PayToPlanAddress",
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"RenderingContactInformation",
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"Supervising",
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"SupervisingAddress",
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"SupervisingContactInformation",
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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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idempotency_key: Required[Annotated[str, PropertyInfo(alias="idempotencyKey")]]
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trading_partner_service_id: Required[Annotated[str, PropertyInfo(alias="tradingPartnerServiceId")]]
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attending: Attending
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billing: Billing
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billing_pay_to_address_name: Annotated[BillingPayToAddressName, PropertyInfo(alias="billingPayToAddressName")]
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billing_pay_to_plan_name: Annotated[BillingPayToPlanName, PropertyInfo(alias="billingPayToPlanName")]
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control_number: Annotated[str, PropertyInfo(alias="controlNumber")]
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correlation_id: Annotated[str, PropertyInfo(alias="correlationId")]
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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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rendering: Rendering
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supervising: Supervising
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trading_partner_name: Annotated[str, PropertyInfo(alias="tradingPartnerName")]
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class BillingAddress(TypedDict, total=False):
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address1: Required[str]
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city: Required[str]
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address2: str
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statement_begin_date: Required[Annotated[str, PropertyInfo(alias="statementBeginDate")]]
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country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
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postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
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state: str
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discharge_hour: Annotated[str, PropertyInfo(alias="dischargeHour")]
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class BillingContactInformation(TypedDict, total=False):
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email: str
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fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
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name: str
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phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
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principal_diagnosis_code: Required[Annotated[str, PropertyInfo(alias="principalDiagnosisCode")]]
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phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
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qualifier_code: Required[Annotated[Literal["ABK", "BK"], PropertyInfo(alias="qualifierCode")]]
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class Billing(TypedDict, total=False):
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address: BillingAddress
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+
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commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
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+
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+
contact_information: Annotated[BillingContactInformation, PropertyInfo(alias="contactInformation")]
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+
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employer_id: Annotated[str, PropertyInfo(alias="employerId")]
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+
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first_name: Annotated[str, PropertyInfo(alias="firstName")]
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last_name: Annotated[str, PropertyInfo(alias="lastName")]
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location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
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middle_name: Annotated[str, PropertyInfo(alias="middleName")]
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npi: str
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organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
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provider_type: Annotated[str, PropertyInfo(alias="providerType")]
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provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
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ssn: str
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state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
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suffix: str
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taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
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+
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+
class ClaimInformationHealthCareCodeInformation(TypedDict, total=False):
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diagnosis_code: Required[Annotated[str, PropertyInfo(alias="diagnosisCode")]]
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diagnosis_type_code: Required[Annotated[Literal["BK", "ABK", "BF", "ABF"], PropertyInfo(alias="diagnosisTypeCode")]]
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+
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+
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+
class ClaimInformationServiceLineProfessionalServiceCompositeDiagnosisCodePointers(TypedDict, total=False):
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diagnosis_code_pointers: Required[Annotated[List[str], PropertyInfo(alias="diagnosisCodePointers")]]
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class
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class ClaimInformationServiceLineProfessionalService(TypedDict, total=False):
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composite_diagnosis_code_pointers: Required[
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+
Annotated[
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+
ClaimInformationServiceLineProfessionalServiceCompositeDiagnosisCodePointers,
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PropertyInfo(alias="compositeDiagnosisCodePointers"),
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249
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+
]
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+
]
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+
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198
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line_item_charge_amount: Required[Annotated[str, PropertyInfo(alias="lineItemChargeAmount")]]
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199
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measurement_unit: Required[Annotated[Literal["
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measurement_unit: Required[Annotated[Literal["MJ", "UN"], PropertyInfo(alias="measurementUnit")]]
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+
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procedure_code: Required[Annotated[str, PropertyInfo(alias="procedureCode")]]
|
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201
257
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-
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procedure_identifier: Required[
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Annotated[Literal["ER", "HC", "IV", "WK"], PropertyInfo(alias="procedureIdentifier")]
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260
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+
]
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203
261
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service_unit_count: Required[Annotated[str, PropertyInfo(alias="serviceUnitCount")]]
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205
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+
copay_status_code: Annotated[Literal["0"], PropertyInfo(alias="copayStatusCode")]
|
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+
|
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206
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description: str
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208
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-
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+
emergency_indicator: Annotated[Literal["Y"], PropertyInfo(alias="emergencyIndicator")]
|
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209
269
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210
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-
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epsdt_indicator: Annotated[Literal["Y"], PropertyInfo(alias="epsdtIndicator")]
|
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211
271
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family_planning_indicator: Annotated[Literal["Y"], PropertyInfo(alias="familyPlanningIndicator")]
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+
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place_of_service_code: Annotated[str, PropertyInfo(alias="placeOfServiceCode")]
|
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213
275
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procedure_modifiers: Annotated[List[str], PropertyInfo(alias="procedureModifiers")]
|
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215
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279
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+
class ClaimInformationServiceLineAmbulanceCertification(TypedDict, total=False):
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certification_condition_indicator: Required[
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281
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+
Annotated[Literal["N", "Y"], PropertyInfo(alias="certificationConditionIndicator")]
|
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282
|
+
]
|
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283
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+
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+
condition_codes: Required[
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285
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+
Annotated[List[Literal["01", "04", "05", "06", "07", "08", "09", "12"]], PropertyInfo(alias="conditionCodes")]
|
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286
|
+
]
|
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287
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+
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+
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+
class ClaimInformationServiceLineAmbulanceDropOffLocation(TypedDict, total=False):
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address1: Required[str]
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291
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+
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+
city: Required[str]
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+
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+
address2: str
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295
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+
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+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
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297
|
+
|
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+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
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299
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+
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300
|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
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+
|
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302
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+
state: str
|
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303
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+
|
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304
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+
|
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305
|
+
class ClaimInformationServiceLineAmbulancePickUpLocation(TypedDict, total=False):
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|
+
address1: Required[str]
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307
|
+
|
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308
|
+
city: Required[str]
|
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309
|
+
|
|
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|
+
address2: str
|
|
311
|
+
|
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312
|
+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
313
|
+
|
|
314
|
+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
315
|
+
|
|
316
|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
317
|
+
|
|
318
|
+
state: str
|
|
319
|
+
|
|
320
|
+
|
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321
|
+
class ClaimInformationServiceLineAmbulanceTransportInformation(TypedDict, total=False):
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|
322
|
+
ambulance_transport_reason_code: Required[
|
|
323
|
+
Annotated[Literal["A", "B", "C", "D", "E"], PropertyInfo(alias="ambulanceTransportReasonCode")]
|
|
324
|
+
]
|
|
325
|
+
|
|
326
|
+
transport_distance_in_miles: Required[Annotated[str, PropertyInfo(alias="transportDistanceInMiles")]]
|
|
327
|
+
|
|
328
|
+
patient_weight_in_pounds: Annotated[str, PropertyInfo(alias="patientWeightInPounds")]
|
|
329
|
+
|
|
330
|
+
round_trip_purpose_description: Annotated[str, PropertyInfo(alias="roundTripPurposeDescription")]
|
|
331
|
+
|
|
332
|
+
stretcher_purpose_description: Annotated[str, PropertyInfo(alias="stretcherPurposeDescription")]
|
|
333
|
+
|
|
334
|
+
|
|
335
|
+
class ClaimInformationServiceLineConditionIndicatorDurableMedicalEquipment(TypedDict, total=False):
|
|
336
|
+
certification_condition_indicator: Required[
|
|
337
|
+
Annotated[Literal["Y", "N"], PropertyInfo(alias="certificationConditionIndicator")]
|
|
338
|
+
]
|
|
339
|
+
|
|
340
|
+
condition_indicator: Required[Annotated[Literal["38", "ZV"], PropertyInfo(alias="conditionIndicator")]]
|
|
341
|
+
|
|
342
|
+
condition_indicator_code: Annotated[Literal["38", "ZV"], PropertyInfo(alias="conditionIndicatorCode")]
|
|
343
|
+
|
|
344
|
+
|
|
345
|
+
class ClaimInformationServiceLineContractInformation(TypedDict, total=False):
|
|
346
|
+
contract_type_code: Required[
|
|
347
|
+
Annotated[Literal["01", "02", "03", "04", "05", "06", "09"], PropertyInfo(alias="contractTypeCode")]
|
|
348
|
+
]
|
|
349
|
+
|
|
350
|
+
contract_amount: Annotated[str, PropertyInfo(alias="contractAmount")]
|
|
351
|
+
|
|
352
|
+
contract_code: Annotated[str, PropertyInfo(alias="contractCode")]
|
|
353
|
+
|
|
354
|
+
contract_percentage: Annotated[str, PropertyInfo(alias="contractPercentage")]
|
|
355
|
+
|
|
356
|
+
contract_version_identifier: Annotated[str, PropertyInfo(alias="contractVersionIdentifier")]
|
|
357
|
+
|
|
358
|
+
terms_discount_percentage: Annotated[str, PropertyInfo(alias="termsDiscountPercentage")]
|
|
359
|
+
|
|
360
|
+
|
|
217
361
|
class ClaimInformationServiceLineDrugIdentification(TypedDict, total=False):
|
|
218
362
|
measurement_unit_code: Required[
|
|
219
363
|
Annotated[Literal["F2", "GR", "ME", "ML", "UN"], PropertyInfo(alias="measurementUnitCode")]
|
|
@@ -223,62 +367,65 @@ class ClaimInformationServiceLineDrugIdentification(TypedDict, total=False):
|
|
|
223
367
|
|
|
224
368
|
national_drug_unit_count: Required[Annotated[str, PropertyInfo(alias="nationalDrugUnitCount")]]
|
|
225
369
|
|
|
370
|
+
service_id_qualifier: Required[
|
|
371
|
+
Annotated[Literal["EN", "EO", "HI", "N4", "ON", "UK", "UP"], PropertyInfo(alias="serviceIdQualifier")]
|
|
372
|
+
]
|
|
373
|
+
|
|
226
374
|
link_sequence_number: Annotated[str, PropertyInfo(alias="linkSequenceNumber")]
|
|
227
375
|
|
|
228
376
|
pharmacy_prescription_number: Annotated[str, PropertyInfo(alias="pharmacyPrescriptionNumber")]
|
|
229
377
|
|
|
230
378
|
|
|
231
|
-
class
|
|
232
|
-
|
|
233
|
-
|
|
234
|
-
|
|
379
|
+
class ClaimInformationServiceLineDurableMedicalEquipmentCertificateOfMedicalNecessity(TypedDict, total=False):
|
|
380
|
+
attachment_transmission_code: Required[
|
|
381
|
+
Annotated[Literal["AB", "AD", "AF", "AG", "NS"], PropertyInfo(alias="attachmentTransmissionCode")]
|
|
382
|
+
]
|
|
235
383
|
|
|
236
|
-
adjustment_quantity: Annotated[str, PropertyInfo(alias="adjustmentQuantity")]
|
|
237
384
|
|
|
385
|
+
class ClaimInformationServiceLineDurableMedicalEquipmentCertification(TypedDict, total=False):
|
|
386
|
+
certification_type_code: Required[Annotated[Literal["I", "R", "S"], PropertyInfo(alias="certificationTypeCode")]]
|
|
238
387
|
|
|
239
|
-
|
|
240
|
-
|
|
241
|
-
Annotated[Literal["CO", "CR", "OA", "PI", "PR"], PropertyInfo(alias="adjustmentGroupCode")]
|
|
388
|
+
durable_medical_equipment_duration_in_months: Required[
|
|
389
|
+
Annotated[str, PropertyInfo(alias="durableMedicalEquipmentDurationInMonths")]
|
|
242
390
|
]
|
|
243
391
|
|
|
244
|
-
claim_adjustment_details: Annotated[
|
|
245
|
-
Iterable[ClaimInformationServiceLineLineAdjudicationInformationLineAdjustmentClaimAdjustmentDetail],
|
|
246
|
-
PropertyInfo(alias="claimAdjustmentDetails"),
|
|
247
|
-
]
|
|
248
392
|
|
|
393
|
+
class ClaimInformationServiceLineDurableMedicalEquipmentService(TypedDict, total=False):
|
|
394
|
+
days: Required[str]
|
|
249
395
|
|
|
250
|
-
|
|
251
|
-
adjudication_or_payment_date: Required[Annotated[str, PropertyInfo(alias="adjudicationOrPaymentDate")]]
|
|
396
|
+
frequency_code: Required[Annotated[Literal["1", "4", "6"], PropertyInfo(alias="frequencyCode")]]
|
|
252
397
|
|
|
253
|
-
|
|
398
|
+
purchase_price: Required[Annotated[str, PropertyInfo(alias="purchasePrice")]]
|
|
254
399
|
|
|
255
|
-
|
|
400
|
+
rental_price: Required[Annotated[str, PropertyInfo(alias="rentalPrice")]]
|
|
256
401
|
|
|
257
|
-
service_line_paid_amount: Required[Annotated[str, PropertyInfo(alias="serviceLinePaidAmount")]]
|
|
258
402
|
|
|
259
|
-
|
|
403
|
+
class ClaimInformationServiceLineFormIdentificationSupportingDocumentation(TypedDict, total=False):
|
|
404
|
+
question_number: Required[Annotated[str, PropertyInfo(alias="questionNumber")]]
|
|
260
405
|
|
|
261
|
-
|
|
406
|
+
question_response: Annotated[str, PropertyInfo(alias="questionResponse")]
|
|
262
407
|
|
|
263
|
-
|
|
264
|
-
Iterable[ClaimInformationServiceLineLineAdjudicationInformationLineAdjustment],
|
|
265
|
-
PropertyInfo(alias="lineAdjustment"),
|
|
266
|
-
]
|
|
408
|
+
question_response_as_date: Annotated[str, PropertyInfo(alias="questionResponseAsDate")]
|
|
267
409
|
|
|
268
|
-
|
|
410
|
+
question_response_as_percent: Annotated[str, PropertyInfo(alias="questionResponseAsPercent")]
|
|
269
411
|
|
|
270
|
-
|
|
412
|
+
question_response_code: Annotated[Literal["N", "W", "Y"], PropertyInfo(alias="questionResponseCode")]
|
|
271
413
|
|
|
272
|
-
procedure_modifier: Annotated[List[str], PropertyInfo(alias="procedureModifier")]
|
|
273
414
|
|
|
274
|
-
|
|
275
|
-
|
|
276
|
-
]
|
|
415
|
+
class ClaimInformationServiceLineFormIdentification(TypedDict, total=False):
|
|
416
|
+
form_identifier: Required[Annotated[str, PropertyInfo(alias="formIdentifier")]]
|
|
277
417
|
|
|
278
|
-
|
|
418
|
+
form_type_code: Required[Annotated[Literal["AS", "UT"], PropertyInfo(alias="formTypeCode")]]
|
|
419
|
+
|
|
420
|
+
supporting_documentation: Annotated[
|
|
421
|
+
Iterable[ClaimInformationServiceLineFormIdentificationSupportingDocumentation],
|
|
422
|
+
PropertyInfo(alias="supportingDocumentation"),
|
|
423
|
+
]
|
|
279
424
|
|
|
280
425
|
|
|
281
|
-
class
|
|
426
|
+
class ClaimInformationServiceLineLineAdjudicationInformationClaimAdjustmentInformationAdjustmentDetail(
|
|
427
|
+
TypedDict, total=False
|
|
428
|
+
):
|
|
282
429
|
adjustment_amount: Required[Annotated[str, PropertyInfo(alias="adjustmentAmount")]]
|
|
283
430
|
|
|
284
431
|
adjustment_reason_code: Required[Annotated[str, PropertyInfo(alias="adjustmentReasonCode")]]
|
|
@@ -286,19 +433,21 @@ class ClaimInformationServiceLineLineAdjustmentInformationClaimAdjustmentClaimAd
|
|
|
286
433
|
adjustment_quantity: Annotated[str, PropertyInfo(alias="adjustmentQuantity")]
|
|
287
434
|
|
|
288
435
|
|
|
289
|
-
class
|
|
290
|
-
|
|
291
|
-
Annotated[
|
|
436
|
+
class ClaimInformationServiceLineLineAdjudicationInformationClaimAdjustmentInformation(TypedDict, total=False):
|
|
437
|
+
adjustment_details: Required[
|
|
438
|
+
Annotated[
|
|
439
|
+
Iterable[ClaimInformationServiceLineLineAdjudicationInformationClaimAdjustmentInformationAdjustmentDetail],
|
|
440
|
+
PropertyInfo(alias="adjustmentDetails"),
|
|
441
|
+
]
|
|
292
442
|
]
|
|
293
443
|
|
|
294
|
-
|
|
295
|
-
|
|
296
|
-
PropertyInfo(alias="claimAdjustmentDetails"),
|
|
444
|
+
adjustment_group_code: Required[
|
|
445
|
+
Annotated[Literal["CO", "CR", "OA", "PI", "PR"], PropertyInfo(alias="adjustmentGroupCode")]
|
|
297
446
|
]
|
|
298
447
|
|
|
299
448
|
|
|
300
|
-
class
|
|
301
|
-
|
|
449
|
+
class ClaimInformationServiceLineLineAdjudicationInformation(TypedDict, total=False):
|
|
450
|
+
adjudication_or_payment_date: Required[Annotated[str, PropertyInfo(alias="adjudicationOrPaymentDate")]]
|
|
302
451
|
|
|
303
452
|
other_payer_primary_identifier: Required[Annotated[str, PropertyInfo(alias="otherPayerPrimaryIdentifier")]]
|
|
304
453
|
|
|
@@ -306,8 +455,6 @@ class ClaimInformationServiceLineLineAdjustmentInformation(TypedDict, total=Fals
|
|
|
306
455
|
|
|
307
456
|
procedure_code: Required[Annotated[str, PropertyInfo(alias="procedureCode")]]
|
|
308
457
|
|
|
309
|
-
remaining_patient_liability: Required[Annotated[str, PropertyInfo(alias="remainingPatientLiability")]]
|
|
310
|
-
|
|
311
458
|
service_id_qualifier: Required[
|
|
312
459
|
Annotated[Literal["ER", "HC", "HP", "IV", "WK"], PropertyInfo(alias="serviceIdQualifier")]
|
|
313
460
|
]
|
|
@@ -316,16 +463,19 @@ class ClaimInformationServiceLineLineAdjustmentInformation(TypedDict, total=Fals
|
|
|
316
463
|
|
|
317
464
|
bundled_or_unbundled_line_number: Annotated[str, PropertyInfo(alias="bundledOrUnbundledLineNumber")]
|
|
318
465
|
|
|
319
|
-
|
|
320
|
-
|
|
466
|
+
claim_adjustment_information: Annotated[
|
|
467
|
+
Iterable[ClaimInformationServiceLineLineAdjudicationInformationClaimAdjustmentInformation],
|
|
468
|
+
PropertyInfo(alias="claimAdjustmentInformation"),
|
|
321
469
|
]
|
|
322
470
|
|
|
323
471
|
procedure_code_description: Annotated[str, PropertyInfo(alias="procedureCodeDescription")]
|
|
324
472
|
|
|
325
|
-
|
|
473
|
+
procedure_modifier: Annotated[List[str], PropertyInfo(alias="procedureModifier")]
|
|
474
|
+
|
|
475
|
+
remaining_patient_liability: Annotated[str, PropertyInfo(alias="remainingPatientLiability")]
|
|
326
476
|
|
|
327
477
|
|
|
328
|
-
class
|
|
478
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+
class ClaimInformationServiceLineLinePricingRepricingInformation(TypedDict, total=False):
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pricing_methodology_code: Required[
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Annotated[
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Literal["00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14"],
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@@ -335,225 +485,208 @@ class ClaimInformationServiceLineLinePricingInformation(TypedDict, total=False):
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repriced_allowed_amount: Required[Annotated[str, PropertyInfo(alias="repricedAllowedAmount")]]
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exception_code: Annotated[Literal["1", "2", "3", "4", "5", "6"], PropertyInfo(alias="exceptionCode")]
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policy_compliance_code: Annotated[Literal["1", "2", "3", "4", "5"], PropertyInfo(alias="policyComplianceCode")]
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reject_reason_code: Annotated[Literal["T1", "T2", "T3", "T4", "T5", "T6"], PropertyInfo(alias="rejectReasonCode")]
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repriced_approved_ambulatory_patient_group_amount: Annotated[
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str, PropertyInfo(alias="repricedApprovedAmbulatoryPatientGroupAmount")
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]
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repriced_approved_ambulatory_patient_group_code: Annotated[
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str, PropertyInfo(alias="repricedApprovedAmbulatoryPatientGroupCode")
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]
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repriced_saving_amount: Annotated[str, PropertyInfo(alias="repricedSavingAmount")]
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repricing_organization_identifier: Annotated[str, PropertyInfo(alias="repricingOrganizationIdentifier")]
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repricing_per_diem_or_flat_rate_amount: Annotated[str, PropertyInfo(alias="repricingPerDiemOrFlatRateAmount")]
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repriced_approved_hcpcs_code: Annotated[str, PropertyInfo(alias="repricedApprovedHCPCSCode")]
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+
class ClaimInformationServiceLineOrderingProviderAddress(TypedDict, total=False):
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address1: Required[str]
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city: Required[str]
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address2: str
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country_code: Annotated[str, PropertyInfo(alias="countryCode")]
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country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
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pricing_methodology_code: Required[
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Annotated[
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Literal["00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14"],
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PropertyInfo(alias="pricingMethodologyCode"),
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]
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]
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postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
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state: str
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exception_code: Annotated[Literal["1", "2", "3", "4", "5", "6"], PropertyInfo(alias="exceptionCode")]
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-
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+
class ClaimInformationServiceLineOrderingProviderContactInformation(TypedDict, total=False):
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name: Required[str]
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]
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email: str
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fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
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+
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phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
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+
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phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
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-
reject_reason_code: Annotated[Literal["T1", "T2", "T3", "T4", "T5", "T6"], PropertyInfo(alias="rejectReasonCode")]
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-
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+
class ClaimInformationServiceLineOrderingProviderSecondaryIdentifier(TypedDict, total=False):
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identifier: Required[str]
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+
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qualifier: Required[str]
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other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
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repriced_approved_hcpcs_code: Annotated[str, PropertyInfo(alias="repricedApprovedHCPCSCode")]
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-
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+
class ClaimInformationServiceLineOrderingProvider(TypedDict, total=False):
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address: ClaimInformationServiceLineOrderingProviderAddress
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claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
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commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
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+
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contact_information: Annotated[
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ClaimInformationServiceLineOrderingProviderContactInformation, PropertyInfo(alias="contactInformation")
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]
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employer_id: Annotated[str, PropertyInfo(alias="employerId")]
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employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
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first_name: Annotated[str, PropertyInfo(alias="firstName")]
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last_name: Annotated[str, PropertyInfo(alias="lastName")]
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location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
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-
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|
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attachment_control_number: Required[Annotated[str, PropertyInfo(alias="attachmentControlNumber")]]
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|
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middle_name: Annotated[str, PropertyInfo(alias="middleName")]
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"AM",
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"AS",
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"B2",
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"B3",
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"B4",
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|
-
"BR",
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|
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"BS",
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|
-
"BT",
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|
-
"CB",
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433
|
-
"CK",
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|
-
"CT",
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435
|
-
"D2",
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436
|
-
"DA",
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437
|
-
"DB",
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438
|
-
"DG",
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439
|
-
"DJ",
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440
|
-
"DS",
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441
|
-
"EB",
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|
-
"HC",
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443
|
-
"HR",
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444
|
-
"I5",
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445
|
-
"IR",
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446
|
-
"LA",
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447
|
-
"M1",
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448
|
-
"MT",
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449
|
-
"NN",
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450
|
-
"OB",
|
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451
|
-
"OC",
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452
|
-
"OD",
|
|
453
|
-
"OE",
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454
|
-
"OX",
|
|
455
|
-
"OZ",
|
|
456
|
-
"P4",
|
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457
|
-
"P5",
|
|
458
|
-
"PE",
|
|
459
|
-
"PN",
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460
|
-
"PO",
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|
461
|
-
"PQ",
|
|
462
|
-
"PY",
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|
463
|
-
"PZ",
|
|
464
|
-
"RB",
|
|
465
|
-
"RR",
|
|
466
|
-
"RT",
|
|
467
|
-
"RX",
|
|
468
|
-
"SG",
|
|
469
|
-
"V5",
|
|
470
|
-
"XP",
|
|
471
|
-
],
|
|
472
|
-
PropertyInfo(alias="attachmentReportTypeCode"),
|
|
473
|
-
]
|
|
568
|
+
naic: str
|
|
569
|
+
|
|
570
|
+
npi: str
|
|
571
|
+
|
|
572
|
+
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
573
|
+
|
|
574
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
575
|
+
|
|
576
|
+
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
577
|
+
|
|
578
|
+
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
579
|
+
|
|
580
|
+
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
581
|
+
|
|
582
|
+
secondary_identifier: Annotated[
|
|
583
|
+
Iterable[ClaimInformationServiceLineOrderingProviderSecondaryIdentifier],
|
|
584
|
+
PropertyInfo(alias="secondaryIdentifier"),
|
|
474
585
|
]
|
|
475
586
|
|
|
476
|
-
|
|
477
|
-
|
|
587
|
+
ssn: str
|
|
588
|
+
|
|
589
|
+
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
590
|
+
|
|
591
|
+
suffix: str
|
|
592
|
+
|
|
593
|
+
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
594
|
+
|
|
595
|
+
|
|
596
|
+
class ClaimInformationServiceLinePurchasedServiceInformation(TypedDict, total=False):
|
|
597
|
+
purchased_service_charge_amount: Required[Annotated[str, PropertyInfo(alias="purchasedServiceChargeAmount")]]
|
|
598
|
+
|
|
599
|
+
purchased_service_provider_identifier: Required[
|
|
600
|
+
Annotated[str, PropertyInfo(alias="purchasedServiceProviderIdentifier")]
|
|
478
601
|
]
|
|
479
602
|
|
|
480
603
|
|
|
481
|
-
class
|
|
482
|
-
|
|
604
|
+
class ClaimInformationServiceLinePurchasedServiceProviderAddress(TypedDict, total=False):
|
|
605
|
+
address1: Required[str]
|
|
483
606
|
|
|
484
|
-
|
|
607
|
+
city: Required[str]
|
|
485
608
|
|
|
486
|
-
|
|
609
|
+
address2: str
|
|
487
610
|
|
|
488
|
-
|
|
611
|
+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
489
612
|
|
|
490
|
-
|
|
613
|
+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
491
614
|
|
|
492
|
-
|
|
615
|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
493
616
|
|
|
494
|
-
|
|
617
|
+
state: str
|
|
495
618
|
|
|
496
|
-
peer_review_authorization_number: Annotated[str, PropertyInfo(alias="peerReviewAuthorizationNumber")]
|
|
497
619
|
|
|
498
|
-
|
|
620
|
+
class ClaimInformationServiceLinePurchasedServiceProviderContactInformation(TypedDict, total=False):
|
|
621
|
+
email: str
|
|
499
622
|
|
|
500
|
-
|
|
623
|
+
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
501
624
|
|
|
502
|
-
|
|
503
|
-
ClaimInformationServiceLineLineSupplementInformationReportInformation, PropertyInfo(alias="reportInformation")
|
|
504
|
-
]
|
|
625
|
+
name: str
|
|
505
626
|
|
|
506
|
-
|
|
507
|
-
Iterable[ClaimInformationServiceLineLineSupplementInformationReportInformation],
|
|
508
|
-
PropertyInfo(alias="reportInformations"),
|
|
509
|
-
]
|
|
627
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
510
628
|
|
|
511
|
-
|
|
629
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
512
630
|
|
|
513
|
-
|
|
514
|
-
|
|
631
|
+
|
|
632
|
+
class ClaimInformationServiceLinePurchasedServiceProviderSecondaryIdentifier(TypedDict, total=False):
|
|
633
|
+
identifier: Required[str]
|
|
634
|
+
|
|
635
|
+
qualifier: Required[str]
|
|
636
|
+
|
|
637
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
638
|
+
|
|
639
|
+
|
|
640
|
+
class ClaimInformationServiceLinePurchasedServiceProvider(TypedDict, total=False):
|
|
641
|
+
address: ClaimInformationServiceLinePurchasedServiceProviderAddress
|
|
642
|
+
|
|
643
|
+
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
644
|
+
|
|
645
|
+
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
646
|
+
|
|
647
|
+
contact_information: Annotated[
|
|
648
|
+
ClaimInformationServiceLinePurchasedServiceProviderContactInformation, PropertyInfo(alias="contactInformation")
|
|
515
649
|
]
|
|
516
650
|
|
|
651
|
+
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
517
652
|
|
|
518
|
-
|
|
519
|
-
last_name: Required[Annotated[str, PropertyInfo(alias="lastName")]]
|
|
653
|
+
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
520
654
|
|
|
521
655
|
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
522
656
|
|
|
523
|
-
|
|
524
|
-
|
|
525
|
-
]
|
|
657
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
658
|
+
|
|
659
|
+
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
526
660
|
|
|
527
661
|
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
528
662
|
|
|
663
|
+
naic: str
|
|
664
|
+
|
|
529
665
|
npi: str
|
|
530
666
|
|
|
531
667
|
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
532
668
|
|
|
533
|
-
|
|
534
|
-
|
|
535
|
-
suffix: str
|
|
536
|
-
|
|
537
|
-
|
|
538
|
-
class ClaimInformationServiceLineOtherOperatingPhysician(TypedDict, total=False):
|
|
539
|
-
last_name: Required[Annotated[str, PropertyInfo(alias="lastName")]]
|
|
669
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
540
670
|
|
|
541
|
-
|
|
671
|
+
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
542
672
|
|
|
543
|
-
|
|
544
|
-
Literal["0B", "1G", "G2", "LU"], PropertyInfo(alias="identificationQualifierCode")
|
|
545
|
-
]
|
|
673
|
+
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
546
674
|
|
|
547
|
-
|
|
675
|
+
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
548
676
|
|
|
549
|
-
|
|
677
|
+
secondary_identifier: Annotated[
|
|
678
|
+
Iterable[ClaimInformationServiceLinePurchasedServiceProviderSecondaryIdentifier],
|
|
679
|
+
PropertyInfo(alias="secondaryIdentifier"),
|
|
680
|
+
]
|
|
550
681
|
|
|
551
|
-
|
|
682
|
+
ssn: str
|
|
552
683
|
|
|
553
|
-
|
|
684
|
+
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
554
685
|
|
|
555
686
|
suffix: str
|
|
556
687
|
|
|
688
|
+
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
689
|
+
|
|
557
690
|
|
|
558
691
|
class ClaimInformationServiceLineReferringProviderAddress(TypedDict, total=False):
|
|
559
692
|
address1: Required[str]
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@@ -572,26 +705,32 @@ class ClaimInformationServiceLineReferringProviderAddress(TypedDict, total=False
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class ClaimInformationServiceLineReferringProviderContactInformation(TypedDict, total=False):
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name: Required[str]
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email: str
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fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
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name: str
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phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
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phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
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class
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class ClaimInformationServiceLineReferringProviderSecondaryIdentifier(TypedDict, total=False):
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identifier: Required[str]
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qualifier: Required[str]
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other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
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class ClaimInformationServiceLineReferringProvider(TypedDict, total=False):
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provider_type: Required[Annotated[str, PropertyInfo(alias="providerType")]]
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address: ClaimInformationServiceLineReferringProviderAddress
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claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
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commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
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contact_information: Annotated[
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@@ -600,6 +739,8 @@ class ClaimInformationServiceLineReferringProvider(TypedDict, total=False):
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employer_id: Annotated[str, PropertyInfo(alias="employerId")]
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employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
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first_name: Annotated[str, PropertyInfo(alias="firstName")]
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last_name: Annotated[str, PropertyInfo(alias="lastName")]
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@@ -608,24 +749,24 @@ class ClaimInformationServiceLineReferringProvider(TypedDict, total=False):
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middle_name: Annotated[str, PropertyInfo(alias="middleName")]
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naic: str
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npi: str
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organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
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other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
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payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
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Iterable[ClaimInformationServiceLineReferringProviderReferenceIdentification],
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PropertyInfo(alias="referenceIdentification"),
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]
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provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
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secondary_identifier: Annotated[
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Iterable[ClaimInformationServiceLineReferringProviderSecondaryIdentifier],
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PropertyInfo(alias="secondaryIdentifier"),
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]
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ssn: str
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state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
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@@ -651,26 +792,32 @@ class ClaimInformationServiceLineRenderingProviderAddress(TypedDict, total=False
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class ClaimInformationServiceLineRenderingProviderContactInformation(TypedDict, total=False):
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name: Required[str]
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email: str
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fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
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name: str
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phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
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phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
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class
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class ClaimInformationServiceLineRenderingProviderSecondaryIdentifier(TypedDict, total=False):
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identifier: Required[str]
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qualifier: Required[str]
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other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
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class ClaimInformationServiceLineRenderingProvider(TypedDict, total=False):
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provider_type: Required[Annotated[str, PropertyInfo(alias="providerType")]]
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address: ClaimInformationServiceLineRenderingProviderAddress
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claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
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commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
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contact_information: Annotated[
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@@ -679,6 +826,8 @@ class ClaimInformationServiceLineRenderingProvider(TypedDict, total=False):
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employer_id: Annotated[str, PropertyInfo(alias="employerId")]
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employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
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first_name: Annotated[str, PropertyInfo(alias="firstName")]
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last_name: Annotated[str, PropertyInfo(alias="lastName")]
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@@ -687,24 +836,24 @@ class ClaimInformationServiceLineRenderingProvider(TypedDict, total=False):
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middle_name: Annotated[str, PropertyInfo(alias="middleName")]
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naic: str
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npi: str
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organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
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other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
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payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
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Iterable[ClaimInformationServiceLineRenderingProviderReferenceIdentification],
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PropertyInfo(alias="referenceIdentification"),
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]
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provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
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secondary_identifier: Annotated[
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Iterable[ClaimInformationServiceLineRenderingProviderSecondaryIdentifier],
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PropertyInfo(alias="secondaryIdentifier"),
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]
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ssn: str
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state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
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@@ -713,37 +862,104 @@ class ClaimInformationServiceLineRenderingProvider(TypedDict, total=False):
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taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
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class ClaimInformationServiceLineServiceFacilityLocationAddress(TypedDict, total=False):
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address1: Required[str]
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city: Required[str]
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address2: str
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country_code: Annotated[str, PropertyInfo(alias="countryCode")]
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country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
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postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
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state: str
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class ClaimInformationServiceLineServiceFacilityLocationSecondaryIdentifier(TypedDict, total=False):
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identifier: Required[str]
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qualifier: Required[str]
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other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
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class ClaimInformationServiceLineServiceFacilityLocation(TypedDict, total=False):
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address: Required[ClaimInformationServiceLineServiceFacilityLocationAddress]
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organization_name: Required[Annotated[str, PropertyInfo(alias="organizationName")]]
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npi: str
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phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
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phone_name: Annotated[str, PropertyInfo(alias="phoneName")]
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phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
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secondary_identifier: Annotated[
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903
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Iterable[ClaimInformationServiceLineServiceFacilityLocationSecondaryIdentifier],
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904
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PropertyInfo(alias="secondaryIdentifier"),
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]
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906
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908
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class ClaimInformationServiceLineServiceLineDateInformation(TypedDict, total=False):
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begin_therapy_date: Annotated[str, PropertyInfo(alias="beginTherapyDate")]
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910
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certification_revision_or_recertification_date: Annotated[
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str, PropertyInfo(alias="certificationRevisionOrRecertificationDate")
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]
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914
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hemoglobin_test_date: Annotated[str, PropertyInfo(alias="hemoglobinTestDate")]
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initial_treatment_date: Annotated[str, PropertyInfo(alias="initialTreatmentDate")]
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last_certification_date: Annotated[str, PropertyInfo(alias="lastCertificationDate")]
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provider_control_number: Required[Annotated[str, PropertyInfo(alias="providerControlNumber")]]
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last_x_ray_date: Annotated[str, PropertyInfo(alias="lastXRayDate")]
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prescription_date: Annotated[str, PropertyInfo(alias="prescriptionDate")]
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repriced_line_item_ref_number: Required[Annotated[str, PropertyInfo(alias="repricedLineItemRefNumber")]]
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serum_creatine_test_date: Annotated[str, PropertyInfo(alias="serumCreatineTestDate")]
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926
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shipped_date: Annotated[str, PropertyInfo(alias="shippedDate")]
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treatment_or_therapy_date: Annotated[str, PropertyInfo(alias="treatmentOrTherapyDate")]
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930
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931
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932
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class ClaimInformationServiceLineServiceLineReferenceInformationPriorAuthorization(TypedDict, total=False):
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prior_authorization_or_referral_number: Required[
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Annotated[str, PropertyInfo(alias="priorAuthorizationOrReferralNumber")]
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935
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]
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936
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other_payer_primary_identifier: Annotated[str, PropertyInfo(alias="otherPayerPrimaryIdentifier")]
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]
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class ClaimInformationServiceLineServiceLineReferenceInformation(TypedDict, total=False):
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941
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adjusted_repriced_line_item_reference_number: Annotated[
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str, PropertyInfo(alias="adjustedRepricedLineItemReferenceNumber")
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943
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]
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944
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945
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clinical_laboratory_improvement_amendment_number: Annotated[
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str, PropertyInfo(alias="clinicalLaboratoryImprovementAmendmentNumber")
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947
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]
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948
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949
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immunization_batch_number: Annotated[str, PropertyInfo(alias="immunizationBatchNumber")]
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mammography_certification_number: Annotated[str, PropertyInfo(alias="mammographyCertificationNumber")]
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952
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953
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prior_authorization: Annotated[
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954
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Iterable[ClaimInformationServiceLineServiceLineReferenceInformationPriorAuthorization],
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955
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PropertyInfo(alias="priorAuthorization"),
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956
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+
]
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957
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referral_number: Annotated[List[str], PropertyInfo(alias="referralNumber")]
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referring_clia_number: Annotated[str, PropertyInfo(alias="referringCliaNumber")]
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961
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+
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repriced_line_item_reference_number: Annotated[str, PropertyInfo(alias="repricedLineItemReferenceNumber")]
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747
963
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748
964
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749
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class ClaimInformationServiceLineServiceLineSupplementalInformation(TypedDict, total=False):
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@@ -789,7 +1005,7 @@ class ClaimInformationServiceLineServiceLineSupplementalInformation(TypedDict, t
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789
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"LA",
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790
1006
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"M1",
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1007
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"MT",
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792
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"
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1008
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+
"NM",
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793
1009
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"OB",
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794
1010
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"OC",
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795
1011
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"OD",
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@@ -823,94 +1039,284 @@ class ClaimInformationServiceLineServiceLineSupplementalInformation(TypedDict, t
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823
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attachment_control_number: Annotated[str, PropertyInfo(alias="attachmentControlNumber")]
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824
1040
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825
1041
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1042
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+
class ClaimInformationServiceLineSupervisingProviderAddress(TypedDict, total=False):
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1043
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address1: Required[str]
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1044
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+
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1045
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city: Required[str]
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1046
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+
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1047
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address2: str
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1048
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+
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1049
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country_code: Annotated[str, PropertyInfo(alias="countryCode")]
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1050
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+
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1051
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country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
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1052
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+
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1053
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postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
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1054
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+
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1055
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state: str
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1056
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+
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1057
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+
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1058
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+
class ClaimInformationServiceLineSupervisingProviderContactInformation(TypedDict, total=False):
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1059
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+
email: str
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1060
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+
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1061
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+
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
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1062
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+
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1063
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+
name: str
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1064
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+
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1065
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+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
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1066
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+
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1067
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+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
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1068
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+
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1069
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+
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1070
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+
class ClaimInformationServiceLineSupervisingProviderSecondaryIdentifier(TypedDict, total=False):
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1071
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+
identifier: Required[str]
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1072
|
+
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1073
|
+
qualifier: Required[str]
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|
1074
|
+
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1075
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+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
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1076
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+
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1077
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+
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1078
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+
class ClaimInformationServiceLineSupervisingProvider(TypedDict, total=False):
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1079
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+
provider_type: Required[Annotated[str, PropertyInfo(alias="providerType")]]
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|
1080
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+
|
|
1081
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+
address: ClaimInformationServiceLineSupervisingProviderAddress
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|
1082
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+
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1083
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+
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
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1084
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+
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1085
|
+
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
1086
|
+
|
|
1087
|
+
contact_information: Annotated[
|
|
1088
|
+
ClaimInformationServiceLineSupervisingProviderContactInformation, PropertyInfo(alias="contactInformation")
|
|
1089
|
+
]
|
|
1090
|
+
|
|
1091
|
+
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
1092
|
+
|
|
1093
|
+
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
1094
|
+
|
|
1095
|
+
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
1096
|
+
|
|
1097
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
1098
|
+
|
|
1099
|
+
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
1100
|
+
|
|
1101
|
+
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
1102
|
+
|
|
1103
|
+
naic: str
|
|
1104
|
+
|
|
1105
|
+
npi: str
|
|
1106
|
+
|
|
1107
|
+
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
1108
|
+
|
|
1109
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1110
|
+
|
|
1111
|
+
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
1112
|
+
|
|
1113
|
+
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
1114
|
+
|
|
1115
|
+
secondary_identifier: Annotated[
|
|
1116
|
+
Iterable[ClaimInformationServiceLineSupervisingProviderSecondaryIdentifier],
|
|
1117
|
+
PropertyInfo(alias="secondaryIdentifier"),
|
|
1118
|
+
]
|
|
1119
|
+
|
|
1120
|
+
ssn: str
|
|
1121
|
+
|
|
1122
|
+
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
1123
|
+
|
|
1124
|
+
suffix: str
|
|
1125
|
+
|
|
1126
|
+
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
1127
|
+
|
|
1128
|
+
|
|
1129
|
+
class ClaimInformationServiceLineTestResult(TypedDict, total=False):
|
|
1130
|
+
measurement_qualifier: Required[
|
|
1131
|
+
Annotated[Literal["HT", "R1", "R2", "R3", "R4"], PropertyInfo(alias="measurementQualifier")]
|
|
1132
|
+
]
|
|
1133
|
+
|
|
1134
|
+
measurement_reference_identification_code: Required[
|
|
1135
|
+
Annotated[Literal["OG", "TR"], PropertyInfo(alias="measurementReferenceIdentificationCode")]
|
|
1136
|
+
]
|
|
1137
|
+
|
|
1138
|
+
test_results: Required[Annotated[str, PropertyInfo(alias="testResults")]]
|
|
1139
|
+
|
|
1140
|
+
|
|
826
1141
|
class ClaimInformationServiceLine(TypedDict, total=False):
|
|
827
|
-
|
|
828
|
-
Annotated[
|
|
1142
|
+
professional_service: Required[
|
|
1143
|
+
Annotated[ClaimInformationServiceLineProfessionalService, PropertyInfo(alias="professionalService")]
|
|
829
1144
|
]
|
|
830
1145
|
|
|
831
|
-
|
|
832
|
-
|
|
1146
|
+
service_date: Required[Annotated[str, PropertyInfo(alias="serviceDate")]]
|
|
1147
|
+
|
|
1148
|
+
additional_notes: Annotated[str, PropertyInfo(alias="additionalNotes")]
|
|
1149
|
+
|
|
1150
|
+
ambulance_certification: Annotated[
|
|
1151
|
+
Iterable[ClaimInformationServiceLineAmbulanceCertification], PropertyInfo(alias="ambulanceCertification")
|
|
1152
|
+
]
|
|
1153
|
+
|
|
1154
|
+
ambulance_drop_off_location: Annotated[
|
|
1155
|
+
ClaimInformationServiceLineAmbulanceDropOffLocation, PropertyInfo(alias="ambulanceDropOffLocation")
|
|
1156
|
+
]
|
|
1157
|
+
|
|
1158
|
+
ambulance_patient_count: Annotated[float, PropertyInfo(alias="ambulancePatientCount")]
|
|
1159
|
+
|
|
1160
|
+
ambulance_pick_up_location: Annotated[
|
|
1161
|
+
ClaimInformationServiceLineAmbulancePickUpLocation, PropertyInfo(alias="ambulancePickUpLocation")
|
|
1162
|
+
]
|
|
1163
|
+
|
|
1164
|
+
ambulance_transport_information: Annotated[
|
|
1165
|
+
ClaimInformationServiceLineAmbulanceTransportInformation, PropertyInfo(alias="ambulanceTransportInformation")
|
|
833
1166
|
]
|
|
834
1167
|
|
|
835
1168
|
assigned_number: Annotated[str, PropertyInfo(alias="assignedNumber")]
|
|
836
1169
|
|
|
837
|
-
|
|
1170
|
+
condition_indicator_durable_medical_equipment: Annotated[
|
|
1171
|
+
ClaimInformationServiceLineConditionIndicatorDurableMedicalEquipment,
|
|
1172
|
+
PropertyInfo(alias="conditionIndicatorDurableMedicalEquipment"),
|
|
1173
|
+
]
|
|
1174
|
+
|
|
1175
|
+
contract_information: Annotated[
|
|
1176
|
+
ClaimInformationServiceLineContractInformation, PropertyInfo(alias="contractInformation")
|
|
1177
|
+
]
|
|
838
1178
|
|
|
839
1179
|
drug_identification: Annotated[
|
|
840
1180
|
ClaimInformationServiceLineDrugIdentification, PropertyInfo(alias="drugIdentification")
|
|
841
1181
|
]
|
|
842
1182
|
|
|
843
|
-
|
|
1183
|
+
durable_medical_equipment_certificate_of_medical_necessity: Annotated[
|
|
1184
|
+
ClaimInformationServiceLineDurableMedicalEquipmentCertificateOfMedicalNecessity,
|
|
1185
|
+
PropertyInfo(alias="durableMedicalEquipmentCertificateOfMedicalNecessity"),
|
|
1186
|
+
]
|
|
1187
|
+
|
|
1188
|
+
durable_medical_equipment_certification: Annotated[
|
|
1189
|
+
ClaimInformationServiceLineDurableMedicalEquipmentCertification,
|
|
1190
|
+
PropertyInfo(alias="durableMedicalEquipmentCertification"),
|
|
1191
|
+
]
|
|
1192
|
+
|
|
1193
|
+
durable_medical_equipment_service: Annotated[
|
|
1194
|
+
ClaimInformationServiceLineDurableMedicalEquipmentService, PropertyInfo(alias="durableMedicalEquipmentService")
|
|
1195
|
+
]
|
|
1196
|
+
|
|
1197
|
+
file_information: Annotated[List[str], PropertyInfo(alias="fileInformation")]
|
|
1198
|
+
|
|
1199
|
+
form_identification: Annotated[
|
|
1200
|
+
Iterable[ClaimInformationServiceLineFormIdentification], PropertyInfo(alias="formIdentification")
|
|
1201
|
+
]
|
|
1202
|
+
|
|
1203
|
+
goal_rehab_or_discharge_plans: Annotated[str, PropertyInfo(alias="goalRehabOrDischargePlans")]
|
|
1204
|
+
|
|
1205
|
+
hospice_employee_indicator: Annotated[bool, PropertyInfo(alias="hospiceEmployeeIndicator")]
|
|
844
1206
|
|
|
845
1207
|
line_adjudication_information: Annotated[
|
|
846
1208
|
Iterable[ClaimInformationServiceLineLineAdjudicationInformation],
|
|
847
1209
|
PropertyInfo(alias="lineAdjudicationInformation"),
|
|
848
1210
|
]
|
|
849
1211
|
|
|
850
|
-
|
|
851
|
-
|
|
1212
|
+
line_pricing_repricing_information: Annotated[
|
|
1213
|
+
ClaimInformationServiceLineLinePricingRepricingInformation,
|
|
1214
|
+
PropertyInfo(alias="linePricingRepricingInformation"),
|
|
1215
|
+
]
|
|
1216
|
+
|
|
1217
|
+
obstetric_anesthesia_additional_units: Annotated[float, PropertyInfo(alias="obstetricAnesthesiaAdditionalUnits")]
|
|
1218
|
+
|
|
1219
|
+
ordering_provider: Annotated[ClaimInformationServiceLineOrderingProvider, PropertyInfo(alias="orderingProvider")]
|
|
1220
|
+
|
|
1221
|
+
postage_tax_amount: Annotated[str, PropertyInfo(alias="postageTaxAmount")]
|
|
1222
|
+
|
|
1223
|
+
purchased_service_information: Annotated[
|
|
1224
|
+
ClaimInformationServiceLinePurchasedServiceInformation, PropertyInfo(alias="purchasedServiceInformation")
|
|
1225
|
+
]
|
|
1226
|
+
|
|
1227
|
+
purchased_service_provider: Annotated[
|
|
1228
|
+
ClaimInformationServiceLinePurchasedServiceProvider, PropertyInfo(alias="purchasedServiceProvider")
|
|
1229
|
+
]
|
|
1230
|
+
|
|
1231
|
+
referring_provider: Annotated[ClaimInformationServiceLineReferringProvider, PropertyInfo(alias="referringProvider")]
|
|
1232
|
+
|
|
1233
|
+
rendering_provider: Annotated[ClaimInformationServiceLineRenderingProvider, PropertyInfo(alias="renderingProvider")]
|
|
1234
|
+
|
|
1235
|
+
sales_tax_amount: Annotated[str, PropertyInfo(alias="salesTaxAmount")]
|
|
1236
|
+
|
|
1237
|
+
service_date_end: Annotated[str, PropertyInfo(alias="serviceDateEnd")]
|
|
1238
|
+
|
|
1239
|
+
service_facility_location: Annotated[
|
|
1240
|
+
ClaimInformationServiceLineServiceFacilityLocation, PropertyInfo(alias="serviceFacilityLocation")
|
|
1241
|
+
]
|
|
1242
|
+
|
|
1243
|
+
service_line_date_information: Annotated[
|
|
1244
|
+
ClaimInformationServiceLineServiceLineDateInformation, PropertyInfo(alias="serviceLineDateInformation")
|
|
1245
|
+
]
|
|
1246
|
+
|
|
1247
|
+
service_line_reference_information: Annotated[
|
|
1248
|
+
ClaimInformationServiceLineServiceLineReferenceInformation,
|
|
1249
|
+
PropertyInfo(alias="serviceLineReferenceInformation"),
|
|
1250
|
+
]
|
|
1251
|
+
|
|
1252
|
+
service_line_supplemental_information: Annotated[
|
|
1253
|
+
Iterable[ClaimInformationServiceLineServiceLineSupplementalInformation],
|
|
1254
|
+
PropertyInfo(alias="serviceLineSupplementalInformation"),
|
|
1255
|
+
]
|
|
1256
|
+
|
|
1257
|
+
supervising_provider: Annotated[
|
|
1258
|
+
ClaimInformationServiceLineSupervisingProvider, PropertyInfo(alias="supervisingProvider")
|
|
1259
|
+
]
|
|
1260
|
+
|
|
1261
|
+
test_results: Annotated[Iterable[ClaimInformationServiceLineTestResult], PropertyInfo(alias="testResults")]
|
|
1262
|
+
|
|
1263
|
+
third_party_organization_notes: Annotated[str, PropertyInfo(alias="thirdPartyOrganizationNotes")]
|
|
1264
|
+
|
|
1265
|
+
|
|
1266
|
+
class ClaimInformationAmbulanceCertification(TypedDict, total=False):
|
|
1267
|
+
certification_condition_indicator: Required[
|
|
1268
|
+
Annotated[Literal["N", "Y"], PropertyInfo(alias="certificationConditionIndicator")]
|
|
1269
|
+
]
|
|
1270
|
+
|
|
1271
|
+
condition_codes: Required[
|
|
1272
|
+
Annotated[List[Literal["01", "04", "05", "06", "07", "08", "09", "12"]], PropertyInfo(alias="conditionCodes")]
|
|
852
1273
|
]
|
|
853
1274
|
|
|
854
|
-
line_note_text: Annotated[str, PropertyInfo(alias="lineNoteText")]
|
|
855
1275
|
|
|
856
|
-
|
|
857
|
-
|
|
858
|
-
|
|
1276
|
+
class ClaimInformationAmbulanceDropOffLocation(TypedDict, total=False):
|
|
1277
|
+
address1: Required[str]
|
|
1278
|
+
|
|
1279
|
+
city: Required[str]
|
|
1280
|
+
|
|
1281
|
+
address2: str
|
|
1282
|
+
|
|
1283
|
+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
859
1284
|
|
|
860
|
-
|
|
861
|
-
ClaimInformationServiceLineLineRepricingInformation, PropertyInfo(alias="lineRepricingInformation")
|
|
862
|
-
]
|
|
1285
|
+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
863
1286
|
|
|
864
|
-
|
|
865
|
-
ClaimInformationServiceLineLineSupplementInformation, PropertyInfo(alias="lineSupplementInformation")
|
|
866
|
-
]
|
|
1287
|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
867
1288
|
|
|
868
|
-
|
|
869
|
-
ClaimInformationServiceLineOperatingPhysician, PropertyInfo(alias="operatingPhysician")
|
|
870
|
-
]
|
|
1289
|
+
state: str
|
|
871
1290
|
|
|
872
|
-
other_operating_physician: Annotated[
|
|
873
|
-
ClaimInformationServiceLineOtherOperatingPhysician, PropertyInfo(alias="otherOperatingPhysician")
|
|
874
|
-
]
|
|
875
1291
|
|
|
876
|
-
|
|
1292
|
+
class ClaimInformationAmbulancePickUpLocation(TypedDict, total=False):
|
|
1293
|
+
address1: Required[str]
|
|
877
1294
|
|
|
878
|
-
|
|
1295
|
+
city: Required[str]
|
|
879
1296
|
|
|
880
|
-
|
|
1297
|
+
address2: str
|
|
881
1298
|
|
|
882
|
-
|
|
1299
|
+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
883
1300
|
|
|
884
|
-
|
|
1301
|
+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
885
1302
|
|
|
886
|
-
|
|
887
|
-
ClaimInformationServiceLineServiceLineDateInformation, PropertyInfo(alias="serviceLineDateInformation")
|
|
888
|
-
]
|
|
1303
|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
889
1304
|
|
|
890
|
-
|
|
891
|
-
ClaimInformationServiceLineServiceLineReferenceInformation,
|
|
892
|
-
PropertyInfo(alias="serviceLineReferenceInformation"),
|
|
893
|
-
]
|
|
1305
|
+
state: str
|
|
894
1306
|
|
|
895
|
-
service_line_supplemental_information: Annotated[
|
|
896
|
-
ClaimInformationServiceLineServiceLineSupplementalInformation,
|
|
897
|
-
PropertyInfo(alias="serviceLineSupplementalInformation"),
|
|
898
|
-
]
|
|
899
1307
|
|
|
900
|
-
|
|
901
|
-
|
|
902
|
-
PropertyInfo(alias="
|
|
1308
|
+
class ClaimInformationAmbulanceTransportInformation(TypedDict, total=False):
|
|
1309
|
+
ambulance_transport_reason_code: Required[
|
|
1310
|
+
Annotated[Literal["A", "B", "C", "D", "E"], PropertyInfo(alias="ambulanceTransportReasonCode")]
|
|
903
1311
|
]
|
|
904
1312
|
|
|
905
|
-
|
|
906
|
-
|
|
907
|
-
third_party_organization_notes: Annotated[str, PropertyInfo(alias="thirdPartyOrganizationNotes")]
|
|
1313
|
+
transport_distance_in_miles: Required[Annotated[str, PropertyInfo(alias="transportDistanceInMiles")]]
|
|
908
1314
|
|
|
1315
|
+
patient_weight_in_pounds: Annotated[str, PropertyInfo(alias="patientWeightInPounds")]
|
|
909
1316
|
|
|
910
|
-
|
|
911
|
-
admitting_diagnosis_code: Required[Annotated[str, PropertyInfo(alias="admittingDiagnosisCode")]]
|
|
1317
|
+
round_trip_purpose_description: Annotated[str, PropertyInfo(alias="roundTripPurposeDescription")]
|
|
912
1318
|
|
|
913
|
-
|
|
1319
|
+
stretcher_purpose_description: Annotated[str, PropertyInfo(alias="stretcherPurposeDescription")]
|
|
914
1320
|
|
|
915
1321
|
|
|
916
1322
|
class ClaimInformationClaimContractInformation(TypedDict, total=False):
|
|
@@ -929,41 +1335,57 @@ class ClaimInformationClaimContractInformation(TypedDict, total=False):
|
|
|
929
1335
|
terms_discount_percentage: Annotated[str, PropertyInfo(alias="termsDiscountPercentage")]
|
|
930
1336
|
|
|
931
1337
|
|
|
932
|
-
class
|
|
933
|
-
|
|
1338
|
+
class ClaimInformationClaimDateInformation(TypedDict, total=False):
|
|
1339
|
+
accident_date: Annotated[str, PropertyInfo(alias="accidentDate")]
|
|
934
1340
|
|
|
935
|
-
|
|
1341
|
+
acute_manifestation_date: Annotated[str, PropertyInfo(alias="acuteManifestationDate")]
|
|
936
1342
|
|
|
937
|
-
|
|
1343
|
+
admission_date: Annotated[str, PropertyInfo(alias="admissionDate")]
|
|
938
1344
|
|
|
939
|
-
|
|
1345
|
+
assumed_and_relinquished_care_begin_date: Annotated[str, PropertyInfo(alias="assumedAndRelinquishedCareBeginDate")]
|
|
940
1346
|
|
|
941
|
-
|
|
1347
|
+
assumed_and_relinquished_care_end_date: Annotated[str, PropertyInfo(alias="assumedAndRelinquishedCareEndDate")]
|
|
942
1348
|
|
|
943
|
-
|
|
1349
|
+
authorized_return_to_work_date: Annotated[str, PropertyInfo(alias="authorizedReturnToWorkDate")]
|
|
944
1350
|
|
|
945
|
-
|
|
1351
|
+
disability_begin_date: Annotated[str, PropertyInfo(alias="disabilityBeginDate")]
|
|
946
1352
|
|
|
947
|
-
|
|
1353
|
+
disability_end_date: Annotated[str, PropertyInfo(alias="disabilityEndDate")]
|
|
948
1354
|
|
|
949
|
-
|
|
950
|
-
|
|
951
|
-
]
|
|
1355
|
+
discharge_date: Annotated[str, PropertyInfo(alias="dischargeDate")]
|
|
1356
|
+
|
|
1357
|
+
first_contact_date: Annotated[str, PropertyInfo(alias="firstContactDate")]
|
|
1358
|
+
|
|
1359
|
+
hearing_and_vision_prescription_date: Annotated[str, PropertyInfo(alias="hearingAndVisionPrescriptionDate")]
|
|
1360
|
+
|
|
1361
|
+
initial_treatment_date: Annotated[str, PropertyInfo(alias="initialTreatmentDate")]
|
|
1362
|
+
|
|
1363
|
+
last_menstrual_period_date: Annotated[str, PropertyInfo(alias="lastMenstrualPeriodDate")]
|
|
952
1364
|
|
|
953
|
-
|
|
1365
|
+
last_seen_date: Annotated[str, PropertyInfo(alias="lastSeenDate")]
|
|
954
1366
|
|
|
955
|
-
|
|
1367
|
+
last_worked_date: Annotated[str, PropertyInfo(alias="lastWorkedDate")]
|
|
956
1368
|
|
|
957
|
-
|
|
1369
|
+
last_x_ray_date: Annotated[str, PropertyInfo(alias="lastXRayDate")]
|
|
958
1370
|
|
|
959
|
-
|
|
1371
|
+
repricer_received_date: Annotated[str, PropertyInfo(alias="repricerReceivedDate")]
|
|
1372
|
+
|
|
1373
|
+
symptom_date: Annotated[str, PropertyInfo(alias="symptomDate")]
|
|
1374
|
+
|
|
1375
|
+
|
|
1376
|
+
class ClaimInformationClaimNote(TypedDict, total=False):
|
|
1377
|
+
additional_information: Annotated[str, PropertyInfo(alias="additionalInformation")]
|
|
960
1378
|
|
|
961
|
-
|
|
1379
|
+
certification_narrative: Annotated[str, PropertyInfo(alias="certificationNarrative")]
|
|
962
1380
|
|
|
963
|
-
|
|
1381
|
+
diagnosis_description: Annotated[str, PropertyInfo(alias="diagnosisDescription")]
|
|
964
1382
|
|
|
1383
|
+
goal_rehab_or_discharge_plans: Annotated[str, PropertyInfo(alias="goalRehabOrDischargePlans")]
|
|
965
1384
|
|
|
966
|
-
|
|
1385
|
+
third_part_org_notes: Annotated[str, PropertyInfo(alias="thirdPartOrgNotes")]
|
|
1386
|
+
|
|
1387
|
+
|
|
1388
|
+
class ClaimInformationClaimPricingRepricingInformation(TypedDict, total=False):
|
|
967
1389
|
pricing_methodology_code: Required[
|
|
968
1390
|
Annotated[
|
|
969
1391
|
Literal["00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14"],
|
|
@@ -977,36 +1399,24 @@ class ClaimInformationClaimPricingInformation(TypedDict, total=False):
|
|
|
977
1399
|
|
|
978
1400
|
policy_compliance_code: Annotated[Literal["1", "2", "3", "4", "5"], PropertyInfo(alias="policyComplianceCode")]
|
|
979
1401
|
|
|
980
|
-
product_or_service_id_qualifier: Annotated[
|
|
981
|
-
Literal["ER", "HC", "HP", "IV", "WK"], PropertyInfo(alias="productOrServiceIDQualifier")
|
|
982
|
-
]
|
|
983
|
-
|
|
984
1402
|
reject_reason_code: Annotated[Literal["T1", "T2", "T3", "T4", "T5", "T6"], PropertyInfo(alias="rejectReasonCode")]
|
|
985
1403
|
|
|
986
|
-
|
|
987
|
-
|
|
988
|
-
repriced_approved_drg_code: Annotated[str, PropertyInfo(alias="repricedApprovedDRGCode")]
|
|
989
|
-
|
|
990
|
-
repriced_approved_hcpcs_code: Annotated[str, PropertyInfo(alias="repricedApprovedHCPCSCode")]
|
|
991
|
-
|
|
992
|
-
repriced_approved_revenue_code: Annotated[str, PropertyInfo(alias="repricedApprovedRevenueCode")]
|
|
993
|
-
|
|
994
|
-
repriced_approved_service_unit_code: Annotated[
|
|
995
|
-
Literal["DA", "UN"], PropertyInfo(alias="repricedApprovedServiceUnitCode")
|
|
1404
|
+
repriced_approved_ambulatory_patient_group_amount: Annotated[
|
|
1405
|
+
str, PropertyInfo(alias="repricedApprovedAmbulatoryPatientGroupAmount")
|
|
996
1406
|
]
|
|
997
1407
|
|
|
998
|
-
|
|
1408
|
+
repriced_approved_ambulatory_patient_group_code: Annotated[
|
|
1409
|
+
str, PropertyInfo(alias="repricedApprovedAmbulatoryPatientGroupCode")
|
|
1410
|
+
]
|
|
999
1411
|
|
|
1000
|
-
|
|
1412
|
+
repriced_saving_amount: Annotated[str, PropertyInfo(alias="repricedSavingAmount")]
|
|
1001
1413
|
|
|
1002
|
-
|
|
1414
|
+
repricing_organization_identifier: Annotated[str, PropertyInfo(alias="repricingOrganizationIdentifier")]
|
|
1003
1415
|
|
|
1004
|
-
|
|
1416
|
+
repricing_per_diem_or_flat_rate_amount: Annotated[str, PropertyInfo(alias="repricingPerDiemOrFlatRateAmount")]
|
|
1005
1417
|
|
|
1006
1418
|
|
|
1007
1419
|
class ClaimInformationClaimSupplementalInformationReportInformation(TypedDict, total=False):
|
|
1008
|
-
attachment_control_number: Required[Annotated[str, PropertyInfo(alias="attachmentControlNumber")]]
|
|
1009
|
-
|
|
1010
1420
|
attachment_report_type_code: Required[
|
|
1011
1421
|
Annotated[
|
|
1012
1422
|
Literal[
|
|
@@ -1049,7 +1459,7 @@ class ClaimInformationClaimSupplementalInformationReportInformation(TypedDict, t
|
|
|
1049
1459
|
"LA",
|
|
1050
1460
|
"M1",
|
|
1051
1461
|
"MT",
|
|
1052
|
-
"
|
|
1462
|
+
"NM",
|
|
1053
1463
|
"OB",
|
|
1054
1464
|
"OC",
|
|
1055
1465
|
"OD",
|
|
@@ -1080,23 +1490,29 @@ class ClaimInformationClaimSupplementalInformationReportInformation(TypedDict, t
|
|
|
1080
1490
|
Annotated[Literal["AA", "BM", "EL", "EM", "FT", "FX"], PropertyInfo(alias="attachmentTransmissionCode")]
|
|
1081
1491
|
]
|
|
1082
1492
|
|
|
1493
|
+
attachment_control_number: Annotated[str, PropertyInfo(alias="attachmentControlNumber")]
|
|
1494
|
+
|
|
1083
1495
|
|
|
1084
1496
|
class ClaimInformationClaimSupplementalInformation(TypedDict, total=False):
|
|
1085
|
-
|
|
1497
|
+
adjusted_repriced_claim_number: Annotated[str, PropertyInfo(alias="adjustedRepricedClaimNumber")]
|
|
1086
1498
|
|
|
1087
|
-
|
|
1499
|
+
care_plan_oversight_number: Annotated[str, PropertyInfo(alias="carePlanOversightNumber")]
|
|
1088
1500
|
|
|
1089
1501
|
claim_control_number: Annotated[str, PropertyInfo(alias="claimControlNumber")]
|
|
1090
1502
|
|
|
1091
1503
|
claim_number: Annotated[str, PropertyInfo(alias="claimNumber")]
|
|
1092
1504
|
|
|
1505
|
+
clia_number: Annotated[str, PropertyInfo(alias="cliaNumber")]
|
|
1506
|
+
|
|
1093
1507
|
demo_project_identifier: Annotated[str, PropertyInfo(alias="demoProjectIdentifier")]
|
|
1094
1508
|
|
|
1095
1509
|
investigational_device_exemption_number: Annotated[str, PropertyInfo(alias="investigationalDeviceExemptionNumber")]
|
|
1096
1510
|
|
|
1511
|
+
mammography_certification_number: Annotated[str, PropertyInfo(alias="mammographyCertificationNumber")]
|
|
1512
|
+
|
|
1097
1513
|
medical_record_number: Annotated[str, PropertyInfo(alias="medicalRecordNumber")]
|
|
1098
1514
|
|
|
1099
|
-
|
|
1515
|
+
medicare_crossover_reference_id: Annotated[str, PropertyInfo(alias="medicareCrossoverReferenceId")]
|
|
1100
1516
|
|
|
1101
1517
|
prior_authorization_number: Annotated[str, PropertyInfo(alias="priorAuthorizationNumber")]
|
|
1102
1518
|
|
|
@@ -1118,12 +1534,8 @@ class ClaimInformationClaimSupplementalInformation(TypedDict, total=False):
|
|
|
1118
1534
|
]
|
|
1119
1535
|
|
|
1120
1536
|
|
|
1121
|
-
class
|
|
1122
|
-
|
|
1123
|
-
|
|
1124
|
-
|
|
1125
|
-
class ClaimInformationDiagnosisRelatedGroupInformation(TypedDict, total=False):
|
|
1126
|
-
drug_related_group_code: Required[Annotated[str, PropertyInfo(alias="drugRelatedGroupCode")]]
|
|
1537
|
+
class ClaimInformationConditionInformation(TypedDict, total=False):
|
|
1538
|
+
condition_codes: Required[Annotated[List[str], PropertyInfo(alias="conditionCodes")]]
|
|
1127
1539
|
|
|
1128
1540
|
|
|
1129
1541
|
class ClaimInformationEpsdtReferral(TypedDict, total=False):
|
|
@@ -1134,48 +1546,6 @@ class ClaimInformationEpsdtReferral(TypedDict, total=False):
|
|
|
1134
1546
|
condition_codes: Required[Annotated[List[Literal["AV", "NU", "S2", "ST"]], PropertyInfo(alias="conditionCodes")]]
|
|
1135
1547
|
|
|
1136
1548
|
|
|
1137
|
-
class ClaimInformationExternalCauseOfInjury(TypedDict, total=False):
|
|
1138
|
-
external_cause_of_injury: Required[Annotated[str, PropertyInfo(alias="externalCauseOfInjury")]]
|
|
1139
|
-
|
|
1140
|
-
qualifier_code: Required[Annotated[Literal["ABN", "BN"], PropertyInfo(alias="qualifierCode")]]
|
|
1141
|
-
|
|
1142
|
-
present_on_admission_indicator: Annotated[
|
|
1143
|
-
Literal["N", "U", "Y", "W"], PropertyInfo(alias="presentOnAdmissionIndicator")
|
|
1144
|
-
]
|
|
1145
|
-
|
|
1146
|
-
|
|
1147
|
-
class ClaimInformationOccurrenceInformationList(TypedDict, total=False):
|
|
1148
|
-
occurrence_span_code: Required[Annotated[str, PropertyInfo(alias="occurrenceSpanCode")]]
|
|
1149
|
-
|
|
1150
|
-
occurrence_span_code_date: Required[Annotated[str, PropertyInfo(alias="occurrenceSpanCodeDate")]]
|
|
1151
|
-
|
|
1152
|
-
|
|
1153
|
-
class ClaimInformationOccurrenceSpanInformation(TypedDict, total=False):
|
|
1154
|
-
occurrence_span_code: Required[Annotated[str, PropertyInfo(alias="occurrenceSpanCode")]]
|
|
1155
|
-
|
|
1156
|
-
occurrence_span_code_end_date: Required[Annotated[str, PropertyInfo(alias="occurrenceSpanCodeEndDate")]]
|
|
1157
|
-
|
|
1158
|
-
occurrence_span_code_start_date: Required[Annotated[str, PropertyInfo(alias="occurrenceSpanCodeStartDate")]]
|
|
1159
|
-
|
|
1160
|
-
|
|
1161
|
-
class ClaimInformationOtherDiagnosisInformationList(TypedDict, total=False):
|
|
1162
|
-
other_diagnosis_code: Required[Annotated[str, PropertyInfo(alias="otherDiagnosisCode")]]
|
|
1163
|
-
|
|
1164
|
-
qualifier_code: Required[Annotated[Literal["ABF", "BF"], PropertyInfo(alias="qualifierCode")]]
|
|
1165
|
-
|
|
1166
|
-
present_on_admission_indicator: Annotated[
|
|
1167
|
-
Literal["N", "Y", "U", "W"], PropertyInfo(alias="presentOnAdmissionIndicator")
|
|
1168
|
-
]
|
|
1169
|
-
|
|
1170
|
-
|
|
1171
|
-
class ClaimInformationOtherProcedureInformationList(TypedDict, total=False):
|
|
1172
|
-
other_procedure_code: Required[Annotated[str, PropertyInfo(alias="otherProcedureCode")]]
|
|
1173
|
-
|
|
1174
|
-
qualifier_code: Required[Annotated[Literal["BBQ", "BQ"], PropertyInfo(alias="qualifierCode")]]
|
|
1175
|
-
|
|
1176
|
-
other_procedure_date: Annotated[str, PropertyInfo(alias="otherProcedureDate")]
|
|
1177
|
-
|
|
1178
|
-
|
|
1179
1549
|
class ClaimInformationOtherSubscriberInformationOtherPayerNameOtherPayerAddress(TypedDict, total=False):
|
|
1180
1550
|
address1: Required[str]
|
|
1181
1551
|
|
|
@@ -1197,6 +1567,8 @@ class ClaimInformationOtherSubscriberInformationOtherPayerNameOtherPayerSecondar
|
|
|
1197
1567
|
|
|
1198
1568
|
qualifier: Required[str]
|
|
1199
1569
|
|
|
1570
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1571
|
+
|
|
1200
1572
|
|
|
1201
1573
|
class ClaimInformationOtherSubscriberInformationOtherPayerName(TypedDict, total=False):
|
|
1202
1574
|
other_payer_identifier: Required[Annotated[str, PropertyInfo(alias="otherPayerIdentifier")]]
|
|
@@ -1207,8 +1579,6 @@ class ClaimInformationOtherSubscriberInformationOtherPayerName(TypedDict, total=
|
|
|
1207
1579
|
|
|
1208
1580
|
other_payer_organization_name: Required[Annotated[str, PropertyInfo(alias="otherPayerOrganizationName")]]
|
|
1209
1581
|
|
|
1210
|
-
other_insured_additional_identifier: Annotated[str, PropertyInfo(alias="otherInsuredAdditionalIdentifier")]
|
|
1211
|
-
|
|
1212
1582
|
other_payer_address: Annotated[
|
|
1213
1583
|
ClaimInformationOtherSubscriberInformationOtherPayerNameOtherPayerAddress,
|
|
1214
1584
|
PropertyInfo(alias="otherPayerAddress"),
|
|
@@ -1232,7 +1602,7 @@ class ClaimInformationOtherSubscriberInformationOtherPayerName(TypedDict, total=
|
|
|
1232
1602
|
]
|
|
1233
1603
|
|
|
1234
1604
|
|
|
1235
|
-
class
|
|
1605
|
+
class ClaimInformationOtherSubscriberInformationOtherSubscriberNameOtherInsuredAddress(TypedDict, total=False):
|
|
1236
1606
|
address1: Required[str]
|
|
1237
1607
|
|
|
1238
1608
|
city: Required[str]
|
|
@@ -1259,20 +1629,21 @@ class ClaimInformationOtherSubscriberInformationOtherSubscriberName(TypedDict, t
|
|
|
1259
1629
|
|
|
1260
1630
|
other_insured_qualifier: Required[Annotated[Literal["1", "2"], PropertyInfo(alias="otherInsuredQualifier")]]
|
|
1261
1631
|
|
|
1262
|
-
|
|
1263
|
-
|
|
1264
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
1632
|
+
other_insured_additional_identifier: Annotated[str, PropertyInfo(alias="otherInsuredAdditionalIdentifier")]
|
|
1265
1633
|
|
|
1266
|
-
|
|
1634
|
+
other_insured_address: Annotated[
|
|
1635
|
+
ClaimInformationOtherSubscriberInformationOtherSubscriberNameOtherInsuredAddress,
|
|
1636
|
+
PropertyInfo(alias="otherInsuredAddress"),
|
|
1637
|
+
]
|
|
1267
1638
|
|
|
1268
1639
|
other_insured_first_name: Annotated[str, PropertyInfo(alias="otherInsuredFirstName")]
|
|
1269
1640
|
|
|
1270
1641
|
other_insured_middle_name: Annotated[str, PropertyInfo(alias="otherInsuredMiddleName")]
|
|
1271
1642
|
|
|
1272
|
-
|
|
1643
|
+
other_insured_name_suffix: Annotated[str, PropertyInfo(alias="otherInsuredNameSuffix")]
|
|
1273
1644
|
|
|
1274
1645
|
|
|
1275
|
-
class
|
|
1646
|
+
class ClaimInformationOtherSubscriberInformationClaimLevelAdjustmentAdjustmentDetail(TypedDict, total=False):
|
|
1276
1647
|
adjustment_amount: Required[Annotated[str, PropertyInfo(alias="adjustmentAmount")]]
|
|
1277
1648
|
|
|
1278
1649
|
adjustment_reason_code: Required[Annotated[str, PropertyInfo(alias="adjustmentReasonCode")]]
|
|
@@ -1281,59 +1652,15 @@ class ClaimInformationOtherSubscriberInformationClaimLevelAdjustmentClaimAdjustm
|
|
|
1281
1652
|
|
|
1282
1653
|
|
|
1283
1654
|
class ClaimInformationOtherSubscriberInformationClaimLevelAdjustment(TypedDict, total=False):
|
|
1284
|
-
|
|
1285
|
-
Annotated[
|
|
1286
|
-
|
|
1287
|
-
|
|
1288
|
-
|
|
1289
|
-
Iterable[ClaimInformationOtherSubscriberInformationClaimLevelAdjustmentClaimAdjustmentDetail],
|
|
1290
|
-
PropertyInfo(alias="claimAdjustmentDetails"),
|
|
1291
|
-
]
|
|
1292
|
-
|
|
1293
|
-
|
|
1294
|
-
class ClaimInformationOtherSubscriberInformationMedicareInpatientAdjudication(TypedDict, total=False):
|
|
1295
|
-
covered_days_or_visits_count: Required[Annotated[str, PropertyInfo(alias="coveredDaysOrVisitsCount")]]
|
|
1296
|
-
|
|
1297
|
-
capital_exception_amount: Annotated[str, PropertyInfo(alias="capitalExceptionAmount")]
|
|
1298
|
-
|
|
1299
|
-
capital_hspdrg_amount: Annotated[str, PropertyInfo(alias="capitalHSPDRGAmount")]
|
|
1300
|
-
|
|
1301
|
-
claim_disproportionate_share_amount: Annotated[str, PropertyInfo(alias="claimDisproportionateShareAmount")]
|
|
1302
|
-
|
|
1303
|
-
claim_drg_amount: Annotated[str, PropertyInfo(alias="claimDRGAmount")]
|
|
1304
|
-
|
|
1305
|
-
claim_indirect_teaching_amount: Annotated[str, PropertyInfo(alias="claimIndirectTeachingAmount")]
|
|
1306
|
-
|
|
1307
|
-
claim_msp_pass_through_amount: Annotated[str, PropertyInfo(alias="claimMspPassThroughAmount")]
|
|
1308
|
-
|
|
1309
|
-
claim_payment_remark_code: Annotated[List[str], PropertyInfo(alias="claimPaymentRemarkCode")]
|
|
1310
|
-
|
|
1311
|
-
claim_pps_capital_amount: Annotated[str, PropertyInfo(alias="claimPpsCapitalAmount")]
|
|
1312
|
-
|
|
1313
|
-
claim_pps_capital_outlier_ammount: Annotated[str, PropertyInfo(alias="claimPpsCapitalOutlierAmmount")]
|
|
1314
|
-
|
|
1315
|
-
cost_report_day_count: Annotated[str, PropertyInfo(alias="costReportDayCount")]
|
|
1316
|
-
|
|
1317
|
-
lifetime_psychiatric_days_count: Annotated[str, PropertyInfo(alias="lifetimePsychiatricDaysCount")]
|
|
1318
|
-
|
|
1319
|
-
non_payable_professional_component_billed_amount: Annotated[
|
|
1320
|
-
str, PropertyInfo(alias="nonPayableProfessionalComponentBilledAmount")
|
|
1321
|
-
]
|
|
1322
|
-
|
|
1323
|
-
old_capital_amount: Annotated[str, PropertyInfo(alias="oldCapitalAmount")]
|
|
1324
|
-
|
|
1325
|
-
pps_capital_dsh_drg_amount: Annotated[str, PropertyInfo(alias="ppsCapitalDshDrgAmount")]
|
|
1326
|
-
|
|
1327
|
-
pps_capital_hsp_drg_amount: Annotated[str, PropertyInfo(alias="ppsCapitalHspDrgAmount")]
|
|
1328
|
-
|
|
1329
|
-
pps_capital_ime_amount: Annotated[str, PropertyInfo(alias="ppsCapitalImeAmount")]
|
|
1330
|
-
|
|
1331
|
-
pps_operating_federal_specific_drg_amount: Annotated[
|
|
1332
|
-
str, PropertyInfo(alias="ppsOperatingFederalSpecificDrgAmount")
|
|
1655
|
+
adjustment_details: Required[
|
|
1656
|
+
Annotated[
|
|
1657
|
+
Iterable[ClaimInformationOtherSubscriberInformationClaimLevelAdjustmentAdjustmentDetail],
|
|
1658
|
+
PropertyInfo(alias="adjustmentDetails"),
|
|
1659
|
+
]
|
|
1333
1660
|
]
|
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1334
1661
|
|
|
1335
|
-
|
|
1336
|
-
|
|
1662
|
+
adjustment_group_code: Required[
|
|
1663
|
+
Annotated[Literal["CO", "CR", "OA", "PI", "PR"], PropertyInfo(alias="adjustmentGroupCode")]
|
|
1337
1664
|
]
|
|
1338
1665
|
|
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1339
1666
|
|
|
@@ -1351,25 +1678,6 @@ class ClaimInformationOtherSubscriberInformationMedicareOutpatientAdjudication(T
|
|
|
1351
1678
|
reimbursement_rate: Annotated[str, PropertyInfo(alias="reimbursementRate")]
|
|
1352
1679
|
|
|
1353
1680
|
|
|
1354
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerAttendingProviderOtherPayerAttendingProviderIdentifier(
|
|
1355
|
-
TypedDict, total=False
|
|
1356
|
-
):
|
|
1357
|
-
identifier: Required[str]
|
|
1358
|
-
|
|
1359
|
-
qualifier: Required[str]
|
|
1360
|
-
|
|
1361
|
-
|
|
1362
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerAttendingProvider(TypedDict, total=False):
|
|
1363
|
-
other_payer_attending_provider_identifier: Required[
|
|
1364
|
-
Annotated[
|
|
1365
|
-
Iterable[
|
|
1366
|
-
ClaimInformationOtherSubscriberInformationOtherPayerAttendingProviderOtherPayerAttendingProviderIdentifier
|
|
1367
|
-
],
|
|
1368
|
-
PropertyInfo(alias="otherPayerAttendingProviderIdentifier"),
|
|
1369
|
-
]
|
|
1370
|
-
]
|
|
1371
|
-
|
|
1372
|
-
|
|
1373
1681
|
class ClaimInformationOtherSubscriberInformationOtherPayerBillingProviderOtherPayerBillingProviderIdentifier(
|
|
1374
1682
|
TypedDict, total=False
|
|
1375
1683
|
):
|
|
@@ -1377,8 +1685,12 @@ class ClaimInformationOtherSubscriberInformationOtherPayerBillingProviderOtherPa
|
|
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1377
1685
|
|
|
1378
1686
|
qualifier: Required[str]
|
|
1379
1687
|
|
|
1688
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1689
|
+
|
|
1380
1690
|
|
|
1381
1691
|
class ClaimInformationOtherSubscriberInformationOtherPayerBillingProvider(TypedDict, total=False):
|
|
1692
|
+
entity_type_qualifier: Required[Annotated[Literal["1", "2"], PropertyInfo(alias="entityTypeQualifier")]]
|
|
1693
|
+
|
|
1382
1694
|
other_payer_billing_provider_identifier: Required[
|
|
1383
1695
|
Annotated[
|
|
1384
1696
|
Iterable[
|
|
@@ -1389,104 +1701,93 @@ class ClaimInformationOtherSubscriberInformationOtherPayerBillingProvider(TypedD
|
|
|
1389
1701
|
]
|
|
1390
1702
|
|
|
1391
1703
|
|
|
1392
|
-
class
|
|
1704
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerReferringProviderOtherPayerReferringProviderIdentifier(
|
|
1393
1705
|
TypedDict, total=False
|
|
1394
1706
|
):
|
|
1395
1707
|
identifier: Required[str]
|
|
1396
1708
|
|
|
1397
1709
|
qualifier: Required[str]
|
|
1398
1710
|
|
|
1711
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1712
|
+
|
|
1399
1713
|
|
|
1400
|
-
class
|
|
1401
|
-
|
|
1714
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerReferringProvider(TypedDict, total=False):
|
|
1715
|
+
other_payer_referring_provider_identifier: Required[
|
|
1402
1716
|
Annotated[
|
|
1403
1717
|
Iterable[
|
|
1404
|
-
|
|
1718
|
+
ClaimInformationOtherSubscriberInformationOtherPayerReferringProviderOtherPayerReferringProviderIdentifier
|
|
1405
1719
|
],
|
|
1406
|
-
PropertyInfo(alias="
|
|
1720
|
+
PropertyInfo(alias="otherPayerReferringProviderIdentifier"),
|
|
1407
1721
|
]
|
|
1408
1722
|
]
|
|
1409
1723
|
|
|
1410
1724
|
|
|
1411
|
-
class
|
|
1725
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerRenderingProviderOtherPayerRenderingProviderSecondaryIdentifier(
|
|
1412
1726
|
TypedDict, total=False
|
|
1413
1727
|
):
|
|
1414
1728
|
identifier: Required[str]
|
|
1415
1729
|
|
|
1416
1730
|
qualifier: Required[str]
|
|
1417
1731
|
|
|
1732
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1418
1733
|
|
|
1419
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerOtherOperatingPhysician(TypedDict, total=False):
|
|
1420
|
-
other_payer_other_operating_physician_identifier: Required[
|
|
1421
|
-
Annotated[
|
|
1422
|
-
Iterable[
|
|
1423
|
-
ClaimInformationOtherSubscriberInformationOtherPayerOtherOperatingPhysicianOtherPayerOtherOperatingPhysicianIdentifier
|
|
1424
|
-
],
|
|
1425
|
-
PropertyInfo(alias="otherPayerOtherOperatingPhysicianIdentifier"),
|
|
1426
|
-
]
|
|
1427
|
-
]
|
|
1428
|
-
|
|
1429
|
-
|
|
1430
|
-
class ClaimInformationOtherSubscriberInformationOtherPayerReferringProviderOtherPayerReferringProviderIdentifier(
|
|
1431
|
-
TypedDict, total=False
|
|
1432
|
-
):
|
|
1433
|
-
identifier: Required[str]
|
|
1434
|
-
|
|
1435
|
-
qualifier: Required[str]
|
|
1436
1734
|
|
|
1735
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerRenderingProvider(TypedDict, total=False):
|
|
1736
|
+
entity_type_qualifier: Required[Annotated[Literal["1", "2"], PropertyInfo(alias="entityTypeQualifier")]]
|
|
1437
1737
|
|
|
1438
|
-
|
|
1439
|
-
|
|
1440
|
-
|
|
1441
|
-
|
|
1442
|
-
|
|
1443
|
-
],
|
|
1444
|
-
PropertyInfo(alias="otherPayerReferringProviderIdentifier"),
|
|
1445
|
-
]
|
|
1738
|
+
other_payer_rendering_provider_secondary_identifier: Annotated[
|
|
1739
|
+
Iterable[
|
|
1740
|
+
ClaimInformationOtherSubscriberInformationOtherPayerRenderingProviderOtherPayerRenderingProviderSecondaryIdentifier
|
|
1741
|
+
],
|
|
1742
|
+
PropertyInfo(alias="otherPayerRenderingProviderSecondaryIdentifier"),
|
|
1446
1743
|
]
|
|
1447
1744
|
|
|
1448
1745
|
|
|
1449
|
-
class
|
|
1746
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocationOtherPayerServiceFacilityLocationSecondaryIdentifier(
|
|
1450
1747
|
TypedDict, total=False
|
|
1451
1748
|
):
|
|
1452
1749
|
identifier: Required[str]
|
|
1453
1750
|
|
|
1454
1751
|
qualifier: Required[str]
|
|
1455
1752
|
|
|
1753
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1456
1754
|
|
|
1457
|
-
|
|
1458
|
-
|
|
1755
|
+
|
|
1756
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocation(TypedDict, total=False):
|
|
1757
|
+
other_payer_service_facility_location_secondary_identifier: Required[
|
|
1459
1758
|
Annotated[
|
|
1460
1759
|
Iterable[
|
|
1461
|
-
|
|
1760
|
+
ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocationOtherPayerServiceFacilityLocationSecondaryIdentifier
|
|
1462
1761
|
],
|
|
1463
|
-
PropertyInfo(alias="
|
|
1762
|
+
PropertyInfo(alias="otherPayerServiceFacilityLocationSecondaryIdentifier"),
|
|
1464
1763
|
]
|
|
1465
1764
|
]
|
|
1466
1765
|
|
|
1467
1766
|
|
|
1468
|
-
class
|
|
1767
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProviderOtherPayerSupervisingProviderIdentifier(
|
|
1469
1768
|
TypedDict, total=False
|
|
1470
1769
|
):
|
|
1471
1770
|
identifier: Required[str]
|
|
1472
1771
|
|
|
1473
1772
|
qualifier: Required[str]
|
|
1474
1773
|
|
|
1774
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1475
1775
|
|
|
1476
|
-
|
|
1477
|
-
|
|
1776
|
+
|
|
1777
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProvider(TypedDict, total=False):
|
|
1778
|
+
other_payer_supervising_provider_identifier: Required[
|
|
1478
1779
|
Annotated[
|
|
1479
1780
|
Iterable[
|
|
1480
|
-
|
|
1781
|
+
ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProviderOtherPayerSupervisingProviderIdentifier
|
|
1481
1782
|
],
|
|
1482
|
-
PropertyInfo(alias="
|
|
1783
|
+
PropertyInfo(alias="otherPayerSupervisingProviderIdentifier"),
|
|
1483
1784
|
]
|
|
1484
1785
|
]
|
|
1485
1786
|
|
|
1486
1787
|
|
|
1487
1788
|
class ClaimInformationOtherSubscriberInformation(TypedDict, total=False):
|
|
1488
1789
|
benefits_assignment_certification_indicator: Required[
|
|
1489
|
-
Annotated[Literal["N", "
|
|
1790
|
+
Annotated[Literal["N", "W", "Y"], PropertyInfo(alias="benefitsAssignmentCertificationIndicator")]
|
|
1490
1791
|
]
|
|
1491
1792
|
|
|
1492
1793
|
claim_filing_indicator_code: Required[
|
|
@@ -1502,6 +1803,7 @@ class ClaimInformationOtherSubscriberInformation(TypedDict, total=False):
|
|
|
1502
1803
|
"AM",
|
|
1503
1804
|
"BL",
|
|
1504
1805
|
"CH",
|
|
1806
|
+
"CI",
|
|
1505
1807
|
"DS",
|
|
1506
1808
|
"FI",
|
|
1507
1809
|
"HM",
|
|
@@ -1550,11 +1852,10 @@ class ClaimInformationOtherSubscriberInformation(TypedDict, total=False):
|
|
|
1550
1852
|
PropertyInfo(alias="claimLevelAdjustments"),
|
|
1551
1853
|
]
|
|
1552
1854
|
|
|
1553
|
-
|
|
1855
|
+
insurance_group_or_policy_number: Annotated[str, PropertyInfo(alias="insuranceGroupOrPolicyNumber")]
|
|
1554
1856
|
|
|
1555
|
-
|
|
1556
|
-
|
|
1557
|
-
PropertyInfo(alias="medicareInpatientAdjudication"),
|
|
1857
|
+
insurance_type_code: Annotated[
|
|
1858
|
+
Literal["12", "13", "14", "15", "16", "41", "42", "43", "47"], PropertyInfo(alias="insuranceTypeCode")
|
|
1558
1859
|
]
|
|
1559
1860
|
|
|
1560
1861
|
medicare_outpatient_adjudication: Annotated[
|
|
@@ -1566,60 +1867,48 @@ class ClaimInformationOtherSubscriberInformation(TypedDict, total=False):
|
|
|
1566
1867
|
|
|
1567
1868
|
other_insured_group_name: Annotated[str, PropertyInfo(alias="otherInsuredGroupName")]
|
|
1568
1869
|
|
|
1569
|
-
other_payer_attending_provider: Annotated[
|
|
1570
|
-
ClaimInformationOtherSubscriberInformationOtherPayerAttendingProvider,
|
|
1571
|
-
PropertyInfo(alias="otherPayerAttendingProvider"),
|
|
1572
|
-
]
|
|
1573
|
-
|
|
1574
1870
|
other_payer_billing_provider: Annotated[
|
|
1575
|
-
ClaimInformationOtherSubscriberInformationOtherPayerBillingProvider,
|
|
1871
|
+
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerBillingProvider],
|
|
1576
1872
|
PropertyInfo(alias="otherPayerBillingProvider"),
|
|
1577
1873
|
]
|
|
1578
1874
|
|
|
1579
|
-
other_payer_operating_physician: Annotated[
|
|
1580
|
-
ClaimInformationOtherSubscriberInformationOtherPayerOperatingPhysician,
|
|
1581
|
-
PropertyInfo(alias="otherPayerOperatingPhysician"),
|
|
1582
|
-
]
|
|
1583
|
-
|
|
1584
|
-
other_payer_other_operating_physician: Annotated[
|
|
1585
|
-
ClaimInformationOtherSubscriberInformationOtherPayerOtherOperatingPhysician,
|
|
1586
|
-
PropertyInfo(alias="otherPayerOtherOperatingPhysician"),
|
|
1587
|
-
]
|
|
1588
|
-
|
|
1589
1875
|
other_payer_referring_provider: Annotated[
|
|
1590
|
-
ClaimInformationOtherSubscriberInformationOtherPayerReferringProvider,
|
|
1876
|
+
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerReferringProvider],
|
|
1591
1877
|
PropertyInfo(alias="otherPayerReferringProvider"),
|
|
1592
1878
|
]
|
|
1593
1879
|
|
|
1594
1880
|
other_payer_rendering_provider: Annotated[
|
|
1595
|
-
ClaimInformationOtherSubscriberInformationOtherPayerRenderingProvider,
|
|
1881
|
+
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerRenderingProvider],
|
|
1596
1882
|
PropertyInfo(alias="otherPayerRenderingProvider"),
|
|
1597
1883
|
]
|
|
1598
1884
|
|
|
1599
1885
|
other_payer_service_facility_location: Annotated[
|
|
1600
|
-
ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocation,
|
|
1886
|
+
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocation],
|
|
1601
1887
|
PropertyInfo(alias="otherPayerServiceFacilityLocation"),
|
|
1602
1888
|
]
|
|
1603
1889
|
|
|
1604
|
-
|
|
1605
|
-
|
|
1606
|
-
|
|
1607
|
-
|
|
1608
|
-
remaining_patient_liability: Annotated[str, PropertyInfo(alias="remainingPatientLiability")]
|
|
1890
|
+
other_payer_supervising_provider: Annotated[
|
|
1891
|
+
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProvider],
|
|
1892
|
+
PropertyInfo(alias="otherPayerSupervisingProvider"),
|
|
1893
|
+
]
|
|
1609
1894
|
|
|
1895
|
+
patient_signature_generated_for_patient: Annotated[bool, PropertyInfo(alias="patientSignatureGeneratedForPatient")]
|
|
1610
1896
|
|
|
1611
|
-
|
|
1612
|
-
patient_reason_for_visit_code: Required[Annotated[str, PropertyInfo(alias="patientReasonForVisitCode")]]
|
|
1897
|
+
payer_paid_amount: Annotated[str, PropertyInfo(alias="payerPaidAmount")]
|
|
1613
1898
|
|
|
1614
|
-
|
|
1899
|
+
remaining_patient_liability: Annotated[str, PropertyInfo(alias="remainingPatientLiability")]
|
|
1615
1900
|
|
|
1616
1901
|
|
|
1617
|
-
class
|
|
1618
|
-
|
|
1902
|
+
class ClaimInformationPatientConditionInformationVision(TypedDict, total=False):
|
|
1903
|
+
certification_condition_indicator: Required[
|
|
1904
|
+
Annotated[Literal["N", "Y"], PropertyInfo(alias="certificationConditionIndicator")]
|
|
1905
|
+
]
|
|
1619
1906
|
|
|
1620
|
-
|
|
1907
|
+
code_category: Required[Annotated[Literal["E1", "E2", "E3"], PropertyInfo(alias="codeCategory")]]
|
|
1621
1908
|
|
|
1622
|
-
|
|
1909
|
+
condition_codes: Required[
|
|
1910
|
+
Annotated[List[Literal["L1", "L2", "L3", "L4", "L5"]], PropertyInfo(alias="conditionCodes")]
|
|
1911
|
+
]
|
|
1623
1912
|
|
|
1624
1913
|
|
|
1625
1914
|
class ClaimInformationServiceFacilityLocationAddress(TypedDict, total=False):
|
|
@@ -1638,24 +1927,40 @@ class ClaimInformationServiceFacilityLocationAddress(TypedDict, total=False):
|
|
|
1638
1927
|
state: str
|
|
1639
1928
|
|
|
1640
1929
|
|
|
1930
|
+
class ClaimInformationServiceFacilityLocationSecondaryIdentifier(TypedDict, total=False):
|
|
1931
|
+
identifier: Required[str]
|
|
1932
|
+
|
|
1933
|
+
qualifier: Required[str]
|
|
1934
|
+
|
|
1935
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1936
|
+
|
|
1937
|
+
|
|
1641
1938
|
class ClaimInformationServiceFacilityLocation(TypedDict, total=False):
|
|
1642
1939
|
address: Required[ClaimInformationServiceFacilityLocationAddress]
|
|
1643
1940
|
|
|
1644
1941
|
organization_name: Required[Annotated[str, PropertyInfo(alias="organizationName")]]
|
|
1645
1942
|
|
|
1646
|
-
|
|
1943
|
+
npi: str
|
|
1944
|
+
|
|
1945
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
1946
|
+
|
|
1947
|
+
phone_name: Annotated[str, PropertyInfo(alias="phoneName")]
|
|
1948
|
+
|
|
1949
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
1647
1950
|
|
|
1648
|
-
|
|
1649
|
-
|
|
1951
|
+
secondary_identifier: Annotated[
|
|
1952
|
+
Iterable[ClaimInformationServiceFacilityLocationSecondaryIdentifier], PropertyInfo(alias="secondaryIdentifier")
|
|
1650
1953
|
]
|
|
1651
1954
|
|
|
1652
|
-
secondary_identifier: Annotated[str, PropertyInfo(alias="secondaryIdentifier")]
|
|
1653
1955
|
|
|
1956
|
+
class ClaimInformationSpinalManipulationServiceInformation(TypedDict, total=False):
|
|
1957
|
+
patient_condition_code: Required[Annotated[str, PropertyInfo(alias="patientConditionCode")]]
|
|
1654
1958
|
|
|
1655
|
-
|
|
1656
|
-
|
|
1959
|
+
patient_condition_description1: Annotated[
|
|
1960
|
+
Literal["A", "C", "D", "E", "F", "G", "M"], PropertyInfo(alias="patientConditionDescription1")
|
|
1961
|
+
]
|
|
1657
1962
|
|
|
1658
|
-
|
|
1963
|
+
patient_condition_description2: Annotated[str, PropertyInfo(alias="patientConditionDescription2")]
|
|
1659
1964
|
|
|
1660
1965
|
|
|
1661
1966
|
class ClaimInformation(TypedDict, total=False):
|
|
@@ -1665,14 +1970,6 @@ class ClaimInformation(TypedDict, total=False):
|
|
|
1665
1970
|
|
|
1666
1971
|
claim_charge_amount: Required[Annotated[str, PropertyInfo(alias="claimChargeAmount")]]
|
|
1667
1972
|
|
|
1668
|
-
claim_code_information: Required[
|
|
1669
|
-
Annotated[ClaimInformationClaimCodeInformation, PropertyInfo(alias="claimCodeInformation")]
|
|
1670
|
-
]
|
|
1671
|
-
|
|
1672
|
-
claim_date_information: Required[
|
|
1673
|
-
Annotated[ClaimInformationClaimDateInformation, PropertyInfo(alias="claimDateInformation")]
|
|
1674
|
-
]
|
|
1675
|
-
|
|
1676
1973
|
claim_filing_code: Required[
|
|
1677
1974
|
Annotated[
|
|
1678
1975
|
Literal[
|
|
@@ -1704,116 +2001,173 @@ class ClaimInformation(TypedDict, total=False):
|
|
|
1704
2001
|
]
|
|
1705
2002
|
]
|
|
1706
2003
|
|
|
1707
|
-
claim_frequency_code: Required[Annotated[
|
|
1708
|
-
|
|
1709
|
-
place_of_service_code: Required[Annotated[str, PropertyInfo(alias="placeOfServiceCode")]]
|
|
2004
|
+
claim_frequency_code: Required[Annotated[Literal["1", "7", "8"], PropertyInfo(alias="claimFrequencyCode")]]
|
|
1710
2005
|
|
|
1711
|
-
|
|
2006
|
+
health_care_code_information: Required[
|
|
2007
|
+
Annotated[Iterable[ClaimInformationHealthCareCodeInformation], PropertyInfo(alias="healthCareCodeInformation")]
|
|
2008
|
+
]
|
|
1712
2009
|
|
|
1713
|
-
|
|
1714
|
-
Annotated[
|
|
2010
|
+
place_of_service_code: Required[
|
|
2011
|
+
Annotated[
|
|
2012
|
+
Literal[
|
|
2013
|
+
"01",
|
|
2014
|
+
"02",
|
|
2015
|
+
"03",
|
|
2016
|
+
"04",
|
|
2017
|
+
"05",
|
|
2018
|
+
"06",
|
|
2019
|
+
"07",
|
|
2020
|
+
"08",
|
|
2021
|
+
"09",
|
|
2022
|
+
"10",
|
|
2023
|
+
"11",
|
|
2024
|
+
"12",
|
|
2025
|
+
"13",
|
|
2026
|
+
"14",
|
|
2027
|
+
"15",
|
|
2028
|
+
"16",
|
|
2029
|
+
"17",
|
|
2030
|
+
"18",
|
|
2031
|
+
"19",
|
|
2032
|
+
"20",
|
|
2033
|
+
"21",
|
|
2034
|
+
"22",
|
|
2035
|
+
"23",
|
|
2036
|
+
"24",
|
|
2037
|
+
"25",
|
|
2038
|
+
"26",
|
|
2039
|
+
"27",
|
|
2040
|
+
"31",
|
|
2041
|
+
"32",
|
|
2042
|
+
"33",
|
|
2043
|
+
"34",
|
|
2044
|
+
"41",
|
|
2045
|
+
"42",
|
|
2046
|
+
"49",
|
|
2047
|
+
"50",
|
|
2048
|
+
"51",
|
|
2049
|
+
"52",
|
|
2050
|
+
"53",
|
|
2051
|
+
"54",
|
|
2052
|
+
"55",
|
|
2053
|
+
"56",
|
|
2054
|
+
"57",
|
|
2055
|
+
"58",
|
|
2056
|
+
"60",
|
|
2057
|
+
"61",
|
|
2058
|
+
"62",
|
|
2059
|
+
"65",
|
|
2060
|
+
"66",
|
|
2061
|
+
"71",
|
|
2062
|
+
"72",
|
|
2063
|
+
"81",
|
|
2064
|
+
"99",
|
|
2065
|
+
],
|
|
2066
|
+
PropertyInfo(alias="placeOfServiceCode"),
|
|
2067
|
+
]
|
|
1715
2068
|
]
|
|
1716
2069
|
|
|
2070
|
+
plan_participation_code: Required[Annotated[Literal["A", "B", "C"], PropertyInfo(alias="planParticipationCode")]]
|
|
2071
|
+
|
|
1717
2072
|
release_information_code: Required[Annotated[Literal["I", "Y"], PropertyInfo(alias="releaseInformationCode")]]
|
|
1718
2073
|
|
|
1719
2074
|
service_lines: Required[Annotated[Iterable[ClaimInformationServiceLine], PropertyInfo(alias="serviceLines")]]
|
|
1720
2075
|
|
|
1721
|
-
|
|
2076
|
+
signature_indicator: Required[Annotated[Literal["N", "Y"], PropertyInfo(alias="signatureIndicator")]]
|
|
1722
2077
|
|
|
1723
|
-
|
|
2078
|
+
ambulance_certification: Annotated[
|
|
2079
|
+
Iterable[ClaimInformationAmbulanceCertification], PropertyInfo(alias="ambulanceCertification")
|
|
2080
|
+
]
|
|
1724
2081
|
|
|
1725
|
-
|
|
1726
|
-
|
|
2082
|
+
ambulance_drop_off_location: Annotated[
|
|
2083
|
+
ClaimInformationAmbulanceDropOffLocation, PropertyInfo(alias="ambulanceDropOffLocation")
|
|
1727
2084
|
]
|
|
1728
2085
|
|
|
1729
|
-
|
|
2086
|
+
ambulance_pick_up_location: Annotated[
|
|
2087
|
+
ClaimInformationAmbulancePickUpLocation, PropertyInfo(alias="ambulancePickUpLocation")
|
|
2088
|
+
]
|
|
1730
2089
|
|
|
1731
|
-
|
|
1732
|
-
|
|
2090
|
+
ambulance_transport_information: Annotated[
|
|
2091
|
+
ClaimInformationAmbulanceTransportInformation, PropertyInfo(alias="ambulanceTransportInformation")
|
|
1733
2092
|
]
|
|
1734
2093
|
|
|
1735
|
-
|
|
1736
|
-
|
|
2094
|
+
anesthesia_related_surgical_procedure: Annotated[
|
|
2095
|
+
List[str], PropertyInfo(alias="anesthesiaRelatedSurgicalProcedure")
|
|
1737
2096
|
]
|
|
1738
2097
|
|
|
1739
|
-
|
|
2098
|
+
auto_accident_country_code: Annotated[str, PropertyInfo(alias="autoAccidentCountryCode")]
|
|
1740
2099
|
|
|
1741
|
-
|
|
1742
|
-
Iterable[Iterable[ClaimInformationConditionCodesList]], PropertyInfo(alias="conditionCodesList")
|
|
1743
|
-
]
|
|
2100
|
+
auto_accident_state_code: Annotated[str, PropertyInfo(alias="autoAccidentStateCode")]
|
|
1744
2101
|
|
|
1745
|
-
|
|
1746
|
-
|
|
2102
|
+
claim_contract_information: Annotated[
|
|
2103
|
+
ClaimInformationClaimContractInformation, PropertyInfo(alias="claimContractInformation")
|
|
1747
2104
|
]
|
|
1748
2105
|
|
|
1749
|
-
|
|
1750
|
-
ClaimInformationDiagnosisRelatedGroupInformation, PropertyInfo(alias="diagnosisRelatedGroupInformation")
|
|
1751
|
-
]
|
|
2106
|
+
claim_date_information: Annotated[ClaimInformationClaimDateInformation, PropertyInfo(alias="claimDateInformation")]
|
|
1752
2107
|
|
|
1753
|
-
|
|
2108
|
+
claim_note: Annotated[ClaimInformationClaimNote, PropertyInfo(alias="claimNote")]
|
|
1754
2109
|
|
|
1755
|
-
|
|
1756
|
-
|
|
2110
|
+
claim_pricing_repricing_information: Annotated[
|
|
2111
|
+
ClaimInformationClaimPricingRepricingInformation, PropertyInfo(alias="claimPricingRepricingInformation")
|
|
1757
2112
|
]
|
|
1758
2113
|
|
|
1759
|
-
|
|
1760
|
-
|
|
1761
|
-
occurrence_information_list: Annotated[
|
|
1762
|
-
Iterable[Iterable[ClaimInformationOccurrenceInformationList]], PropertyInfo(alias="occurrenceInformationList")
|
|
2114
|
+
claim_supplemental_information: Annotated[
|
|
2115
|
+
ClaimInformationClaimSupplementalInformation, PropertyInfo(alias="claimSupplementalInformation")
|
|
1763
2116
|
]
|
|
1764
2117
|
|
|
1765
|
-
|
|
1766
|
-
Iterable[
|
|
2118
|
+
condition_information: Annotated[
|
|
2119
|
+
Iterable[ClaimInformationConditionInformation], PropertyInfo(alias="conditionInformation")
|
|
1767
2120
|
]
|
|
1768
2121
|
|
|
1769
|
-
|
|
1770
|
-
|
|
1771
|
-
|
|
2122
|
+
death_date: Annotated[str, PropertyInfo(alias="deathDate")]
|
|
2123
|
+
|
|
2124
|
+
delay_reason_code: Annotated[
|
|
2125
|
+
Literal["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "15"], PropertyInfo(alias="delayReasonCode")
|
|
1772
2126
|
]
|
|
1773
2127
|
|
|
1774
|
-
|
|
1775
|
-
|
|
1776
|
-
|
|
1777
|
-
|
|
2128
|
+
epsdt_referral: Annotated[ClaimInformationEpsdtReferral, PropertyInfo(alias="epsdtReferral")]
|
|
2129
|
+
|
|
2130
|
+
file_information: Annotated[str, PropertyInfo(alias="fileInformation")]
|
|
2131
|
+
|
|
2132
|
+
file_information_list: Annotated[List[str], PropertyInfo(alias="fileInformationList")]
|
|
2133
|
+
|
|
2134
|
+
homebound_indicator: Annotated[bool, PropertyInfo(alias="homeboundIndicator")]
|
|
1778
2135
|
|
|
1779
2136
|
other_subscriber_information: Annotated[
|
|
1780
|
-
ClaimInformationOtherSubscriberInformation, PropertyInfo(alias="otherSubscriberInformation")
|
|
2137
|
+
Iterable[ClaimInformationOtherSubscriberInformation], PropertyInfo(alias="otherSubscriberInformation")
|
|
1781
2138
|
]
|
|
1782
2139
|
|
|
1783
2140
|
patient_amount_paid: Annotated[str, PropertyInfo(alias="patientAmountPaid")]
|
|
1784
2141
|
|
|
1785
|
-
|
|
1786
|
-
|
|
1787
|
-
|
|
1788
|
-
Iterable[ClaimInformationPatientReasonForVisit], PropertyInfo(alias="patientReasonForVisits")
|
|
2142
|
+
patient_condition_information_vision: Annotated[
|
|
2143
|
+
Iterable[ClaimInformationPatientConditionInformationVision],
|
|
2144
|
+
PropertyInfo(alias="patientConditionInformationVision"),
|
|
1789
2145
|
]
|
|
1790
2146
|
|
|
2147
|
+
patient_signature_source_code: Annotated[bool, PropertyInfo(alias="patientSignatureSourceCode")]
|
|
2148
|
+
|
|
1791
2149
|
patient_weight: Annotated[str, PropertyInfo(alias="patientWeight")]
|
|
1792
2150
|
|
|
1793
|
-
|
|
1794
|
-
ClaimInformationPrincipalProcedureInformation, PropertyInfo(alias="principalProcedureInformation")
|
|
1795
|
-
]
|
|
2151
|
+
pregnancy_indicator: Annotated[Literal["Y"], PropertyInfo(alias="pregnancyIndicator")]
|
|
1796
2152
|
|
|
1797
2153
|
property_casualty_claim_number: Annotated[str, PropertyInfo(alias="propertyCasualtyClaimNumber")]
|
|
1798
2154
|
|
|
2155
|
+
related_causes_code: Annotated[List[Literal["AA", "EM", "OA"]], PropertyInfo(alias="relatedCausesCode")]
|
|
2156
|
+
|
|
1799
2157
|
service_facility_location: Annotated[
|
|
1800
2158
|
ClaimInformationServiceFacilityLocation, PropertyInfo(alias="serviceFacilityLocation")
|
|
1801
2159
|
]
|
|
1802
2160
|
|
|
1803
|
-
|
|
1804
|
-
|
|
1805
|
-
treatment_code_information_list: Annotated[Iterable[List[str]], PropertyInfo(alias="treatmentCodeInformationList")]
|
|
2161
|
+
special_program_code: Annotated[Literal["02", "03", "05", "09"], PropertyInfo(alias="specialProgramCode")]
|
|
1806
2162
|
|
|
1807
|
-
|
|
1808
|
-
|
|
2163
|
+
spinal_manipulation_service_information: Annotated[
|
|
2164
|
+
ClaimInformationSpinalManipulationServiceInformation, PropertyInfo(alias="spinalManipulationServiceInformation")
|
|
1809
2165
|
]
|
|
1810
2166
|
|
|
1811
2167
|
|
|
1812
2168
|
class Receiver(TypedDict, total=False):
|
|
1813
2169
|
organization_name: Required[Annotated[str, PropertyInfo(alias="organizationName")]]
|
|
1814
2170
|
|
|
1815
|
-
tax_id: Annotated[str, PropertyInfo(alias="taxId")]
|
|
1816
|
-
|
|
1817
2171
|
|
|
1818
2172
|
class SubmitterContactInformation(TypedDict, total=False):
|
|
1819
2173
|
email: str
|
|
@@ -1822,17 +2176,23 @@ class SubmitterContactInformation(TypedDict, total=False):
|
|
|
1822
2176
|
|
|
1823
2177
|
name: str
|
|
1824
2178
|
|
|
1825
|
-
|
|
2179
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
1826
2180
|
|
|
1827
|
-
|
|
2181
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
1828
2182
|
|
|
1829
2183
|
|
|
1830
2184
|
class Submitter(TypedDict, total=False):
|
|
1831
2185
|
contact_information: Required[Annotated[SubmitterContactInformation, PropertyInfo(alias="contactInformation")]]
|
|
1832
2186
|
|
|
1833
|
-
|
|
2187
|
+
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2188
|
+
|
|
2189
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2190
|
+
|
|
2191
|
+
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
2192
|
+
|
|
2193
|
+
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
1834
2194
|
|
|
1835
|
-
|
|
2195
|
+
submitter_identification: Annotated[str, PropertyInfo(alias="submitterIdentification")]
|
|
1836
2196
|
|
|
1837
2197
|
|
|
1838
2198
|
class SubscriberAddress(TypedDict, total=False):
|
|
@@ -1851,40 +2211,58 @@ class SubscriberAddress(TypedDict, total=False):
|
|
|
1851
2211
|
state: str
|
|
1852
2212
|
|
|
1853
2213
|
|
|
1854
|
-
class
|
|
1855
|
-
|
|
2214
|
+
class SubscriberContactInformation(TypedDict, total=False):
|
|
2215
|
+
name: Required[str]
|
|
1856
2216
|
|
|
1857
|
-
|
|
2217
|
+
email: str
|
|
1858
2218
|
|
|
1859
|
-
|
|
1860
|
-
|
|
1861
|
-
|
|
1862
|
-
|
|
1863
|
-
|
|
1864
|
-
]
|
|
2219
|
+
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2220
|
+
|
|
2221
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2222
|
+
|
|
2223
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
1865
2224
|
|
|
2225
|
+
|
|
2226
|
+
class Subscriber(TypedDict, total=False):
|
|
1866
2227
|
address: SubscriberAddress
|
|
1867
2228
|
|
|
2229
|
+
contact_information: Annotated[SubscriberContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2230
|
+
|
|
1868
2231
|
date_of_birth: Annotated[str, PropertyInfo(alias="dateOfBirth")]
|
|
1869
2232
|
|
|
2233
|
+
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2234
|
+
|
|
1870
2235
|
gender: Literal["M", "F", "U"]
|
|
1871
2236
|
|
|
1872
2237
|
group_number: Annotated[str, PropertyInfo(alias="groupNumber")]
|
|
1873
2238
|
|
|
2239
|
+
insurance_type_code: Annotated[
|
|
2240
|
+
Literal["12", "13", "14", "15", "16", "41", "42", "43", "47"], PropertyInfo(alias="insuranceTypeCode")
|
|
2241
|
+
]
|
|
2242
|
+
|
|
2243
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2244
|
+
|
|
1874
2245
|
member_id: Annotated[str, PropertyInfo(alias="memberId")]
|
|
1875
2246
|
|
|
1876
2247
|
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
1877
2248
|
|
|
2249
|
+
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2250
|
+
|
|
2251
|
+
payment_responsibility_level_code: Annotated[
|
|
2252
|
+
Literal["A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U"],
|
|
2253
|
+
PropertyInfo(alias="paymentResponsibilityLevelCode"),
|
|
2254
|
+
]
|
|
2255
|
+
|
|
1878
2256
|
policy_number: Annotated[str, PropertyInfo(alias="policyNumber")]
|
|
1879
2257
|
|
|
1880
2258
|
ssn: str
|
|
1881
2259
|
|
|
1882
|
-
|
|
2260
|
+
subscriber_group_name: Annotated[str, PropertyInfo(alias="subscriberGroupName")]
|
|
1883
2261
|
|
|
1884
2262
|
suffix: str
|
|
1885
2263
|
|
|
1886
2264
|
|
|
1887
|
-
class
|
|
2265
|
+
class DependentAddress(TypedDict, total=False):
|
|
1888
2266
|
address1: Required[str]
|
|
1889
2267
|
|
|
1890
2268
|
city: Required[str]
|
|
@@ -1900,49 +2278,47 @@ class AttendingAddress(TypedDict, total=False):
|
|
|
1900
2278
|
state: str
|
|
1901
2279
|
|
|
1902
2280
|
|
|
1903
|
-
class
|
|
2281
|
+
class DependentContactInformation(TypedDict, total=False):
|
|
1904
2282
|
name: Required[str]
|
|
1905
2283
|
|
|
1906
2284
|
email: str
|
|
1907
2285
|
|
|
1908
2286
|
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
1909
2287
|
|
|
1910
|
-
|
|
1911
|
-
|
|
1912
|
-
valid_contact: Annotated[bool, PropertyInfo(alias="validContact")]
|
|
2288
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
1913
2289
|
|
|
2290
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
1914
2291
|
|
|
1915
|
-
class Attending(TypedDict, total=False):
|
|
1916
|
-
address: AttendingAddress
|
|
1917
2292
|
|
|
1918
|
-
|
|
2293
|
+
class Dependent(TypedDict, total=False):
|
|
2294
|
+
date_of_birth: Required[Annotated[str, PropertyInfo(alias="dateOfBirth")]]
|
|
1919
2295
|
|
|
1920
|
-
|
|
2296
|
+
first_name: Required[Annotated[str, PropertyInfo(alias="firstName")]]
|
|
1921
2297
|
|
|
1922
|
-
|
|
2298
|
+
gender: Required[Literal["M", "F", "U"]]
|
|
1923
2299
|
|
|
1924
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2300
|
+
last_name: Required[Annotated[str, PropertyInfo(alias="lastName")]]
|
|
1925
2301
|
|
|
1926
|
-
|
|
2302
|
+
relationship_to_subscriber_code: Required[
|
|
2303
|
+
Annotated[
|
|
2304
|
+
Literal["01", "19", "20", "21", "39", "40", "53", "G8"], PropertyInfo(alias="relationshipToSubscriberCode")
|
|
2305
|
+
]
|
|
2306
|
+
]
|
|
1927
2307
|
|
|
1928
|
-
|
|
2308
|
+
address: DependentAddress
|
|
1929
2309
|
|
|
1930
|
-
|
|
2310
|
+
contact_information: Annotated[DependentContactInformation, PropertyInfo(alias="contactInformation")]
|
|
1931
2311
|
|
|
1932
|
-
|
|
2312
|
+
member_id: Annotated[str, PropertyInfo(alias="memberId")]
|
|
1933
2313
|
|
|
1934
|
-
|
|
1935
|
-
Literal["0B", "1G", "G2", "LU"], PropertyInfo(alias="secondaryIdentificationQualifierCode")
|
|
1936
|
-
]
|
|
2314
|
+
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
1937
2315
|
|
|
1938
|
-
|
|
2316
|
+
ssn: str
|
|
1939
2317
|
|
|
1940
2318
|
suffix: str
|
|
1941
2319
|
|
|
1942
|
-
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
1943
|
-
|
|
1944
2320
|
|
|
1945
|
-
class
|
|
2321
|
+
class OrderingAddress(TypedDict, total=False):
|
|
1946
2322
|
address1: Required[str]
|
|
1947
2323
|
|
|
1948
2324
|
city: Required[str]
|
|
@@ -1958,28 +2334,30 @@ class BillingAddress(TypedDict, total=False):
|
|
|
1958
2334
|
state: str
|
|
1959
2335
|
|
|
1960
2336
|
|
|
1961
|
-
class
|
|
1962
|
-
name: Required[str]
|
|
1963
|
-
|
|
2337
|
+
class OrderingContactInformation(TypedDict, total=False):
|
|
1964
2338
|
email: str
|
|
1965
2339
|
|
|
1966
2340
|
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
1967
2341
|
|
|
1968
|
-
|
|
2342
|
+
name: str
|
|
1969
2343
|
|
|
1970
|
-
|
|
2344
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
1971
2345
|
|
|
2346
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
1972
2347
|
|
|
1973
|
-
class Billing(TypedDict, total=False):
|
|
1974
|
-
address: Required[BillingAddress]
|
|
1975
2348
|
|
|
1976
|
-
|
|
2349
|
+
class Ordering(TypedDict, total=False):
|
|
2350
|
+
address: OrderingAddress
|
|
1977
2351
|
|
|
1978
|
-
|
|
2352
|
+
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
1979
2353
|
|
|
1980
2354
|
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
1981
2355
|
|
|
1982
|
-
contact_information: Annotated[
|
|
2356
|
+
contact_information: Annotated[OrderingContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2357
|
+
|
|
2358
|
+
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
2359
|
+
|
|
2360
|
+
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
1983
2361
|
|
|
1984
2362
|
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
1985
2363
|
|
|
@@ -1989,17 +2367,19 @@ class Billing(TypedDict, total=False):
|
|
|
1989
2367
|
|
|
1990
2368
|
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
1991
2369
|
|
|
2370
|
+
naic: str
|
|
2371
|
+
|
|
2372
|
+
npi: str
|
|
2373
|
+
|
|
1992
2374
|
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
1993
2375
|
|
|
1994
|
-
|
|
2376
|
+
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
2377
|
+
|
|
2378
|
+
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
1995
2379
|
|
|
1996
2380
|
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
1997
2381
|
|
|
1998
|
-
|
|
1999
|
-
Literal["0B", "1G", "G2", "LU"], PropertyInfo(alias="secondaryIdentificationQualifierCode")
|
|
2000
|
-
]
|
|
2001
|
-
|
|
2002
|
-
secondary_identifier: Annotated[str, PropertyInfo(alias="secondaryIdentifier")]
|
|
2382
|
+
ssn: str
|
|
2003
2383
|
|
|
2004
2384
|
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2005
2385
|
|
|
@@ -2008,7 +2388,7 @@ class Billing(TypedDict, total=False):
|
|
|
2008
2388
|
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
2009
2389
|
|
|
2010
2390
|
|
|
2011
|
-
class
|
|
2391
|
+
class PayerAddress(TypedDict, total=False):
|
|
2012
2392
|
address1: Required[str]
|
|
2013
2393
|
|
|
2014
2394
|
city: Required[str]
|
|
@@ -2024,13 +2404,7 @@ class BillingPayToAddressNameAddress(TypedDict, total=False):
|
|
|
2024
2404
|
state: str
|
|
2025
2405
|
|
|
2026
2406
|
|
|
2027
|
-
class
|
|
2028
|
-
address: Required[BillingPayToAddressNameAddress]
|
|
2029
|
-
|
|
2030
|
-
entity_type_qualifier: Required[Annotated[Literal["2"], PropertyInfo(alias="entityTypeQualifier")]]
|
|
2031
|
-
|
|
2032
|
-
|
|
2033
|
-
class BillingPayToPlanNameAddress(TypedDict, total=False):
|
|
2407
|
+
class PayToAddress(TypedDict, total=False):
|
|
2034
2408
|
address1: Required[str]
|
|
2035
2409
|
|
|
2036
2410
|
city: Required[str]
|
|
@@ -2046,27 +2420,7 @@ class BillingPayToPlanNameAddress(TypedDict, total=False):
|
|
|
2046
2420
|
state: str
|
|
2047
2421
|
|
|
2048
2422
|
|
|
2049
|
-
class
|
|
2050
|
-
identification_code: Required[Annotated[str, PropertyInfo(alias="identificationCode")]]
|
|
2051
|
-
|
|
2052
|
-
identification_code_qualifier: Required[
|
|
2053
|
-
Annotated[Literal["PI", "XV"], PropertyInfo(alias="identificationCodeQualifier")]
|
|
2054
|
-
]
|
|
2055
|
-
|
|
2056
|
-
organization_name: Required[Annotated[str, PropertyInfo(alias="organizationName")]]
|
|
2057
|
-
|
|
2058
|
-
tax_id: Required[Annotated[str, PropertyInfo(alias="taxId")]]
|
|
2059
|
-
|
|
2060
|
-
address: BillingPayToPlanNameAddress
|
|
2061
|
-
|
|
2062
|
-
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
2063
|
-
|
|
2064
|
-
naic: str
|
|
2065
|
-
|
|
2066
|
-
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
2067
|
-
|
|
2068
|
-
|
|
2069
|
-
class DependentAddress(TypedDict, total=False):
|
|
2423
|
+
class PayToPlanAddress(TypedDict, total=False):
|
|
2070
2424
|
address1: Required[str]
|
|
2071
2425
|
|
|
2072
2426
|
city: Required[str]
|
|
@@ -2082,63 +2436,68 @@ class DependentAddress(TypedDict, total=False):
|
|
|
2082
2436
|
state: str
|
|
2083
2437
|
|
|
2084
2438
|
|
|
2085
|
-
class
|
|
2086
|
-
|
|
2439
|
+
class PayToPlan(TypedDict, total=False):
|
|
2440
|
+
address: Required[PayToPlanAddress]
|
|
2087
2441
|
|
|
2088
|
-
|
|
2442
|
+
organization_name: Required[Annotated[str, PropertyInfo(alias="organizationName")]]
|
|
2089
2443
|
|
|
2090
|
-
|
|
2444
|
+
primary_identifier: Required[Annotated[str, PropertyInfo(alias="primaryIdentifier")]]
|
|
2091
2445
|
|
|
2092
|
-
|
|
2446
|
+
primary_identifier_type_code: Required[
|
|
2447
|
+
Annotated[Literal["PI", "XV"], PropertyInfo(alias="primaryIdentifierTypeCode")]
|
|
2448
|
+
]
|
|
2093
2449
|
|
|
2094
|
-
|
|
2095
|
-
|
|
2096
|
-
|
|
2097
|
-
|
|
2450
|
+
tax_identification_number: Required[Annotated[str, PropertyInfo(alias="taxIdentificationNumber")]]
|
|
2451
|
+
|
|
2452
|
+
secondary_identifier: Annotated[str, PropertyInfo(alias="secondaryIdentifier")]
|
|
2453
|
+
|
|
2454
|
+
secondary_identifier_type_code: Annotated[
|
|
2455
|
+
Literal["2U", "FY", "NF"], PropertyInfo(alias="secondaryIdentifierTypeCode")
|
|
2098
2456
|
]
|
|
2099
2457
|
|
|
2100
|
-
address: DependentAddress
|
|
2101
2458
|
|
|
2102
|
-
|
|
2459
|
+
class ProviderAddress(TypedDict, total=False):
|
|
2460
|
+
address1: Required[str]
|
|
2103
2461
|
|
|
2104
|
-
|
|
2462
|
+
city: Required[str]
|
|
2105
2463
|
|
|
2106
|
-
|
|
2464
|
+
address2: str
|
|
2107
2465
|
|
|
2466
|
+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
2108
2467
|
|
|
2109
|
-
|
|
2110
|
-
received_277_ca: Annotated[str, PropertyInfo(alias="RECEIVED_277CA")]
|
|
2111
|
-
"""A success event ID for the 277CA transaction"""
|
|
2468
|
+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
2112
2469
|
|
|
2470
|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
2113
2471
|
|
|
2114
|
-
|
|
2115
|
-
last_name: Required[Annotated[str, PropertyInfo(alias="lastName")]]
|
|
2472
|
+
state: str
|
|
2116
2473
|
|
|
2117
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2118
2474
|
|
|
2119
|
-
|
|
2120
|
-
|
|
2121
|
-
]
|
|
2475
|
+
class ProviderContactInformation(TypedDict, total=False):
|
|
2476
|
+
email: str
|
|
2122
2477
|
|
|
2123
|
-
|
|
2478
|
+
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2124
2479
|
|
|
2125
|
-
|
|
2480
|
+
name: str
|
|
2126
2481
|
|
|
2127
|
-
|
|
2482
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2128
2483
|
|
|
2129
|
-
|
|
2484
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2130
2485
|
|
|
2131
|
-
suffix: str
|
|
2132
2486
|
|
|
2487
|
+
class Provider(TypedDict, total=False):
|
|
2488
|
+
address: ProviderAddress
|
|
2133
2489
|
|
|
2134
|
-
|
|
2135
|
-
|
|
2490
|
+
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
2491
|
+
|
|
2492
|
+
contact_information: Annotated[ProviderContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2493
|
+
|
|
2494
|
+
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
2136
2495
|
|
|
2137
2496
|
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2138
2497
|
|
|
2139
|
-
|
|
2140
|
-
|
|
2141
|
-
]
|
|
2498
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2499
|
+
|
|
2500
|
+
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
2142
2501
|
|
|
2143
2502
|
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
2144
2503
|
|
|
@@ -2146,28 +2505,20 @@ class OtherOperatingPhysician(TypedDict, total=False):
|
|
|
2146
2505
|
|
|
2147
2506
|
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2148
2507
|
|
|
2149
|
-
|
|
2150
|
-
|
|
2151
|
-
suffix: str
|
|
2152
|
-
|
|
2153
|
-
|
|
2154
|
-
class PayerAddress(TypedDict, total=False):
|
|
2155
|
-
address1: Required[str]
|
|
2156
|
-
|
|
2157
|
-
city: Required[str]
|
|
2508
|
+
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
2158
2509
|
|
|
2159
|
-
|
|
2510
|
+
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
2160
2511
|
|
|
2161
|
-
|
|
2512
|
+
ssn: str
|
|
2162
2513
|
|
|
2163
|
-
|
|
2514
|
+
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2164
2515
|
|
|
2165
|
-
|
|
2516
|
+
suffix: str
|
|
2166
2517
|
|
|
2167
|
-
|
|
2518
|
+
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
2168
2519
|
|
|
2169
2520
|
|
|
2170
|
-
class
|
|
2521
|
+
class ReferringAddress(TypedDict, total=False):
|
|
2171
2522
|
address1: Required[str]
|
|
2172
2523
|
|
|
2173
2524
|
city: Required[str]
|
|
@@ -2183,31 +2534,24 @@ class ProviderAddress(TypedDict, total=False):
|
|
|
2183
2534
|
state: str
|
|
2184
2535
|
|
|
2185
2536
|
|
|
2186
|
-
class
|
|
2187
|
-
name: Required[str]
|
|
2188
|
-
|
|
2537
|
+
class ReferringContactInformation(TypedDict, total=False):
|
|
2189
2538
|
email: str
|
|
2190
2539
|
|
|
2191
2540
|
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2192
2541
|
|
|
2193
|
-
|
|
2542
|
+
name: str
|
|
2194
2543
|
|
|
2195
|
-
|
|
2544
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2196
2545
|
|
|
2546
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2197
2547
|
|
|
2198
|
-
class Provider(TypedDict, total=False):
|
|
2199
|
-
provider_type: Required[
|
|
2200
|
-
Annotated[
|
|
2201
|
-
Literal["BillingProvider", "AttendingProvider", "ReferringProvider", "RenderingProvider"],
|
|
2202
|
-
PropertyInfo(alias="providerType"),
|
|
2203
|
-
]
|
|
2204
|
-
]
|
|
2205
2548
|
|
|
2206
|
-
|
|
2549
|
+
class Referring(TypedDict, total=False):
|
|
2550
|
+
address: ReferringAddress
|
|
2207
2551
|
|
|
2208
|
-
|
|
2552
|
+
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
2209
2553
|
|
|
2210
|
-
|
|
2554
|
+
contact_information: Annotated[ReferringContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2211
2555
|
|
|
2212
2556
|
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2213
2557
|
|
|
@@ -2219,18 +2563,18 @@ class Provider(TypedDict, total=False):
|
|
|
2219
2563
|
|
|
2220
2564
|
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2221
2565
|
|
|
2222
|
-
|
|
2223
|
-
Literal["0B", "1G", "G2", "LU"], PropertyInfo(alias="secondaryIdentificationQualifierCode")
|
|
2224
|
-
]
|
|
2566
|
+
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
2225
2567
|
|
|
2226
|
-
|
|
2568
|
+
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
2569
|
+
|
|
2570
|
+
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2227
2571
|
|
|
2228
2572
|
suffix: str
|
|
2229
2573
|
|
|
2230
2574
|
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
2231
2575
|
|
|
2232
2576
|
|
|
2233
|
-
class
|
|
2577
|
+
class RenderingAddress(TypedDict, total=False):
|
|
2234
2578
|
address1: Required[str]
|
|
2235
2579
|
|
|
2236
2580
|
city: Required[str]
|
|
@@ -2246,31 +2590,29 @@ class ReferringAddress(TypedDict, total=False):
|
|
|
2246
2590
|
state: str
|
|
2247
2591
|
|
|
2248
2592
|
|
|
2249
|
-
class
|
|
2250
|
-
name: Required[str]
|
|
2251
|
-
|
|
2593
|
+
class RenderingContactInformation(TypedDict, total=False):
|
|
2252
2594
|
email: str
|
|
2253
2595
|
|
|
2254
2596
|
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2255
2597
|
|
|
2256
|
-
|
|
2598
|
+
name: str
|
|
2257
2599
|
|
|
2258
|
-
|
|
2600
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2259
2601
|
|
|
2602
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2260
2603
|
|
|
2261
|
-
class Referring(TypedDict, total=False):
|
|
2262
|
-
last_name: Required[Annotated[str, PropertyInfo(alias="lastName")]]
|
|
2263
2604
|
|
|
2264
|
-
|
|
2605
|
+
class Rendering(TypedDict, total=False):
|
|
2606
|
+
address: RenderingAddress
|
|
2265
2607
|
|
|
2266
2608
|
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
2267
2609
|
|
|
2268
|
-
contact_information: Annotated[
|
|
2269
|
-
|
|
2270
|
-
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
2610
|
+
contact_information: Annotated[RenderingContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2271
2611
|
|
|
2272
2612
|
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2273
2613
|
|
|
2614
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2615
|
+
|
|
2274
2616
|
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
2275
2617
|
|
|
2276
2618
|
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
@@ -2279,16 +2621,10 @@ class Referring(TypedDict, total=False):
|
|
|
2279
2621
|
|
|
2280
2622
|
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2281
2623
|
|
|
2282
|
-
provider_type: Annotated[
|
|
2624
|
+
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
2283
2625
|
|
|
2284
2626
|
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
2285
2627
|
|
|
2286
|
-
secondary_identification_qualifier_code: Annotated[
|
|
2287
|
-
Literal["0B", "1G", "G2"], PropertyInfo(alias="secondaryIdentificationQualifierCode")
|
|
2288
|
-
]
|
|
2289
|
-
|
|
2290
|
-
secondary_identifier: Annotated[str, PropertyInfo(alias="secondaryIdentifier")]
|
|
2291
|
-
|
|
2292
2628
|
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2293
2629
|
|
|
2294
2630
|
suffix: str
|
|
@@ -2296,7 +2632,7 @@ class Referring(TypedDict, total=False):
|
|
|
2296
2632
|
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
2297
2633
|
|
|
2298
2634
|
|
|
2299
|
-
class
|
|
2635
|
+
class SupervisingAddress(TypedDict, total=False):
|
|
2300
2636
|
address1: Required[str]
|
|
2301
2637
|
|
|
2302
2638
|
city: Required[str]
|
|
@@ -2312,31 +2648,31 @@ class RenderingAddress(TypedDict, total=False):
|
|
|
2312
2648
|
state: str
|
|
2313
2649
|
|
|
2314
2650
|
|
|
2315
|
-
class
|
|
2316
|
-
name: Required[str]
|
|
2317
|
-
|
|
2651
|
+
class SupervisingContactInformation(TypedDict, total=False):
|
|
2318
2652
|
email: str
|
|
2319
2653
|
|
|
2320
2654
|
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2321
2655
|
|
|
2322
|
-
|
|
2656
|
+
name: str
|
|
2323
2657
|
|
|
2324
|
-
|
|
2658
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2325
2659
|
|
|
2660
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2326
2661
|
|
|
2327
|
-
class Rendering(TypedDict, total=False):
|
|
2328
|
-
last_name: Required[Annotated[str, PropertyInfo(alias="lastName")]]
|
|
2329
2662
|
|
|
2330
|
-
|
|
2663
|
+
class Supervising(TypedDict, total=False):
|
|
2664
|
+
address: SupervisingAddress
|
|
2331
2665
|
|
|
2332
2666
|
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
2333
2667
|
|
|
2334
|
-
contact_information: Annotated[
|
|
2668
|
+
contact_information: Annotated[SupervisingContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2335
2669
|
|
|
2336
2670
|
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
2337
2671
|
|
|
2338
2672
|
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2339
2673
|
|
|
2674
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2675
|
+
|
|
2340
2676
|
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
2341
2677
|
|
|
2342
2678
|
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
@@ -2349,11 +2685,7 @@ class Rendering(TypedDict, total=False):
|
|
|
2349
2685
|
|
|
2350
2686
|
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
2351
2687
|
|
|
2352
|
-
|
|
2353
|
-
Literal["0B", "1G", "G2", "LU"], PropertyInfo(alias="secondaryIdentificationQualifierCode")
|
|
2354
|
-
]
|
|
2355
|
-
|
|
2356
|
-
secondary_identifier: Annotated[str, PropertyInfo(alias="secondaryIdentifier")]
|
|
2688
|
+
ssn: str
|
|
2357
2689
|
|
|
2358
2690
|
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2359
2691
|
|