samplehc 0.5.0__py3-none-any.whl → 0.7.0__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 -36
- samplehc/resources/v2/communication.py +8 -0
- samplehc/resources/v2/database.py +19 -9
- samplehc/resources/v2/events/__init__.py +33 -0
- samplehc/resources/v2/{events.py → events/events.py} +42 -10
- samplehc/resources/v2/events/hie/__init__.py +33 -0
- samplehc/resources/v2/events/hie/adt.py +249 -0
- samplehc/resources/v2/events/hie/hie.py +102 -0
- 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/ledger/ledger.py +152 -0
- samplehc/resources/v2/v2.py +40 -8
- samplehc/types/v2/__init__.py +8 -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 -884
- 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/events/__init__.py +3 -0
- samplehc/types/v2/events/hie/__init__.py +5 -0
- samplehc/types/v2/events/hie/adt_subscribe_params.py +92 -0
- 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/types/v2/ledger_post_remittance_accepted_params.py +37 -0
- samplehc/types/v2/ledger_post_remittance_accepted_response.py +12 -0
- {samplehc-0.5.0.dist-info → samplehc-0.7.0.dist-info}/METADATA +1 -1
- {samplehc-0.5.0.dist-info → samplehc-0.7.0.dist-info}/RECORD +55 -21
- {samplehc-0.5.0.dist-info → samplehc-0.7.0.dist-info}/WHEEL +0 -0
- {samplehc-0.5.0.dist-info → samplehc-0.7.0.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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"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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"SubscriberContactInformation",
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"DependentContactInformation",
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"OrderingContactInformation",
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"PayToAddress",
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"PayToPlan",
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"PayToPlanAddress",
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"SupervisingAddress",
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class ClaimSubmitParams(TypedDict, total=False):
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billing: Required[Billing]
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claim_information: Required[Annotated[ClaimInformation, PropertyInfo(alias="claimInformation")]]
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is_testing: Required[Annotated[bool, PropertyInfo(alias="isTesting")]]
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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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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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country_code: Annotated[str, PropertyInfo(alias="countryCode")]
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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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principal_diagnosis_code: Required[Annotated[str, PropertyInfo(alias="principalDiagnosisCode")]]
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name: str
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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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+
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+
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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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contact_information: Annotated[BillingContactInformation, PropertyInfo(alias="contactInformation")]
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employer_id: Annotated[str, PropertyInfo(alias="employerId")]
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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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class ClaimInformationHealthCareCodeInformation(TypedDict, total=False):
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diagnosis_code: Required[Annotated[str, PropertyInfo(alias="diagnosisCode")]]
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+
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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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+
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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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+
]
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+
]
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-
class ClaimInformationServiceLineInstitutionalService(TypedDict, total=False):
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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
255
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202
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-
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256
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+
procedure_identifier: Required[
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Annotated[Literal["ER", "HC", "IV", "WK"], PropertyInfo(alias="procedureIdentifier")]
|
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258
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+
]
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203
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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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description: str
|
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-
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+
emergency_indicator: Annotated[Literal["Y"], PropertyInfo(alias="emergencyIndicator")]
|
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209
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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
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212
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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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procedure_modifiers: Annotated[List[str], PropertyInfo(alias="procedureModifiers")]
|
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215
275
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276
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|
+
class ClaimInformationServiceLineAmbulanceCertification(TypedDict, total=False):
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|
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certification_condition_indicator: Required[
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279
|
+
Annotated[Literal["N", "Y"], PropertyInfo(alias="certificationConditionIndicator")]
|
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280
|
+
]
|
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281
|
+
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+
condition_codes: Required[
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283
|
+
Annotated[List[Literal["01", "04", "05", "06", "07", "08", "09", "12"]], PropertyInfo(alias="conditionCodes")]
|
|
284
|
+
]
|
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|
+
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+
|
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287
|
+
class ClaimInformationServiceLineAmbulanceDropOffLocation(TypedDict, total=False):
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|
+
address1: Required[str]
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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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+
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+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
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|
+
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|
+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
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297
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+
|
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|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
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|
+
|
|
300
|
+
state: str
|
|
301
|
+
|
|
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|
+
|
|
303
|
+
class ClaimInformationServiceLineAmbulancePickUpLocation(TypedDict, total=False):
|
|
304
|
+
address1: Required[str]
|
|
305
|
+
|
|
306
|
+
city: Required[str]
|
|
307
|
+
|
|
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|
+
address2: str
|
|
309
|
+
|
|
310
|
+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
311
|
+
|
|
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|
+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
313
|
+
|
|
314
|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
315
|
+
|
|
316
|
+
state: str
|
|
317
|
+
|
|
318
|
+
|
|
319
|
+
class ClaimInformationServiceLineAmbulanceTransportInformation(TypedDict, total=False):
|
|
320
|
+
ambulance_transport_reason_code: Required[
|
|
321
|
+
Annotated[Literal["A", "B", "C", "D", "E"], PropertyInfo(alias="ambulanceTransportReasonCode")]
|
|
322
|
+
]
|
|
323
|
+
|
|
324
|
+
transport_distance_in_miles: Required[Annotated[str, PropertyInfo(alias="transportDistanceInMiles")]]
|
|
325
|
+
|
|
326
|
+
patient_weight_in_pounds: Annotated[str, PropertyInfo(alias="patientWeightInPounds")]
|
|
327
|
+
|
|
328
|
+
round_trip_purpose_description: Annotated[str, PropertyInfo(alias="roundTripPurposeDescription")]
|
|
329
|
+
|
|
330
|
+
stretcher_purpose_description: Annotated[str, PropertyInfo(alias="stretcherPurposeDescription")]
|
|
331
|
+
|
|
332
|
+
|
|
333
|
+
class ClaimInformationServiceLineConditionIndicatorDurableMedicalEquipment(TypedDict, total=False):
|
|
334
|
+
certification_condition_indicator: Required[
|
|
335
|
+
Annotated[Literal["Y", "N"], PropertyInfo(alias="certificationConditionIndicator")]
|
|
336
|
+
]
|
|
337
|
+
|
|
338
|
+
condition_indicator: Required[Annotated[Literal["38", "ZV"], PropertyInfo(alias="conditionIndicator")]]
|
|
339
|
+
|
|
340
|
+
condition_indicator_code: Annotated[Literal["38", "ZV"], PropertyInfo(alias="conditionIndicatorCode")]
|
|
341
|
+
|
|
342
|
+
|
|
343
|
+
class ClaimInformationServiceLineContractInformation(TypedDict, total=False):
|
|
344
|
+
contract_type_code: Required[
|
|
345
|
+
Annotated[Literal["01", "02", "03", "04", "05", "06", "09"], PropertyInfo(alias="contractTypeCode")]
|
|
346
|
+
]
|
|
347
|
+
|
|
348
|
+
contract_amount: Annotated[str, PropertyInfo(alias="contractAmount")]
|
|
349
|
+
|
|
350
|
+
contract_code: Annotated[str, PropertyInfo(alias="contractCode")]
|
|
351
|
+
|
|
352
|
+
contract_percentage: Annotated[str, PropertyInfo(alias="contractPercentage")]
|
|
353
|
+
|
|
354
|
+
contract_version_identifier: Annotated[str, PropertyInfo(alias="contractVersionIdentifier")]
|
|
355
|
+
|
|
356
|
+
terms_discount_percentage: Annotated[str, PropertyInfo(alias="termsDiscountPercentage")]
|
|
357
|
+
|
|
358
|
+
|
|
217
359
|
class ClaimInformationServiceLineDrugIdentification(TypedDict, total=False):
|
|
218
360
|
measurement_unit_code: Required[
|
|
219
361
|
Annotated[Literal["F2", "GR", "ME", "ML", "UN"], PropertyInfo(alias="measurementUnitCode")]
|
|
@@ -223,62 +365,65 @@ class ClaimInformationServiceLineDrugIdentification(TypedDict, total=False):
|
|
|
223
365
|
|
|
224
366
|
national_drug_unit_count: Required[Annotated[str, PropertyInfo(alias="nationalDrugUnitCount")]]
|
|
225
367
|
|
|
368
|
+
service_id_qualifier: Required[
|
|
369
|
+
Annotated[Literal["EN", "EO", "HI", "N4", "ON", "UK", "UP"], PropertyInfo(alias="serviceIdQualifier")]
|
|
370
|
+
]
|
|
371
|
+
|
|
226
372
|
link_sequence_number: Annotated[str, PropertyInfo(alias="linkSequenceNumber")]
|
|
227
373
|
|
|
228
374
|
pharmacy_prescription_number: Annotated[str, PropertyInfo(alias="pharmacyPrescriptionNumber")]
|
|
229
375
|
|
|
230
376
|
|
|
231
|
-
class
|
|
232
|
-
|
|
233
|
-
|
|
234
|
-
|
|
377
|
+
class ClaimInformationServiceLineDurableMedicalEquipmentCertificateOfMedicalNecessity(TypedDict, total=False):
|
|
378
|
+
attachment_transmission_code: Required[
|
|
379
|
+
Annotated[Literal["AB", "AD", "AF", "AG", "NS"], PropertyInfo(alias="attachmentTransmissionCode")]
|
|
380
|
+
]
|
|
235
381
|
|
|
236
|
-
adjustment_quantity: Annotated[str, PropertyInfo(alias="adjustmentQuantity")]
|
|
237
382
|
|
|
383
|
+
class ClaimInformationServiceLineDurableMedicalEquipmentCertification(TypedDict, total=False):
|
|
384
|
+
certification_type_code: Required[Annotated[Literal["I", "R", "S"], PropertyInfo(alias="certificationTypeCode")]]
|
|
238
385
|
|
|
239
|
-
|
|
240
|
-
|
|
241
|
-
Annotated[Literal["CO", "CR", "OA", "PI", "PR"], PropertyInfo(alias="adjustmentGroupCode")]
|
|
386
|
+
durable_medical_equipment_duration_in_months: Required[
|
|
387
|
+
Annotated[str, PropertyInfo(alias="durableMedicalEquipmentDurationInMonths")]
|
|
242
388
|
]
|
|
243
389
|
|
|
244
|
-
claim_adjustment_details: Annotated[
|
|
245
|
-
Iterable[ClaimInformationServiceLineLineAdjudicationInformationLineAdjustmentClaimAdjustmentDetail],
|
|
246
|
-
PropertyInfo(alias="claimAdjustmentDetails"),
|
|
247
|
-
]
|
|
248
390
|
|
|
391
|
+
class ClaimInformationServiceLineDurableMedicalEquipmentService(TypedDict, total=False):
|
|
392
|
+
days: Required[str]
|
|
249
393
|
|
|
250
|
-
|
|
251
|
-
adjudication_or_payment_date: Required[Annotated[str, PropertyInfo(alias="adjudicationOrPaymentDate")]]
|
|
394
|
+
frequency_code: Required[Annotated[Literal["1", "4", "6"], PropertyInfo(alias="frequencyCode")]]
|
|
252
395
|
|
|
253
|
-
|
|
396
|
+
purchase_price: Required[Annotated[str, PropertyInfo(alias="purchasePrice")]]
|
|
254
397
|
|
|
255
|
-
|
|
398
|
+
rental_price: Required[Annotated[str, PropertyInfo(alias="rentalPrice")]]
|
|
256
399
|
|
|
257
|
-
service_line_paid_amount: Required[Annotated[str, PropertyInfo(alias="serviceLinePaidAmount")]]
|
|
258
400
|
|
|
259
|
-
|
|
401
|
+
class ClaimInformationServiceLineFormIdentificationSupportingDocumentation(TypedDict, total=False):
|
|
402
|
+
question_number: Required[Annotated[str, PropertyInfo(alias="questionNumber")]]
|
|
260
403
|
|
|
261
|
-
|
|
404
|
+
question_response: Annotated[str, PropertyInfo(alias="questionResponse")]
|
|
262
405
|
|
|
263
|
-
|
|
264
|
-
Iterable[ClaimInformationServiceLineLineAdjudicationInformationLineAdjustment],
|
|
265
|
-
PropertyInfo(alias="lineAdjustment"),
|
|
266
|
-
]
|
|
406
|
+
question_response_as_date: Annotated[str, PropertyInfo(alias="questionResponseAsDate")]
|
|
267
407
|
|
|
268
|
-
|
|
408
|
+
question_response_as_percent: Annotated[str, PropertyInfo(alias="questionResponseAsPercent")]
|
|
269
409
|
|
|
270
|
-
|
|
410
|
+
question_response_code: Annotated[Literal["N", "W", "Y"], PropertyInfo(alias="questionResponseCode")]
|
|
271
411
|
|
|
272
|
-
procedure_modifier: Annotated[List[str], PropertyInfo(alias="procedureModifier")]
|
|
273
412
|
|
|
274
|
-
|
|
275
|
-
|
|
276
|
-
]
|
|
413
|
+
class ClaimInformationServiceLineFormIdentification(TypedDict, total=False):
|
|
414
|
+
form_identifier: Required[Annotated[str, PropertyInfo(alias="formIdentifier")]]
|
|
277
415
|
|
|
278
|
-
|
|
416
|
+
form_type_code: Required[Annotated[Literal["AS", "UT"], PropertyInfo(alias="formTypeCode")]]
|
|
417
|
+
|
|
418
|
+
supporting_documentation: Annotated[
|
|
419
|
+
Iterable[ClaimInformationServiceLineFormIdentificationSupportingDocumentation],
|
|
420
|
+
PropertyInfo(alias="supportingDocumentation"),
|
|
421
|
+
]
|
|
279
422
|
|
|
280
423
|
|
|
281
|
-
class
|
|
424
|
+
class ClaimInformationServiceLineLineAdjudicationInformationClaimAdjustmentInformationAdjustmentDetail(
|
|
425
|
+
TypedDict, total=False
|
|
426
|
+
):
|
|
282
427
|
adjustment_amount: Required[Annotated[str, PropertyInfo(alias="adjustmentAmount")]]
|
|
283
428
|
|
|
284
429
|
adjustment_reason_code: Required[Annotated[str, PropertyInfo(alias="adjustmentReasonCode")]]
|
|
@@ -286,19 +431,21 @@ class ClaimInformationServiceLineLineAdjustmentInformationClaimAdjustmentClaimAd
|
|
|
286
431
|
adjustment_quantity: Annotated[str, PropertyInfo(alias="adjustmentQuantity")]
|
|
287
432
|
|
|
288
433
|
|
|
289
|
-
class
|
|
290
|
-
|
|
291
|
-
Annotated[
|
|
434
|
+
class ClaimInformationServiceLineLineAdjudicationInformationClaimAdjustmentInformation(TypedDict, total=False):
|
|
435
|
+
adjustment_details: Required[
|
|
436
|
+
Annotated[
|
|
437
|
+
Iterable[ClaimInformationServiceLineLineAdjudicationInformationClaimAdjustmentInformationAdjustmentDetail],
|
|
438
|
+
PropertyInfo(alias="adjustmentDetails"),
|
|
439
|
+
]
|
|
292
440
|
]
|
|
293
441
|
|
|
294
|
-
|
|
295
|
-
|
|
296
|
-
PropertyInfo(alias="claimAdjustmentDetails"),
|
|
442
|
+
adjustment_group_code: Required[
|
|
443
|
+
Annotated[Literal["CO", "CR", "OA", "PI", "PR"], PropertyInfo(alias="adjustmentGroupCode")]
|
|
297
444
|
]
|
|
298
445
|
|
|
299
446
|
|
|
300
|
-
class
|
|
301
|
-
|
|
447
|
+
class ClaimInformationServiceLineLineAdjudicationInformation(TypedDict, total=False):
|
|
448
|
+
adjudication_or_payment_date: Required[Annotated[str, PropertyInfo(alias="adjudicationOrPaymentDate")]]
|
|
302
449
|
|
|
303
450
|
other_payer_primary_identifier: Required[Annotated[str, PropertyInfo(alias="otherPayerPrimaryIdentifier")]]
|
|
304
451
|
|
|
@@ -306,8 +453,6 @@ class ClaimInformationServiceLineLineAdjustmentInformation(TypedDict, total=Fals
|
|
|
306
453
|
|
|
307
454
|
procedure_code: Required[Annotated[str, PropertyInfo(alias="procedureCode")]]
|
|
308
455
|
|
|
309
|
-
remaining_patient_liability: Required[Annotated[str, PropertyInfo(alias="remainingPatientLiability")]]
|
|
310
|
-
|
|
311
456
|
service_id_qualifier: Required[
|
|
312
457
|
Annotated[Literal["ER", "HC", "HP", "IV", "WK"], PropertyInfo(alias="serviceIdQualifier")]
|
|
313
458
|
]
|
|
@@ -316,16 +461,19 @@ class ClaimInformationServiceLineLineAdjustmentInformation(TypedDict, total=Fals
|
|
|
316
461
|
|
|
317
462
|
bundled_or_unbundled_line_number: Annotated[str, PropertyInfo(alias="bundledOrUnbundledLineNumber")]
|
|
318
463
|
|
|
319
|
-
|
|
320
|
-
|
|
464
|
+
claim_adjustment_information: Annotated[
|
|
465
|
+
Iterable[ClaimInformationServiceLineLineAdjudicationInformationClaimAdjustmentInformation],
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+
PropertyInfo(alias="claimAdjustmentInformation"),
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]
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procedure_code_description: Annotated[str, PropertyInfo(alias="procedureCodeDescription")]
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-
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+
procedure_modifier: Annotated[List[str], PropertyInfo(alias="procedureModifier")]
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+
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+
remaining_patient_liability: Annotated[str, PropertyInfo(alias="remainingPatientLiability")]
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-
class
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+
class ClaimInformationServiceLineLinePricingRepricingInformation(TypedDict, total=False):
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pricing_methodology_code: Required[
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330
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Annotated[
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331
479
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Literal["00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14"],
|
|
@@ -335,225 +483,208 @@ 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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-
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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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503
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352
|
-
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+
repricing_per_diem_or_flat_rate_amount: Annotated[str, PropertyInfo(alias="repricingPerDiemOrFlatRateAmount")]
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353
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|
-
repriced_approved_service_unit_count: Annotated[str, PropertyInfo(alias="repricedApprovedServiceUnitCount")]
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355
506
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356
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-
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507
|
+
class ClaimInformationServiceLineOrderingProviderAddress(TypedDict, total=False):
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508
|
+
address1: Required[str]
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357
509
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358
|
-
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510
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+
city: Required[str]
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359
511
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360
|
-
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512
|
+
address2: str
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361
513
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514
|
+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
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362
515
|
|
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363
|
-
|
|
364
|
-
pricing_methodology_code: Required[
|
|
365
|
-
Annotated[
|
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366
|
-
Literal["00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14"],
|
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367
|
-
PropertyInfo(alias="pricingMethodologyCode"),
|
|
368
|
-
]
|
|
369
|
-
]
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516
|
+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
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370
517
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371
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-
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518
|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
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372
519
|
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373
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-
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520
|
+
state: str
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374
521
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375
|
-
policy_compliance_code: Annotated[Literal["1", "2", "3", "4", "5"], PropertyInfo(alias="policyComplianceCode")]
|
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376
522
|
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377
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-
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378
|
-
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379
|
-
]
|
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523
|
+
class ClaimInformationServiceLineOrderingProviderContactInformation(TypedDict, total=False):
|
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524
|
+
name: Required[str]
|
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380
525
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381
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-
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526
|
+
email: str
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382
527
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-
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528
|
+
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
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384
529
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385
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-
|
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530
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
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386
531
|
|
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387
|
-
|
|
532
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
388
533
|
|
|
389
|
-
repriced_approved_revenue_code: Annotated[str, PropertyInfo(alias="repricedApprovedRevenueCode")]
|
|
390
534
|
|
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391
|
-
|
|
392
|
-
|
|
393
|
-
]
|
|
535
|
+
class ClaimInformationServiceLineOrderingProviderSecondaryIdentifier(TypedDict, total=False):
|
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536
|
+
identifier: Required[str]
|
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394
537
|
|
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395
|
-
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538
|
+
qualifier: Required[str]
|
|
396
539
|
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|
397
|
-
|
|
540
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
398
541
|
|
|
399
|
-
repriced_per_diem: Annotated[str, PropertyInfo(alias="repricedPerDiem")]
|
|
400
542
|
|
|
401
|
-
|
|
543
|
+
class ClaimInformationServiceLineOrderingProvider(TypedDict, total=False):
|
|
544
|
+
address: ClaimInformationServiceLineOrderingProviderAddress
|
|
402
545
|
|
|
546
|
+
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
403
547
|
|
|
404
|
-
|
|
405
|
-
attachment_control_number: Required[Annotated[str, PropertyInfo(alias="attachmentControlNumber")]]
|
|
548
|
+
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
406
549
|
|
|
407
|
-
|
|
408
|
-
|
|
409
|
-
Literal[
|
|
410
|
-
"03",
|
|
411
|
-
"04",
|
|
412
|
-
"05",
|
|
413
|
-
"06",
|
|
414
|
-
"07",
|
|
415
|
-
"08",
|
|
416
|
-
"09",
|
|
417
|
-
"10",
|
|
418
|
-
"11",
|
|
419
|
-
"13",
|
|
420
|
-
"15",
|
|
421
|
-
"21",
|
|
422
|
-
"A3",
|
|
423
|
-
"A4",
|
|
424
|
-
"AM",
|
|
425
|
-
"AS",
|
|
426
|
-
"B2",
|
|
427
|
-
"B3",
|
|
428
|
-
"B4",
|
|
429
|
-
"BR",
|
|
430
|
-
"BS",
|
|
431
|
-
"BT",
|
|
432
|
-
"CB",
|
|
433
|
-
"CK",
|
|
434
|
-
"CT",
|
|
435
|
-
"D2",
|
|
436
|
-
"DA",
|
|
437
|
-
"DB",
|
|
438
|
-
"DG",
|
|
439
|
-
"DJ",
|
|
440
|
-
"DS",
|
|
441
|
-
"EB",
|
|
442
|
-
"HC",
|
|
443
|
-
"HR",
|
|
444
|
-
"I5",
|
|
445
|
-
"IR",
|
|
446
|
-
"LA",
|
|
447
|
-
"M1",
|
|
448
|
-
"MT",
|
|
449
|
-
"NN",
|
|
450
|
-
"OB",
|
|
451
|
-
"OC",
|
|
452
|
-
"OD",
|
|
453
|
-
"OE",
|
|
454
|
-
"OX",
|
|
455
|
-
"OZ",
|
|
456
|
-
"P4",
|
|
457
|
-
"P5",
|
|
458
|
-
"PE",
|
|
459
|
-
"PN",
|
|
460
|
-
"PO",
|
|
461
|
-
"PQ",
|
|
462
|
-
"PY",
|
|
463
|
-
"PZ",
|
|
464
|
-
"RB",
|
|
465
|
-
"RR",
|
|
466
|
-
"RT",
|
|
467
|
-
"RX",
|
|
468
|
-
"SG",
|
|
469
|
-
"V5",
|
|
470
|
-
"XP",
|
|
471
|
-
],
|
|
472
|
-
PropertyInfo(alias="attachmentReportTypeCode"),
|
|
473
|
-
]
|
|
550
|
+
contact_information: Annotated[
|
|
551
|
+
ClaimInformationServiceLineOrderingProviderContactInformation, PropertyInfo(alias="contactInformation")
|
|
474
552
|
]
|
|
475
553
|
|
|
476
|
-
|
|
477
|
-
Annotated[Literal["AA", "BM", "EL", "EM", "FT", "FX"], PropertyInfo(alias="attachmentTransmissionCode")]
|
|
478
|
-
]
|
|
554
|
+
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
479
555
|
|
|
556
|
+
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
480
557
|
|
|
481
|
-
|
|
482
|
-
adjusted_repriced_claim_ref_number: Annotated[str, PropertyInfo(alias="adjustedRepricedClaimRefNumber")]
|
|
558
|
+
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
483
559
|
|
|
484
|
-
|
|
560
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
485
561
|
|
|
486
|
-
|
|
562
|
+
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
487
563
|
|
|
488
|
-
|
|
564
|
+
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
489
565
|
|
|
490
|
-
|
|
566
|
+
naic: str
|
|
491
567
|
|
|
492
|
-
|
|
568
|
+
npi: str
|
|
493
569
|
|
|
494
|
-
|
|
570
|
+
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
495
571
|
|
|
496
|
-
|
|
572
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
497
573
|
|
|
498
|
-
|
|
574
|
+
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
499
575
|
|
|
500
|
-
|
|
576
|
+
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
501
577
|
|
|
502
|
-
|
|
503
|
-
|
|
578
|
+
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
579
|
+
|
|
580
|
+
secondary_identifier: Annotated[
|
|
581
|
+
Iterable[ClaimInformationServiceLineOrderingProviderSecondaryIdentifier],
|
|
582
|
+
PropertyInfo(alias="secondaryIdentifier"),
|
|
504
583
|
]
|
|
505
584
|
|
|
506
|
-
|
|
507
|
-
|
|
508
|
-
|
|
585
|
+
ssn: str
|
|
586
|
+
|
|
587
|
+
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
588
|
+
|
|
589
|
+
suffix: str
|
|
590
|
+
|
|
591
|
+
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
592
|
+
|
|
593
|
+
|
|
594
|
+
class ClaimInformationServiceLinePurchasedServiceInformation(TypedDict, total=False):
|
|
595
|
+
purchased_service_charge_amount: Required[Annotated[str, PropertyInfo(alias="purchasedServiceChargeAmount")]]
|
|
596
|
+
|
|
597
|
+
purchased_service_provider_identifier: Required[
|
|
598
|
+
Annotated[str, PropertyInfo(alias="purchasedServiceProviderIdentifier")]
|
|
509
599
|
]
|
|
510
600
|
|
|
511
|
-
repriced_claim_number: Annotated[str, PropertyInfo(alias="repricedClaimNumber")]
|
|
512
601
|
|
|
513
|
-
|
|
514
|
-
|
|
602
|
+
class ClaimInformationServiceLinePurchasedServiceProviderAddress(TypedDict, total=False):
|
|
603
|
+
address1: Required[str]
|
|
604
|
+
|
|
605
|
+
city: Required[str]
|
|
606
|
+
|
|
607
|
+
address2: str
|
|
608
|
+
|
|
609
|
+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
610
|
+
|
|
611
|
+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
612
|
+
|
|
613
|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
614
|
+
|
|
615
|
+
state: str
|
|
616
|
+
|
|
617
|
+
|
|
618
|
+
class ClaimInformationServiceLinePurchasedServiceProviderContactInformation(TypedDict, total=False):
|
|
619
|
+
email: str
|
|
620
|
+
|
|
621
|
+
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
622
|
+
|
|
623
|
+
name: str
|
|
624
|
+
|
|
625
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
626
|
+
|
|
627
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
628
|
+
|
|
629
|
+
|
|
630
|
+
class ClaimInformationServiceLinePurchasedServiceProviderSecondaryIdentifier(TypedDict, total=False):
|
|
631
|
+
identifier: Required[str]
|
|
632
|
+
|
|
633
|
+
qualifier: Required[str]
|
|
634
|
+
|
|
635
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
636
|
+
|
|
637
|
+
|
|
638
|
+
class ClaimInformationServiceLinePurchasedServiceProvider(TypedDict, total=False):
|
|
639
|
+
address: ClaimInformationServiceLinePurchasedServiceProviderAddress
|
|
640
|
+
|
|
641
|
+
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
642
|
+
|
|
643
|
+
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
644
|
+
|
|
645
|
+
contact_information: Annotated[
|
|
646
|
+
ClaimInformationServiceLinePurchasedServiceProviderContactInformation, PropertyInfo(alias="contactInformation")
|
|
515
647
|
]
|
|
516
648
|
|
|
649
|
+
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
517
650
|
|
|
518
|
-
|
|
519
|
-
last_name: Required[Annotated[str, PropertyInfo(alias="lastName")]]
|
|
651
|
+
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
520
652
|
|
|
521
653
|
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
522
654
|
|
|
523
|
-
|
|
524
|
-
|
|
525
|
-
]
|
|
655
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
656
|
+
|
|
657
|
+
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
526
658
|
|
|
527
659
|
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
528
660
|
|
|
661
|
+
naic: str
|
|
662
|
+
|
|
529
663
|
npi: str
|
|
530
664
|
|
|
531
665
|
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
532
666
|
|
|
533
|
-
|
|
534
|
-
|
|
535
|
-
suffix: str
|
|
536
|
-
|
|
537
|
-
|
|
538
|
-
class ClaimInformationServiceLineOtherOperatingPhysician(TypedDict, total=False):
|
|
539
|
-
last_name: Required[Annotated[str, PropertyInfo(alias="lastName")]]
|
|
667
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
540
668
|
|
|
541
|
-
|
|
669
|
+
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
542
670
|
|
|
543
|
-
|
|
544
|
-
Literal["0B", "1G", "G2", "LU"], PropertyInfo(alias="identificationQualifierCode")
|
|
545
|
-
]
|
|
671
|
+
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
546
672
|
|
|
547
|
-
|
|
673
|
+
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
548
674
|
|
|
549
|
-
|
|
675
|
+
secondary_identifier: Annotated[
|
|
676
|
+
Iterable[ClaimInformationServiceLinePurchasedServiceProviderSecondaryIdentifier],
|
|
677
|
+
PropertyInfo(alias="secondaryIdentifier"),
|
|
678
|
+
]
|
|
550
679
|
|
|
551
|
-
|
|
680
|
+
ssn: str
|
|
552
681
|
|
|
553
|
-
|
|
682
|
+
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
554
683
|
|
|
555
684
|
suffix: str
|
|
556
685
|
|
|
686
|
+
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
687
|
+
|
|
557
688
|
|
|
558
689
|
class ClaimInformationServiceLineReferringProviderAddress(TypedDict, total=False):
|
|
559
690
|
address1: Required[str]
|
|
@@ -572,26 +703,32 @@ class ClaimInformationServiceLineReferringProviderAddress(TypedDict, total=False
|
|
|
572
703
|
|
|
573
704
|
|
|
574
705
|
class ClaimInformationServiceLineReferringProviderContactInformation(TypedDict, total=False):
|
|
575
|
-
name: Required[str]
|
|
576
|
-
|
|
577
706
|
email: str
|
|
578
707
|
|
|
579
708
|
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
580
709
|
|
|
581
|
-
|
|
710
|
+
name: str
|
|
582
711
|
|
|
583
|
-
|
|
712
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
713
|
+
|
|
714
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
584
715
|
|
|
585
716
|
|
|
586
|
-
class
|
|
717
|
+
class ClaimInformationServiceLineReferringProviderSecondaryIdentifier(TypedDict, total=False):
|
|
587
718
|
identifier: Required[str]
|
|
588
719
|
|
|
589
720
|
qualifier: Required[str]
|
|
590
721
|
|
|
722
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
723
|
+
|
|
591
724
|
|
|
592
725
|
class ClaimInformationServiceLineReferringProvider(TypedDict, total=False):
|
|
726
|
+
provider_type: Required[Annotated[str, PropertyInfo(alias="providerType")]]
|
|
727
|
+
|
|
593
728
|
address: ClaimInformationServiceLineReferringProviderAddress
|
|
594
729
|
|
|
730
|
+
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
731
|
+
|
|
595
732
|
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
596
733
|
|
|
597
734
|
contact_information: Annotated[
|
|
@@ -600,6 +737,8 @@ class ClaimInformationServiceLineReferringProvider(TypedDict, total=False):
|
|
|
600
737
|
|
|
601
738
|
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
602
739
|
|
|
740
|
+
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
741
|
+
|
|
603
742
|
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
604
743
|
|
|
605
744
|
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
@@ -608,24 +747,24 @@ class ClaimInformationServiceLineReferringProvider(TypedDict, total=False):
|
|
|
608
747
|
|
|
609
748
|
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
610
749
|
|
|
750
|
+
naic: str
|
|
751
|
+
|
|
611
752
|
npi: str
|
|
612
753
|
|
|
613
754
|
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
614
755
|
|
|
615
|
-
|
|
756
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
616
757
|
|
|
617
|
-
|
|
758
|
+
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
618
759
|
|
|
619
|
-
|
|
620
|
-
Iterable[ClaimInformationServiceLineReferringProviderReferenceIdentification],
|
|
621
|
-
PropertyInfo(alias="referenceIdentification"),
|
|
622
|
-
]
|
|
760
|
+
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
623
761
|
|
|
624
|
-
|
|
625
|
-
|
|
762
|
+
secondary_identifier: Annotated[
|
|
763
|
+
Iterable[ClaimInformationServiceLineReferringProviderSecondaryIdentifier],
|
|
764
|
+
PropertyInfo(alias="secondaryIdentifier"),
|
|
626
765
|
]
|
|
627
766
|
|
|
628
|
-
|
|
767
|
+
ssn: str
|
|
629
768
|
|
|
630
769
|
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
631
770
|
|
|
@@ -651,26 +790,32 @@ class ClaimInformationServiceLineRenderingProviderAddress(TypedDict, total=False
|
|
|
651
790
|
|
|
652
791
|
|
|
653
792
|
class ClaimInformationServiceLineRenderingProviderContactInformation(TypedDict, total=False):
|
|
654
|
-
name: Required[str]
|
|
655
|
-
|
|
656
793
|
email: str
|
|
657
794
|
|
|
658
795
|
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
659
796
|
|
|
660
|
-
|
|
797
|
+
name: str
|
|
798
|
+
|
|
799
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
661
800
|
|
|
662
|
-
|
|
801
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
663
802
|
|
|
664
803
|
|
|
665
|
-
class
|
|
804
|
+
class ClaimInformationServiceLineRenderingProviderSecondaryIdentifier(TypedDict, total=False):
|
|
666
805
|
identifier: Required[str]
|
|
667
806
|
|
|
668
807
|
qualifier: Required[str]
|
|
669
808
|
|
|
809
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
810
|
+
|
|
670
811
|
|
|
671
812
|
class ClaimInformationServiceLineRenderingProvider(TypedDict, total=False):
|
|
813
|
+
provider_type: Required[Annotated[str, PropertyInfo(alias="providerType")]]
|
|
814
|
+
|
|
672
815
|
address: ClaimInformationServiceLineRenderingProviderAddress
|
|
673
816
|
|
|
817
|
+
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
818
|
+
|
|
674
819
|
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
675
820
|
|
|
676
821
|
contact_information: Annotated[
|
|
@@ -679,6 +824,8 @@ class ClaimInformationServiceLineRenderingProvider(TypedDict, total=False):
|
|
|
679
824
|
|
|
680
825
|
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
681
826
|
|
|
827
|
+
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
828
|
+
|
|
682
829
|
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
683
830
|
|
|
684
831
|
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
@@ -687,24 +834,24 @@ class ClaimInformationServiceLineRenderingProvider(TypedDict, total=False):
|
|
|
687
834
|
|
|
688
835
|
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
689
836
|
|
|
837
|
+
naic: str
|
|
838
|
+
|
|
690
839
|
npi: str
|
|
691
840
|
|
|
692
841
|
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
693
842
|
|
|
694
|
-
|
|
843
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
695
844
|
|
|
696
|
-
|
|
845
|
+
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
697
846
|
|
|
698
|
-
|
|
699
|
-
Iterable[ClaimInformationServiceLineRenderingProviderReferenceIdentification],
|
|
700
|
-
PropertyInfo(alias="referenceIdentification"),
|
|
701
|
-
]
|
|
847
|
+
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
702
848
|
|
|
703
|
-
|
|
704
|
-
|
|
849
|
+
secondary_identifier: Annotated[
|
|
850
|
+
Iterable[ClaimInformationServiceLineRenderingProviderSecondaryIdentifier],
|
|
851
|
+
PropertyInfo(alias="secondaryIdentifier"),
|
|
705
852
|
]
|
|
706
853
|
|
|
707
|
-
|
|
854
|
+
ssn: str
|
|
708
855
|
|
|
709
856
|
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
710
857
|
|
|
@@ -713,37 +860,104 @@ class ClaimInformationServiceLineRenderingProvider(TypedDict, total=False):
|
|
|
713
860
|
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
714
861
|
|
|
715
862
|
|
|
863
|
+
class ClaimInformationServiceLineServiceFacilityLocationAddress(TypedDict, total=False):
|
|
864
|
+
address1: Required[str]
|
|
865
|
+
|
|
866
|
+
city: Required[str]
|
|
867
|
+
|
|
868
|
+
address2: str
|
|
869
|
+
|
|
870
|
+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
871
|
+
|
|
872
|
+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
873
|
+
|
|
874
|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
875
|
+
|
|
876
|
+
state: str
|
|
877
|
+
|
|
878
|
+
|
|
879
|
+
class ClaimInformationServiceLineServiceFacilityLocationSecondaryIdentifier(TypedDict, total=False):
|
|
880
|
+
identifier: Required[str]
|
|
881
|
+
|
|
882
|
+
qualifier: Required[str]
|
|
883
|
+
|
|
884
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
885
|
+
|
|
886
|
+
|
|
887
|
+
class ClaimInformationServiceLineServiceFacilityLocation(TypedDict, total=False):
|
|
888
|
+
address: Required[ClaimInformationServiceLineServiceFacilityLocationAddress]
|
|
889
|
+
|
|
890
|
+
organization_name: Required[Annotated[str, PropertyInfo(alias="organizationName")]]
|
|
891
|
+
|
|
892
|
+
npi: str
|
|
893
|
+
|
|
894
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
895
|
+
|
|
896
|
+
phone_name: Annotated[str, PropertyInfo(alias="phoneName")]
|
|
897
|
+
|
|
898
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
899
|
+
|
|
900
|
+
secondary_identifier: Annotated[
|
|
901
|
+
Iterable[ClaimInformationServiceLineServiceFacilityLocationSecondaryIdentifier],
|
|
902
|
+
PropertyInfo(alias="secondaryIdentifier"),
|
|
903
|
+
]
|
|
904
|
+
|
|
905
|
+
|
|
716
906
|
class ClaimInformationServiceLineServiceLineDateInformation(TypedDict, total=False):
|
|
717
|
-
|
|
907
|
+
begin_therapy_date: Annotated[str, PropertyInfo(alias="beginTherapyDate")]
|
|
718
908
|
|
|
719
|
-
|
|
909
|
+
certification_revision_or_recertification_date: Annotated[
|
|
910
|
+
str, PropertyInfo(alias="certificationRevisionOrRecertificationDate")
|
|
911
|
+
]
|
|
720
912
|
|
|
721
|
-
|
|
913
|
+
hemoglobin_test_date: Annotated[str, PropertyInfo(alias="hemoglobinTestDate")]
|
|
722
914
|
|
|
723
|
-
|
|
915
|
+
initial_treatment_date: Annotated[str, PropertyInfo(alias="initialTreatmentDate")]
|
|
724
916
|
|
|
917
|
+
last_certification_date: Annotated[str, PropertyInfo(alias="lastCertificationDate")]
|
|
725
918
|
|
|
726
|
-
|
|
727
|
-
provider_control_number: Required[Annotated[str, PropertyInfo(alias="providerControlNumber")]]
|
|
919
|
+
last_x_ray_date: Annotated[str, PropertyInfo(alias="lastXRayDate")]
|
|
728
920
|
|
|
921
|
+
prescription_date: Annotated[str, PropertyInfo(alias="prescriptionDate")]
|
|
729
922
|
|
|
730
|
-
|
|
731
|
-
repriced_line_item_ref_number: Required[Annotated[str, PropertyInfo(alias="repricedLineItemRefNumber")]]
|
|
923
|
+
serum_creatine_test_date: Annotated[str, PropertyInfo(alias="serumCreatineTestDate")]
|
|
732
924
|
|
|
925
|
+
shipped_date: Annotated[str, PropertyInfo(alias="shippedDate")]
|
|
733
926
|
|
|
734
|
-
|
|
735
|
-
|
|
736
|
-
|
|
737
|
-
|
|
738
|
-
|
|
927
|
+
treatment_or_therapy_date: Annotated[str, PropertyInfo(alias="treatmentOrTherapyDate")]
|
|
928
|
+
|
|
929
|
+
|
|
930
|
+
class ClaimInformationServiceLineServiceLineReferenceInformationPriorAuthorization(TypedDict, total=False):
|
|
931
|
+
prior_authorization_or_referral_number: Required[
|
|
932
|
+
Annotated[str, PropertyInfo(alias="priorAuthorizationOrReferralNumber")]
|
|
739
933
|
]
|
|
740
934
|
|
|
935
|
+
other_payer_primary_identifier: Annotated[str, PropertyInfo(alias="otherPayerPrimaryIdentifier")]
|
|
741
936
|
|
|
742
|
-
|
|
743
|
-
|
|
744
|
-
|
|
745
|
-
|
|
746
|
-
]
|
|
937
|
+
|
|
938
|
+
class ClaimInformationServiceLineServiceLineReferenceInformation(TypedDict, total=False):
|
|
939
|
+
adjusted_repriced_line_item_reference_number: Annotated[
|
|
940
|
+
str, PropertyInfo(alias="adjustedRepricedLineItemReferenceNumber")
|
|
941
|
+
]
|
|
942
|
+
|
|
943
|
+
clinical_laboratory_improvement_amendment_number: Annotated[
|
|
944
|
+
str, PropertyInfo(alias="clinicalLaboratoryImprovementAmendmentNumber")
|
|
945
|
+
]
|
|
946
|
+
|
|
947
|
+
immunization_batch_number: Annotated[str, PropertyInfo(alias="immunizationBatchNumber")]
|
|
948
|
+
|
|
949
|
+
mammography_certification_number: Annotated[str, PropertyInfo(alias="mammographyCertificationNumber")]
|
|
950
|
+
|
|
951
|
+
prior_authorization: Annotated[
|
|
952
|
+
Iterable[ClaimInformationServiceLineServiceLineReferenceInformationPriorAuthorization],
|
|
953
|
+
PropertyInfo(alias="priorAuthorization"),
|
|
954
|
+
]
|
|
955
|
+
|
|
956
|
+
referral_number: Annotated[List[str], PropertyInfo(alias="referralNumber")]
|
|
957
|
+
|
|
958
|
+
referring_clia_number: Annotated[str, PropertyInfo(alias="referringCliaNumber")]
|
|
959
|
+
|
|
960
|
+
repriced_line_item_reference_number: Annotated[str, PropertyInfo(alias="repricedLineItemReferenceNumber")]
|
|
747
961
|
|
|
748
962
|
|
|
749
963
|
class ClaimInformationServiceLineServiceLineSupplementalInformation(TypedDict, total=False):
|
|
@@ -789,7 +1003,7 @@ class ClaimInformationServiceLineServiceLineSupplementalInformation(TypedDict, t
|
|
|
789
1003
|
"LA",
|
|
790
1004
|
"M1",
|
|
791
1005
|
"MT",
|
|
792
|
-
"
|
|
1006
|
+
"NM",
|
|
793
1007
|
"OB",
|
|
794
1008
|
"OC",
|
|
795
1009
|
"OD",
|
|
@@ -823,94 +1037,284 @@ class ClaimInformationServiceLineServiceLineSupplementalInformation(TypedDict, t
|
|
|
823
1037
|
attachment_control_number: Annotated[str, PropertyInfo(alias="attachmentControlNumber")]
|
|
824
1038
|
|
|
825
1039
|
|
|
1040
|
+
class ClaimInformationServiceLineSupervisingProviderAddress(TypedDict, total=False):
|
|
1041
|
+
address1: Required[str]
|
|
1042
|
+
|
|
1043
|
+
city: Required[str]
|
|
1044
|
+
|
|
1045
|
+
address2: str
|
|
1046
|
+
|
|
1047
|
+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
1048
|
+
|
|
1049
|
+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
1050
|
+
|
|
1051
|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
1052
|
+
|
|
1053
|
+
state: str
|
|
1054
|
+
|
|
1055
|
+
|
|
1056
|
+
class ClaimInformationServiceLineSupervisingProviderContactInformation(TypedDict, total=False):
|
|
1057
|
+
email: str
|
|
1058
|
+
|
|
1059
|
+
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
1060
|
+
|
|
1061
|
+
name: str
|
|
1062
|
+
|
|
1063
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
1064
|
+
|
|
1065
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
1066
|
+
|
|
1067
|
+
|
|
1068
|
+
class ClaimInformationServiceLineSupervisingProviderSecondaryIdentifier(TypedDict, total=False):
|
|
1069
|
+
identifier: Required[str]
|
|
1070
|
+
|
|
1071
|
+
qualifier: Required[str]
|
|
1072
|
+
|
|
1073
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1074
|
+
|
|
1075
|
+
|
|
1076
|
+
class ClaimInformationServiceLineSupervisingProvider(TypedDict, total=False):
|
|
1077
|
+
provider_type: Required[Annotated[str, PropertyInfo(alias="providerType")]]
|
|
1078
|
+
|
|
1079
|
+
address: ClaimInformationServiceLineSupervisingProviderAddress
|
|
1080
|
+
|
|
1081
|
+
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
1082
|
+
|
|
1083
|
+
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
1084
|
+
|
|
1085
|
+
contact_information: Annotated[
|
|
1086
|
+
ClaimInformationServiceLineSupervisingProviderContactInformation, PropertyInfo(alias="contactInformation")
|
|
1087
|
+
]
|
|
1088
|
+
|
|
1089
|
+
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
1090
|
+
|
|
1091
|
+
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
1092
|
+
|
|
1093
|
+
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
1094
|
+
|
|
1095
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
1096
|
+
|
|
1097
|
+
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
1098
|
+
|
|
1099
|
+
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
1100
|
+
|
|
1101
|
+
naic: str
|
|
1102
|
+
|
|
1103
|
+
npi: str
|
|
1104
|
+
|
|
1105
|
+
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
1106
|
+
|
|
1107
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1108
|
+
|
|
1109
|
+
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
1110
|
+
|
|
1111
|
+
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
1112
|
+
|
|
1113
|
+
secondary_identifier: Annotated[
|
|
1114
|
+
Iterable[ClaimInformationServiceLineSupervisingProviderSecondaryIdentifier],
|
|
1115
|
+
PropertyInfo(alias="secondaryIdentifier"),
|
|
1116
|
+
]
|
|
1117
|
+
|
|
1118
|
+
ssn: str
|
|
1119
|
+
|
|
1120
|
+
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
1121
|
+
|
|
1122
|
+
suffix: str
|
|
1123
|
+
|
|
1124
|
+
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
1125
|
+
|
|
1126
|
+
|
|
1127
|
+
class ClaimInformationServiceLineTestResult(TypedDict, total=False):
|
|
1128
|
+
measurement_qualifier: Required[
|
|
1129
|
+
Annotated[Literal["HT", "R1", "R2", "R3", "R4"], PropertyInfo(alias="measurementQualifier")]
|
|
1130
|
+
]
|
|
1131
|
+
|
|
1132
|
+
measurement_reference_identification_code: Required[
|
|
1133
|
+
Annotated[Literal["OG", "TR"], PropertyInfo(alias="measurementReferenceIdentificationCode")]
|
|
1134
|
+
]
|
|
1135
|
+
|
|
1136
|
+
test_results: Required[Annotated[str, PropertyInfo(alias="testResults")]]
|
|
1137
|
+
|
|
1138
|
+
|
|
826
1139
|
class ClaimInformationServiceLine(TypedDict, total=False):
|
|
827
|
-
|
|
828
|
-
Annotated[
|
|
1140
|
+
professional_service: Required[
|
|
1141
|
+
Annotated[ClaimInformationServiceLineProfessionalService, PropertyInfo(alias="professionalService")]
|
|
829
1142
|
]
|
|
830
1143
|
|
|
831
|
-
|
|
832
|
-
|
|
1144
|
+
service_date: Required[Annotated[str, PropertyInfo(alias="serviceDate")]]
|
|
1145
|
+
|
|
1146
|
+
additional_notes: Annotated[str, PropertyInfo(alias="additionalNotes")]
|
|
1147
|
+
|
|
1148
|
+
ambulance_certification: Annotated[
|
|
1149
|
+
Iterable[ClaimInformationServiceLineAmbulanceCertification], PropertyInfo(alias="ambulanceCertification")
|
|
1150
|
+
]
|
|
1151
|
+
|
|
1152
|
+
ambulance_drop_off_location: Annotated[
|
|
1153
|
+
ClaimInformationServiceLineAmbulanceDropOffLocation, PropertyInfo(alias="ambulanceDropOffLocation")
|
|
1154
|
+
]
|
|
1155
|
+
|
|
1156
|
+
ambulance_patient_count: Annotated[float, PropertyInfo(alias="ambulancePatientCount")]
|
|
1157
|
+
|
|
1158
|
+
ambulance_pick_up_location: Annotated[
|
|
1159
|
+
ClaimInformationServiceLineAmbulancePickUpLocation, PropertyInfo(alias="ambulancePickUpLocation")
|
|
1160
|
+
]
|
|
1161
|
+
|
|
1162
|
+
ambulance_transport_information: Annotated[
|
|
1163
|
+
ClaimInformationServiceLineAmbulanceTransportInformation, PropertyInfo(alias="ambulanceTransportInformation")
|
|
833
1164
|
]
|
|
834
1165
|
|
|
835
1166
|
assigned_number: Annotated[str, PropertyInfo(alias="assignedNumber")]
|
|
836
1167
|
|
|
837
|
-
|
|
1168
|
+
condition_indicator_durable_medical_equipment: Annotated[
|
|
1169
|
+
ClaimInformationServiceLineConditionIndicatorDurableMedicalEquipment,
|
|
1170
|
+
PropertyInfo(alias="conditionIndicatorDurableMedicalEquipment"),
|
|
1171
|
+
]
|
|
1172
|
+
|
|
1173
|
+
contract_information: Annotated[
|
|
1174
|
+
ClaimInformationServiceLineContractInformation, PropertyInfo(alias="contractInformation")
|
|
1175
|
+
]
|
|
838
1176
|
|
|
839
1177
|
drug_identification: Annotated[
|
|
840
1178
|
ClaimInformationServiceLineDrugIdentification, PropertyInfo(alias="drugIdentification")
|
|
841
1179
|
]
|
|
842
1180
|
|
|
843
|
-
|
|
1181
|
+
durable_medical_equipment_certificate_of_medical_necessity: Annotated[
|
|
1182
|
+
ClaimInformationServiceLineDurableMedicalEquipmentCertificateOfMedicalNecessity,
|
|
1183
|
+
PropertyInfo(alias="durableMedicalEquipmentCertificateOfMedicalNecessity"),
|
|
1184
|
+
]
|
|
1185
|
+
|
|
1186
|
+
durable_medical_equipment_certification: Annotated[
|
|
1187
|
+
ClaimInformationServiceLineDurableMedicalEquipmentCertification,
|
|
1188
|
+
PropertyInfo(alias="durableMedicalEquipmentCertification"),
|
|
1189
|
+
]
|
|
1190
|
+
|
|
1191
|
+
durable_medical_equipment_service: Annotated[
|
|
1192
|
+
ClaimInformationServiceLineDurableMedicalEquipmentService, PropertyInfo(alias="durableMedicalEquipmentService")
|
|
1193
|
+
]
|
|
1194
|
+
|
|
1195
|
+
file_information: Annotated[List[str], PropertyInfo(alias="fileInformation")]
|
|
1196
|
+
|
|
1197
|
+
form_identification: Annotated[
|
|
1198
|
+
Iterable[ClaimInformationServiceLineFormIdentification], PropertyInfo(alias="formIdentification")
|
|
1199
|
+
]
|
|
1200
|
+
|
|
1201
|
+
goal_rehab_or_discharge_plans: Annotated[str, PropertyInfo(alias="goalRehabOrDischargePlans")]
|
|
1202
|
+
|
|
1203
|
+
hospice_employee_indicator: Annotated[bool, PropertyInfo(alias="hospiceEmployeeIndicator")]
|
|
844
1204
|
|
|
845
1205
|
line_adjudication_information: Annotated[
|
|
846
1206
|
Iterable[ClaimInformationServiceLineLineAdjudicationInformation],
|
|
847
1207
|
PropertyInfo(alias="lineAdjudicationInformation"),
|
|
848
1208
|
]
|
|
849
1209
|
|
|
850
|
-
|
|
851
|
-
|
|
1210
|
+
line_pricing_repricing_information: Annotated[
|
|
1211
|
+
ClaimInformationServiceLineLinePricingRepricingInformation,
|
|
1212
|
+
PropertyInfo(alias="linePricingRepricingInformation"),
|
|
1213
|
+
]
|
|
1214
|
+
|
|
1215
|
+
obstetric_anesthesia_additional_units: Annotated[float, PropertyInfo(alias="obstetricAnesthesiaAdditionalUnits")]
|
|
1216
|
+
|
|
1217
|
+
ordering_provider: Annotated[ClaimInformationServiceLineOrderingProvider, PropertyInfo(alias="orderingProvider")]
|
|
1218
|
+
|
|
1219
|
+
postage_tax_amount: Annotated[str, PropertyInfo(alias="postageTaxAmount")]
|
|
1220
|
+
|
|
1221
|
+
purchased_service_information: Annotated[
|
|
1222
|
+
ClaimInformationServiceLinePurchasedServiceInformation, PropertyInfo(alias="purchasedServiceInformation")
|
|
1223
|
+
]
|
|
1224
|
+
|
|
1225
|
+
purchased_service_provider: Annotated[
|
|
1226
|
+
ClaimInformationServiceLinePurchasedServiceProvider, PropertyInfo(alias="purchasedServiceProvider")
|
|
1227
|
+
]
|
|
1228
|
+
|
|
1229
|
+
referring_provider: Annotated[ClaimInformationServiceLineReferringProvider, PropertyInfo(alias="referringProvider")]
|
|
1230
|
+
|
|
1231
|
+
rendering_provider: Annotated[ClaimInformationServiceLineRenderingProvider, PropertyInfo(alias="renderingProvider")]
|
|
1232
|
+
|
|
1233
|
+
sales_tax_amount: Annotated[str, PropertyInfo(alias="salesTaxAmount")]
|
|
1234
|
+
|
|
1235
|
+
service_date_end: Annotated[str, PropertyInfo(alias="serviceDateEnd")]
|
|
1236
|
+
|
|
1237
|
+
service_facility_location: Annotated[
|
|
1238
|
+
ClaimInformationServiceLineServiceFacilityLocation, PropertyInfo(alias="serviceFacilityLocation")
|
|
1239
|
+
]
|
|
1240
|
+
|
|
1241
|
+
service_line_date_information: Annotated[
|
|
1242
|
+
ClaimInformationServiceLineServiceLineDateInformation, PropertyInfo(alias="serviceLineDateInformation")
|
|
1243
|
+
]
|
|
1244
|
+
|
|
1245
|
+
service_line_reference_information: Annotated[
|
|
1246
|
+
ClaimInformationServiceLineServiceLineReferenceInformation,
|
|
1247
|
+
PropertyInfo(alias="serviceLineReferenceInformation"),
|
|
1248
|
+
]
|
|
1249
|
+
|
|
1250
|
+
service_line_supplemental_information: Annotated[
|
|
1251
|
+
Iterable[ClaimInformationServiceLineServiceLineSupplementalInformation],
|
|
1252
|
+
PropertyInfo(alias="serviceLineSupplementalInformation"),
|
|
1253
|
+
]
|
|
1254
|
+
|
|
1255
|
+
supervising_provider: Annotated[
|
|
1256
|
+
ClaimInformationServiceLineSupervisingProvider, PropertyInfo(alias="supervisingProvider")
|
|
1257
|
+
]
|
|
1258
|
+
|
|
1259
|
+
test_results: Annotated[Iterable[ClaimInformationServiceLineTestResult], PropertyInfo(alias="testResults")]
|
|
1260
|
+
|
|
1261
|
+
third_party_organization_notes: Annotated[str, PropertyInfo(alias="thirdPartyOrganizationNotes")]
|
|
1262
|
+
|
|
1263
|
+
|
|
1264
|
+
class ClaimInformationAmbulanceCertification(TypedDict, total=False):
|
|
1265
|
+
certification_condition_indicator: Required[
|
|
1266
|
+
Annotated[Literal["N", "Y"], PropertyInfo(alias="certificationConditionIndicator")]
|
|
1267
|
+
]
|
|
1268
|
+
|
|
1269
|
+
condition_codes: Required[
|
|
1270
|
+
Annotated[List[Literal["01", "04", "05", "06", "07", "08", "09", "12"]], PropertyInfo(alias="conditionCodes")]
|
|
852
1271
|
]
|
|
853
1272
|
|
|
854
|
-
line_note_text: Annotated[str, PropertyInfo(alias="lineNoteText")]
|
|
855
1273
|
|
|
856
|
-
|
|
857
|
-
|
|
858
|
-
|
|
1274
|
+
class ClaimInformationAmbulanceDropOffLocation(TypedDict, total=False):
|
|
1275
|
+
address1: Required[str]
|
|
1276
|
+
|
|
1277
|
+
city: Required[str]
|
|
1278
|
+
|
|
1279
|
+
address2: str
|
|
1280
|
+
|
|
1281
|
+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
859
1282
|
|
|
860
|
-
|
|
861
|
-
ClaimInformationServiceLineLineRepricingInformation, PropertyInfo(alias="lineRepricingInformation")
|
|
862
|
-
]
|
|
1283
|
+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
863
1284
|
|
|
864
|
-
|
|
865
|
-
ClaimInformationServiceLineLineSupplementInformation, PropertyInfo(alias="lineSupplementInformation")
|
|
866
|
-
]
|
|
1285
|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
867
1286
|
|
|
868
|
-
|
|
869
|
-
ClaimInformationServiceLineOperatingPhysician, PropertyInfo(alias="operatingPhysician")
|
|
870
|
-
]
|
|
1287
|
+
state: str
|
|
871
1288
|
|
|
872
|
-
other_operating_physician: Annotated[
|
|
873
|
-
ClaimInformationServiceLineOtherOperatingPhysician, PropertyInfo(alias="otherOperatingPhysician")
|
|
874
|
-
]
|
|
875
1289
|
|
|
876
|
-
|
|
1290
|
+
class ClaimInformationAmbulancePickUpLocation(TypedDict, total=False):
|
|
1291
|
+
address1: Required[str]
|
|
877
1292
|
|
|
878
|
-
|
|
1293
|
+
city: Required[str]
|
|
879
1294
|
|
|
880
|
-
|
|
1295
|
+
address2: str
|
|
881
1296
|
|
|
882
|
-
|
|
1297
|
+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
883
1298
|
|
|
884
|
-
|
|
1299
|
+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
885
1300
|
|
|
886
|
-
|
|
887
|
-
ClaimInformationServiceLineServiceLineDateInformation, PropertyInfo(alias="serviceLineDateInformation")
|
|
888
|
-
]
|
|
1301
|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
889
1302
|
|
|
890
|
-
|
|
891
|
-
ClaimInformationServiceLineServiceLineReferenceInformation,
|
|
892
|
-
PropertyInfo(alias="serviceLineReferenceInformation"),
|
|
893
|
-
]
|
|
1303
|
+
state: str
|
|
894
1304
|
|
|
895
|
-
service_line_supplemental_information: Annotated[
|
|
896
|
-
ClaimInformationServiceLineServiceLineSupplementalInformation,
|
|
897
|
-
PropertyInfo(alias="serviceLineSupplementalInformation"),
|
|
898
|
-
]
|
|
899
1305
|
|
|
900
|
-
|
|
901
|
-
|
|
902
|
-
PropertyInfo(alias="
|
|
1306
|
+
class ClaimInformationAmbulanceTransportInformation(TypedDict, total=False):
|
|
1307
|
+
ambulance_transport_reason_code: Required[
|
|
1308
|
+
Annotated[Literal["A", "B", "C", "D", "E"], PropertyInfo(alias="ambulanceTransportReasonCode")]
|
|
903
1309
|
]
|
|
904
1310
|
|
|
905
|
-
|
|
906
|
-
|
|
907
|
-
third_party_organization_notes: Annotated[str, PropertyInfo(alias="thirdPartyOrganizationNotes")]
|
|
1311
|
+
transport_distance_in_miles: Required[Annotated[str, PropertyInfo(alias="transportDistanceInMiles")]]
|
|
908
1312
|
|
|
1313
|
+
patient_weight_in_pounds: Annotated[str, PropertyInfo(alias="patientWeightInPounds")]
|
|
909
1314
|
|
|
910
|
-
|
|
911
|
-
admitting_diagnosis_code: Required[Annotated[str, PropertyInfo(alias="admittingDiagnosisCode")]]
|
|
1315
|
+
round_trip_purpose_description: Annotated[str, PropertyInfo(alias="roundTripPurposeDescription")]
|
|
912
1316
|
|
|
913
|
-
|
|
1317
|
+
stretcher_purpose_description: Annotated[str, PropertyInfo(alias="stretcherPurposeDescription")]
|
|
914
1318
|
|
|
915
1319
|
|
|
916
1320
|
class ClaimInformationClaimContractInformation(TypedDict, total=False):
|
|
@@ -929,41 +1333,57 @@ class ClaimInformationClaimContractInformation(TypedDict, total=False):
|
|
|
929
1333
|
terms_discount_percentage: Annotated[str, PropertyInfo(alias="termsDiscountPercentage")]
|
|
930
1334
|
|
|
931
1335
|
|
|
932
|
-
class
|
|
933
|
-
|
|
1336
|
+
class ClaimInformationClaimDateInformation(TypedDict, total=False):
|
|
1337
|
+
accident_date: Annotated[str, PropertyInfo(alias="accidentDate")]
|
|
934
1338
|
|
|
935
|
-
|
|
1339
|
+
acute_manifestation_date: Annotated[str, PropertyInfo(alias="acuteManifestationDate")]
|
|
936
1340
|
|
|
937
|
-
|
|
1341
|
+
admission_date: Annotated[str, PropertyInfo(alias="admissionDate")]
|
|
938
1342
|
|
|
939
|
-
|
|
1343
|
+
assumed_and_relinquished_care_begin_date: Annotated[str, PropertyInfo(alias="assumedAndRelinquishedCareBeginDate")]
|
|
940
1344
|
|
|
941
|
-
|
|
1345
|
+
assumed_and_relinquished_care_end_date: Annotated[str, PropertyInfo(alias="assumedAndRelinquishedCareEndDate")]
|
|
942
1346
|
|
|
943
|
-
|
|
1347
|
+
authorized_return_to_work_date: Annotated[str, PropertyInfo(alias="authorizedReturnToWorkDate")]
|
|
944
1348
|
|
|
945
|
-
|
|
1349
|
+
disability_begin_date: Annotated[str, PropertyInfo(alias="disabilityBeginDate")]
|
|
946
1350
|
|
|
947
|
-
|
|
1351
|
+
disability_end_date: Annotated[str, PropertyInfo(alias="disabilityEndDate")]
|
|
948
1352
|
|
|
949
|
-
|
|
950
|
-
|
|
951
|
-
]
|
|
1353
|
+
discharge_date: Annotated[str, PropertyInfo(alias="dischargeDate")]
|
|
1354
|
+
|
|
1355
|
+
first_contact_date: Annotated[str, PropertyInfo(alias="firstContactDate")]
|
|
1356
|
+
|
|
1357
|
+
hearing_and_vision_prescription_date: Annotated[str, PropertyInfo(alias="hearingAndVisionPrescriptionDate")]
|
|
1358
|
+
|
|
1359
|
+
initial_treatment_date: Annotated[str, PropertyInfo(alias="initialTreatmentDate")]
|
|
1360
|
+
|
|
1361
|
+
last_menstrual_period_date: Annotated[str, PropertyInfo(alias="lastMenstrualPeriodDate")]
|
|
952
1362
|
|
|
953
|
-
|
|
1363
|
+
last_seen_date: Annotated[str, PropertyInfo(alias="lastSeenDate")]
|
|
954
1364
|
|
|
955
|
-
|
|
1365
|
+
last_worked_date: Annotated[str, PropertyInfo(alias="lastWorkedDate")]
|
|
956
1366
|
|
|
957
|
-
|
|
1367
|
+
last_x_ray_date: Annotated[str, PropertyInfo(alias="lastXRayDate")]
|
|
958
1368
|
|
|
959
|
-
|
|
1369
|
+
repricer_received_date: Annotated[str, PropertyInfo(alias="repricerReceivedDate")]
|
|
1370
|
+
|
|
1371
|
+
symptom_date: Annotated[str, PropertyInfo(alias="symptomDate")]
|
|
1372
|
+
|
|
1373
|
+
|
|
1374
|
+
class ClaimInformationClaimNote(TypedDict, total=False):
|
|
1375
|
+
additional_information: Annotated[str, PropertyInfo(alias="additionalInformation")]
|
|
960
1376
|
|
|
961
|
-
|
|
1377
|
+
certification_narrative: Annotated[str, PropertyInfo(alias="certificationNarrative")]
|
|
962
1378
|
|
|
963
|
-
|
|
1379
|
+
diagnosis_description: Annotated[str, PropertyInfo(alias="diagnosisDescription")]
|
|
964
1380
|
|
|
1381
|
+
goal_rehab_or_discharge_plans: Annotated[str, PropertyInfo(alias="goalRehabOrDischargePlans")]
|
|
965
1382
|
|
|
966
|
-
|
|
1383
|
+
third_part_org_notes: Annotated[str, PropertyInfo(alias="thirdPartOrgNotes")]
|
|
1384
|
+
|
|
1385
|
+
|
|
1386
|
+
class ClaimInformationClaimPricingRepricingInformation(TypedDict, total=False):
|
|
967
1387
|
pricing_methodology_code: Required[
|
|
968
1388
|
Annotated[
|
|
969
1389
|
Literal["00", "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14"],
|
|
@@ -977,36 +1397,24 @@ class ClaimInformationClaimPricingInformation(TypedDict, total=False):
|
|
|
977
1397
|
|
|
978
1398
|
policy_compliance_code: Annotated[Literal["1", "2", "3", "4", "5"], PropertyInfo(alias="policyComplianceCode")]
|
|
979
1399
|
|
|
980
|
-
product_or_service_id_qualifier: Annotated[
|
|
981
|
-
Literal["ER", "HC", "HP", "IV", "WK"], PropertyInfo(alias="productOrServiceIDQualifier")
|
|
982
|
-
]
|
|
983
|
-
|
|
984
1400
|
reject_reason_code: Annotated[Literal["T1", "T2", "T3", "T4", "T5", "T6"], PropertyInfo(alias="rejectReasonCode")]
|
|
985
1401
|
|
|
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")
|
|
1402
|
+
repriced_approved_ambulatory_patient_group_amount: Annotated[
|
|
1403
|
+
str, PropertyInfo(alias="repricedApprovedAmbulatoryPatientGroupAmount")
|
|
996
1404
|
]
|
|
997
1405
|
|
|
998
|
-
|
|
1406
|
+
repriced_approved_ambulatory_patient_group_code: Annotated[
|
|
1407
|
+
str, PropertyInfo(alias="repricedApprovedAmbulatoryPatientGroupCode")
|
|
1408
|
+
]
|
|
999
1409
|
|
|
1000
|
-
|
|
1410
|
+
repriced_saving_amount: Annotated[str, PropertyInfo(alias="repricedSavingAmount")]
|
|
1001
1411
|
|
|
1002
|
-
|
|
1412
|
+
repricing_organization_identifier: Annotated[str, PropertyInfo(alias="repricingOrganizationIdentifier")]
|
|
1003
1413
|
|
|
1004
|
-
|
|
1414
|
+
repricing_per_diem_or_flat_rate_amount: Annotated[str, PropertyInfo(alias="repricingPerDiemOrFlatRateAmount")]
|
|
1005
1415
|
|
|
1006
1416
|
|
|
1007
1417
|
class ClaimInformationClaimSupplementalInformationReportInformation(TypedDict, total=False):
|
|
1008
|
-
attachment_control_number: Required[Annotated[str, PropertyInfo(alias="attachmentControlNumber")]]
|
|
1009
|
-
|
|
1010
1418
|
attachment_report_type_code: Required[
|
|
1011
1419
|
Annotated[
|
|
1012
1420
|
Literal[
|
|
@@ -1049,7 +1457,7 @@ class ClaimInformationClaimSupplementalInformationReportInformation(TypedDict, t
|
|
|
1049
1457
|
"LA",
|
|
1050
1458
|
"M1",
|
|
1051
1459
|
"MT",
|
|
1052
|
-
"
|
|
1460
|
+
"NM",
|
|
1053
1461
|
"OB",
|
|
1054
1462
|
"OC",
|
|
1055
1463
|
"OD",
|
|
@@ -1080,23 +1488,29 @@ class ClaimInformationClaimSupplementalInformationReportInformation(TypedDict, t
|
|
|
1080
1488
|
Annotated[Literal["AA", "BM", "EL", "EM", "FT", "FX"], PropertyInfo(alias="attachmentTransmissionCode")]
|
|
1081
1489
|
]
|
|
1082
1490
|
|
|
1491
|
+
attachment_control_number: Annotated[str, PropertyInfo(alias="attachmentControlNumber")]
|
|
1492
|
+
|
|
1083
1493
|
|
|
1084
1494
|
class ClaimInformationClaimSupplementalInformation(TypedDict, total=False):
|
|
1085
|
-
|
|
1495
|
+
adjusted_repriced_claim_number: Annotated[str, PropertyInfo(alias="adjustedRepricedClaimNumber")]
|
|
1086
1496
|
|
|
1087
|
-
|
|
1497
|
+
care_plan_oversight_number: Annotated[str, PropertyInfo(alias="carePlanOversightNumber")]
|
|
1088
1498
|
|
|
1089
1499
|
claim_control_number: Annotated[str, PropertyInfo(alias="claimControlNumber")]
|
|
1090
1500
|
|
|
1091
1501
|
claim_number: Annotated[str, PropertyInfo(alias="claimNumber")]
|
|
1092
1502
|
|
|
1503
|
+
clia_number: Annotated[str, PropertyInfo(alias="cliaNumber")]
|
|
1504
|
+
|
|
1093
1505
|
demo_project_identifier: Annotated[str, PropertyInfo(alias="demoProjectIdentifier")]
|
|
1094
1506
|
|
|
1095
1507
|
investigational_device_exemption_number: Annotated[str, PropertyInfo(alias="investigationalDeviceExemptionNumber")]
|
|
1096
1508
|
|
|
1509
|
+
mammography_certification_number: Annotated[str, PropertyInfo(alias="mammographyCertificationNumber")]
|
|
1510
|
+
|
|
1097
1511
|
medical_record_number: Annotated[str, PropertyInfo(alias="medicalRecordNumber")]
|
|
1098
1512
|
|
|
1099
|
-
|
|
1513
|
+
medicare_crossover_reference_id: Annotated[str, PropertyInfo(alias="medicareCrossoverReferenceId")]
|
|
1100
1514
|
|
|
1101
1515
|
prior_authorization_number: Annotated[str, PropertyInfo(alias="priorAuthorizationNumber")]
|
|
1102
1516
|
|
|
@@ -1118,12 +1532,8 @@ class ClaimInformationClaimSupplementalInformation(TypedDict, total=False):
|
|
|
1118
1532
|
]
|
|
1119
1533
|
|
|
1120
1534
|
|
|
1121
|
-
class
|
|
1122
|
-
|
|
1123
|
-
|
|
1124
|
-
|
|
1125
|
-
class ClaimInformationDiagnosisRelatedGroupInformation(TypedDict, total=False):
|
|
1126
|
-
drug_related_group_code: Required[Annotated[str, PropertyInfo(alias="drugRelatedGroupCode")]]
|
|
1535
|
+
class ClaimInformationConditionInformation(TypedDict, total=False):
|
|
1536
|
+
condition_codes: Required[Annotated[List[str], PropertyInfo(alias="conditionCodes")]]
|
|
1127
1537
|
|
|
1128
1538
|
|
|
1129
1539
|
class ClaimInformationEpsdtReferral(TypedDict, total=False):
|
|
@@ -1134,48 +1544,6 @@ class ClaimInformationEpsdtReferral(TypedDict, total=False):
|
|
|
1134
1544
|
condition_codes: Required[Annotated[List[Literal["AV", "NU", "S2", "ST"]], PropertyInfo(alias="conditionCodes")]]
|
|
1135
1545
|
|
|
1136
1546
|
|
|
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
1547
|
class ClaimInformationOtherSubscriberInformationOtherPayerNameOtherPayerAddress(TypedDict, total=False):
|
|
1180
1548
|
address1: Required[str]
|
|
1181
1549
|
|
|
@@ -1197,6 +1565,8 @@ class ClaimInformationOtherSubscriberInformationOtherPayerNameOtherPayerSecondar
|
|
|
1197
1565
|
|
|
1198
1566
|
qualifier: Required[str]
|
|
1199
1567
|
|
|
1568
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1569
|
+
|
|
1200
1570
|
|
|
1201
1571
|
class ClaimInformationOtherSubscriberInformationOtherPayerName(TypedDict, total=False):
|
|
1202
1572
|
other_payer_identifier: Required[Annotated[str, PropertyInfo(alias="otherPayerIdentifier")]]
|
|
@@ -1207,8 +1577,6 @@ class ClaimInformationOtherSubscriberInformationOtherPayerName(TypedDict, total=
|
|
|
1207
1577
|
|
|
1208
1578
|
other_payer_organization_name: Required[Annotated[str, PropertyInfo(alias="otherPayerOrganizationName")]]
|
|
1209
1579
|
|
|
1210
|
-
other_insured_additional_identifier: Annotated[str, PropertyInfo(alias="otherInsuredAdditionalIdentifier")]
|
|
1211
|
-
|
|
1212
1580
|
other_payer_address: Annotated[
|
|
1213
1581
|
ClaimInformationOtherSubscriberInformationOtherPayerNameOtherPayerAddress,
|
|
1214
1582
|
PropertyInfo(alias="otherPayerAddress"),
|
|
@@ -1232,7 +1600,7 @@ class ClaimInformationOtherSubscriberInformationOtherPayerName(TypedDict, total=
|
|
|
1232
1600
|
]
|
|
1233
1601
|
|
|
1234
1602
|
|
|
1235
|
-
class
|
|
1603
|
+
class ClaimInformationOtherSubscriberInformationOtherSubscriberNameOtherInsuredAddress(TypedDict, total=False):
|
|
1236
1604
|
address1: Required[str]
|
|
1237
1605
|
|
|
1238
1606
|
city: Required[str]
|
|
@@ -1259,20 +1627,21 @@ class ClaimInformationOtherSubscriberInformationOtherSubscriberName(TypedDict, t
|
|
|
1259
1627
|
|
|
1260
1628
|
other_insured_qualifier: Required[Annotated[Literal["1", "2"], PropertyInfo(alias="otherInsuredQualifier")]]
|
|
1261
1629
|
|
|
1262
|
-
|
|
1263
|
-
|
|
1264
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
1630
|
+
other_insured_additional_identifier: Annotated[str, PropertyInfo(alias="otherInsuredAdditionalIdentifier")]
|
|
1265
1631
|
|
|
1266
|
-
|
|
1632
|
+
other_insured_address: Annotated[
|
|
1633
|
+
ClaimInformationOtherSubscriberInformationOtherSubscriberNameOtherInsuredAddress,
|
|
1634
|
+
PropertyInfo(alias="otherInsuredAddress"),
|
|
1635
|
+
]
|
|
1267
1636
|
|
|
1268
1637
|
other_insured_first_name: Annotated[str, PropertyInfo(alias="otherInsuredFirstName")]
|
|
1269
1638
|
|
|
1270
1639
|
other_insured_middle_name: Annotated[str, PropertyInfo(alias="otherInsuredMiddleName")]
|
|
1271
1640
|
|
|
1272
|
-
|
|
1641
|
+
other_insured_name_suffix: Annotated[str, PropertyInfo(alias="otherInsuredNameSuffix")]
|
|
1273
1642
|
|
|
1274
1643
|
|
|
1275
|
-
class
|
|
1644
|
+
class ClaimInformationOtherSubscriberInformationClaimLevelAdjustmentAdjustmentDetail(TypedDict, total=False):
|
|
1276
1645
|
adjustment_amount: Required[Annotated[str, PropertyInfo(alias="adjustmentAmount")]]
|
|
1277
1646
|
|
|
1278
1647
|
adjustment_reason_code: Required[Annotated[str, PropertyInfo(alias="adjustmentReasonCode")]]
|
|
@@ -1281,59 +1650,15 @@ class ClaimInformationOtherSubscriberInformationClaimLevelAdjustmentClaimAdjustm
|
|
|
1281
1650
|
|
|
1282
1651
|
|
|
1283
1652
|
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")
|
|
1653
|
+
adjustment_details: Required[
|
|
1654
|
+
Annotated[
|
|
1655
|
+
Iterable[ClaimInformationOtherSubscriberInformationClaimLevelAdjustmentAdjustmentDetail],
|
|
1656
|
+
PropertyInfo(alias="adjustmentDetails"),
|
|
1657
|
+
]
|
|
1333
1658
|
]
|
|
1334
1659
|
|
|
1335
|
-
|
|
1336
|
-
|
|
1660
|
+
adjustment_group_code: Required[
|
|
1661
|
+
Annotated[Literal["CO", "CR", "OA", "PI", "PR"], PropertyInfo(alias="adjustmentGroupCode")]
|
|
1337
1662
|
]
|
|
1338
1663
|
|
|
1339
1664
|
|
|
@@ -1351,25 +1676,6 @@ class ClaimInformationOtherSubscriberInformationMedicareOutpatientAdjudication(T
|
|
|
1351
1676
|
reimbursement_rate: Annotated[str, PropertyInfo(alias="reimbursementRate")]
|
|
1352
1677
|
|
|
1353
1678
|
|
|
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
1679
|
class ClaimInformationOtherSubscriberInformationOtherPayerBillingProviderOtherPayerBillingProviderIdentifier(
|
|
1374
1680
|
TypedDict, total=False
|
|
1375
1681
|
):
|
|
@@ -1377,8 +1683,12 @@ class ClaimInformationOtherSubscriberInformationOtherPayerBillingProviderOtherPa
|
|
|
1377
1683
|
|
|
1378
1684
|
qualifier: Required[str]
|
|
1379
1685
|
|
|
1686
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1687
|
+
|
|
1380
1688
|
|
|
1381
1689
|
class ClaimInformationOtherSubscriberInformationOtherPayerBillingProvider(TypedDict, total=False):
|
|
1690
|
+
entity_type_qualifier: Required[Annotated[Literal["1", "2"], PropertyInfo(alias="entityTypeQualifier")]]
|
|
1691
|
+
|
|
1382
1692
|
other_payer_billing_provider_identifier: Required[
|
|
1383
1693
|
Annotated[
|
|
1384
1694
|
Iterable[
|
|
@@ -1389,104 +1699,93 @@ class ClaimInformationOtherSubscriberInformationOtherPayerBillingProvider(TypedD
|
|
|
1389
1699
|
]
|
|
1390
1700
|
|
|
1391
1701
|
|
|
1392
|
-
class
|
|
1702
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerReferringProviderOtherPayerReferringProviderIdentifier(
|
|
1393
1703
|
TypedDict, total=False
|
|
1394
1704
|
):
|
|
1395
1705
|
identifier: Required[str]
|
|
1396
1706
|
|
|
1397
1707
|
qualifier: Required[str]
|
|
1398
1708
|
|
|
1709
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1710
|
+
|
|
1399
1711
|
|
|
1400
|
-
class
|
|
1401
|
-
|
|
1712
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerReferringProvider(TypedDict, total=False):
|
|
1713
|
+
other_payer_referring_provider_identifier: Required[
|
|
1402
1714
|
Annotated[
|
|
1403
1715
|
Iterable[
|
|
1404
|
-
|
|
1716
|
+
ClaimInformationOtherSubscriberInformationOtherPayerReferringProviderOtherPayerReferringProviderIdentifier
|
|
1405
1717
|
],
|
|
1406
|
-
PropertyInfo(alias="
|
|
1718
|
+
PropertyInfo(alias="otherPayerReferringProviderIdentifier"),
|
|
1407
1719
|
]
|
|
1408
1720
|
]
|
|
1409
1721
|
|
|
1410
1722
|
|
|
1411
|
-
class
|
|
1723
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerRenderingProviderOtherPayerRenderingProviderSecondaryIdentifier(
|
|
1412
1724
|
TypedDict, total=False
|
|
1413
1725
|
):
|
|
1414
1726
|
identifier: Required[str]
|
|
1415
1727
|
|
|
1416
1728
|
qualifier: Required[str]
|
|
1417
1729
|
|
|
1730
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1418
1731
|
|
|
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
1732
|
|
|
1733
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerRenderingProvider(TypedDict, total=False):
|
|
1734
|
+
entity_type_qualifier: Required[Annotated[Literal["1", "2"], PropertyInfo(alias="entityTypeQualifier")]]
|
|
1437
1735
|
|
|
1438
|
-
|
|
1439
|
-
|
|
1440
|
-
|
|
1441
|
-
|
|
1442
|
-
|
|
1443
|
-
],
|
|
1444
|
-
PropertyInfo(alias="otherPayerReferringProviderIdentifier"),
|
|
1445
|
-
]
|
|
1736
|
+
other_payer_rendering_provider_secondary_identifier: Annotated[
|
|
1737
|
+
Iterable[
|
|
1738
|
+
ClaimInformationOtherSubscriberInformationOtherPayerRenderingProviderOtherPayerRenderingProviderSecondaryIdentifier
|
|
1739
|
+
],
|
|
1740
|
+
PropertyInfo(alias="otherPayerRenderingProviderSecondaryIdentifier"),
|
|
1446
1741
|
]
|
|
1447
1742
|
|
|
1448
1743
|
|
|
1449
|
-
class
|
|
1744
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocationOtherPayerServiceFacilityLocationSecondaryIdentifier(
|
|
1450
1745
|
TypedDict, total=False
|
|
1451
1746
|
):
|
|
1452
1747
|
identifier: Required[str]
|
|
1453
1748
|
|
|
1454
1749
|
qualifier: Required[str]
|
|
1455
1750
|
|
|
1751
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1456
1752
|
|
|
1457
|
-
|
|
1458
|
-
|
|
1753
|
+
|
|
1754
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocation(TypedDict, total=False):
|
|
1755
|
+
other_payer_service_facility_location_secondary_identifier: Required[
|
|
1459
1756
|
Annotated[
|
|
1460
1757
|
Iterable[
|
|
1461
|
-
|
|
1758
|
+
ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocationOtherPayerServiceFacilityLocationSecondaryIdentifier
|
|
1462
1759
|
],
|
|
1463
|
-
PropertyInfo(alias="
|
|
1760
|
+
PropertyInfo(alias="otherPayerServiceFacilityLocationSecondaryIdentifier"),
|
|
1464
1761
|
]
|
|
1465
1762
|
]
|
|
1466
1763
|
|
|
1467
1764
|
|
|
1468
|
-
class
|
|
1765
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProviderOtherPayerSupervisingProviderIdentifier(
|
|
1469
1766
|
TypedDict, total=False
|
|
1470
1767
|
):
|
|
1471
1768
|
identifier: Required[str]
|
|
1472
1769
|
|
|
1473
1770
|
qualifier: Required[str]
|
|
1474
1771
|
|
|
1772
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1475
1773
|
|
|
1476
|
-
|
|
1477
|
-
|
|
1774
|
+
|
|
1775
|
+
class ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProvider(TypedDict, total=False):
|
|
1776
|
+
other_payer_supervising_provider_identifier: Required[
|
|
1478
1777
|
Annotated[
|
|
1479
1778
|
Iterable[
|
|
1480
|
-
|
|
1779
|
+
ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProviderOtherPayerSupervisingProviderIdentifier
|
|
1481
1780
|
],
|
|
1482
|
-
PropertyInfo(alias="
|
|
1781
|
+
PropertyInfo(alias="otherPayerSupervisingProviderIdentifier"),
|
|
1483
1782
|
]
|
|
1484
1783
|
]
|
|
1485
1784
|
|
|
1486
1785
|
|
|
1487
1786
|
class ClaimInformationOtherSubscriberInformation(TypedDict, total=False):
|
|
1488
1787
|
benefits_assignment_certification_indicator: Required[
|
|
1489
|
-
Annotated[Literal["N", "
|
|
1788
|
+
Annotated[Literal["N", "W", "Y"], PropertyInfo(alias="benefitsAssignmentCertificationIndicator")]
|
|
1490
1789
|
]
|
|
1491
1790
|
|
|
1492
1791
|
claim_filing_indicator_code: Required[
|
|
@@ -1502,6 +1801,7 @@ class ClaimInformationOtherSubscriberInformation(TypedDict, total=False):
|
|
|
1502
1801
|
"AM",
|
|
1503
1802
|
"BL",
|
|
1504
1803
|
"CH",
|
|
1804
|
+
"CI",
|
|
1505
1805
|
"DS",
|
|
1506
1806
|
"FI",
|
|
1507
1807
|
"HM",
|
|
@@ -1550,11 +1850,10 @@ class ClaimInformationOtherSubscriberInformation(TypedDict, total=False):
|
|
|
1550
1850
|
PropertyInfo(alias="claimLevelAdjustments"),
|
|
1551
1851
|
]
|
|
1552
1852
|
|
|
1553
|
-
|
|
1853
|
+
insurance_group_or_policy_number: Annotated[str, PropertyInfo(alias="insuranceGroupOrPolicyNumber")]
|
|
1554
1854
|
|
|
1555
|
-
|
|
1556
|
-
|
|
1557
|
-
PropertyInfo(alias="medicareInpatientAdjudication"),
|
|
1855
|
+
insurance_type_code: Annotated[
|
|
1856
|
+
Literal["12", "13", "14", "15", "16", "41", "42", "43", "47"], PropertyInfo(alias="insuranceTypeCode")
|
|
1558
1857
|
]
|
|
1559
1858
|
|
|
1560
1859
|
medicare_outpatient_adjudication: Annotated[
|
|
@@ -1566,60 +1865,48 @@ class ClaimInformationOtherSubscriberInformation(TypedDict, total=False):
|
|
|
1566
1865
|
|
|
1567
1866
|
other_insured_group_name: Annotated[str, PropertyInfo(alias="otherInsuredGroupName")]
|
|
1568
1867
|
|
|
1569
|
-
other_payer_attending_provider: Annotated[
|
|
1570
|
-
ClaimInformationOtherSubscriberInformationOtherPayerAttendingProvider,
|
|
1571
|
-
PropertyInfo(alias="otherPayerAttendingProvider"),
|
|
1572
|
-
]
|
|
1573
|
-
|
|
1574
1868
|
other_payer_billing_provider: Annotated[
|
|
1575
|
-
ClaimInformationOtherSubscriberInformationOtherPayerBillingProvider,
|
|
1869
|
+
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerBillingProvider],
|
|
1576
1870
|
PropertyInfo(alias="otherPayerBillingProvider"),
|
|
1577
1871
|
]
|
|
1578
1872
|
|
|
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
1873
|
other_payer_referring_provider: Annotated[
|
|
1590
|
-
ClaimInformationOtherSubscriberInformationOtherPayerReferringProvider,
|
|
1874
|
+
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerReferringProvider],
|
|
1591
1875
|
PropertyInfo(alias="otherPayerReferringProvider"),
|
|
1592
1876
|
]
|
|
1593
1877
|
|
|
1594
1878
|
other_payer_rendering_provider: Annotated[
|
|
1595
|
-
ClaimInformationOtherSubscriberInformationOtherPayerRenderingProvider,
|
|
1879
|
+
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerRenderingProvider],
|
|
1596
1880
|
PropertyInfo(alias="otherPayerRenderingProvider"),
|
|
1597
1881
|
]
|
|
1598
1882
|
|
|
1599
1883
|
other_payer_service_facility_location: Annotated[
|
|
1600
|
-
ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocation,
|
|
1884
|
+
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerServiceFacilityLocation],
|
|
1601
1885
|
PropertyInfo(alias="otherPayerServiceFacilityLocation"),
|
|
1602
1886
|
]
|
|
1603
1887
|
|
|
1604
|
-
|
|
1605
|
-
|
|
1606
|
-
|
|
1607
|
-
|
|
1608
|
-
remaining_patient_liability: Annotated[str, PropertyInfo(alias="remainingPatientLiability")]
|
|
1888
|
+
other_payer_supervising_provider: Annotated[
|
|
1889
|
+
Iterable[ClaimInformationOtherSubscriberInformationOtherPayerSupervisingProvider],
|
|
1890
|
+
PropertyInfo(alias="otherPayerSupervisingProvider"),
|
|
1891
|
+
]
|
|
1609
1892
|
|
|
1893
|
+
patient_signature_generated_for_patient: Annotated[bool, PropertyInfo(alias="patientSignatureGeneratedForPatient")]
|
|
1610
1894
|
|
|
1611
|
-
|
|
1612
|
-
patient_reason_for_visit_code: Required[Annotated[str, PropertyInfo(alias="patientReasonForVisitCode")]]
|
|
1895
|
+
payer_paid_amount: Annotated[str, PropertyInfo(alias="payerPaidAmount")]
|
|
1613
1896
|
|
|
1614
|
-
|
|
1897
|
+
remaining_patient_liability: Annotated[str, PropertyInfo(alias="remainingPatientLiability")]
|
|
1615
1898
|
|
|
1616
1899
|
|
|
1617
|
-
class
|
|
1618
|
-
|
|
1900
|
+
class ClaimInformationPatientConditionInformationVision(TypedDict, total=False):
|
|
1901
|
+
certification_condition_indicator: Required[
|
|
1902
|
+
Annotated[Literal["N", "Y"], PropertyInfo(alias="certificationConditionIndicator")]
|
|
1903
|
+
]
|
|
1619
1904
|
|
|
1620
|
-
|
|
1905
|
+
code_category: Required[Annotated[Literal["E1", "E2", "E3"], PropertyInfo(alias="codeCategory")]]
|
|
1621
1906
|
|
|
1622
|
-
|
|
1907
|
+
condition_codes: Required[
|
|
1908
|
+
Annotated[List[Literal["L1", "L2", "L3", "L4", "L5"]], PropertyInfo(alias="conditionCodes")]
|
|
1909
|
+
]
|
|
1623
1910
|
|
|
1624
1911
|
|
|
1625
1912
|
class ClaimInformationServiceFacilityLocationAddress(TypedDict, total=False):
|
|
@@ -1638,24 +1925,40 @@ class ClaimInformationServiceFacilityLocationAddress(TypedDict, total=False):
|
|
|
1638
1925
|
state: str
|
|
1639
1926
|
|
|
1640
1927
|
|
|
1928
|
+
class ClaimInformationServiceFacilityLocationSecondaryIdentifier(TypedDict, total=False):
|
|
1929
|
+
identifier: Required[str]
|
|
1930
|
+
|
|
1931
|
+
qualifier: Required[str]
|
|
1932
|
+
|
|
1933
|
+
other_identifier: Annotated[str, PropertyInfo(alias="otherIdentifier")]
|
|
1934
|
+
|
|
1935
|
+
|
|
1641
1936
|
class ClaimInformationServiceFacilityLocation(TypedDict, total=False):
|
|
1642
1937
|
address: Required[ClaimInformationServiceFacilityLocationAddress]
|
|
1643
1938
|
|
|
1644
1939
|
organization_name: Required[Annotated[str, PropertyInfo(alias="organizationName")]]
|
|
1645
1940
|
|
|
1646
|
-
|
|
1941
|
+
npi: str
|
|
1942
|
+
|
|
1943
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
1944
|
+
|
|
1945
|
+
phone_name: Annotated[str, PropertyInfo(alias="phoneName")]
|
|
1946
|
+
|
|
1947
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
1647
1948
|
|
|
1648
|
-
|
|
1649
|
-
|
|
1949
|
+
secondary_identifier: Annotated[
|
|
1950
|
+
Iterable[ClaimInformationServiceFacilityLocationSecondaryIdentifier], PropertyInfo(alias="secondaryIdentifier")
|
|
1650
1951
|
]
|
|
1651
1952
|
|
|
1652
|
-
secondary_identifier: Annotated[str, PropertyInfo(alias="secondaryIdentifier")]
|
|
1653
1953
|
|
|
1954
|
+
class ClaimInformationSpinalManipulationServiceInformation(TypedDict, total=False):
|
|
1955
|
+
patient_condition_code: Required[Annotated[str, PropertyInfo(alias="patientConditionCode")]]
|
|
1654
1956
|
|
|
1655
|
-
|
|
1656
|
-
|
|
1957
|
+
patient_condition_description1: Annotated[
|
|
1958
|
+
Literal["A", "C", "D", "E", "F", "G", "M"], PropertyInfo(alias="patientConditionDescription1")
|
|
1959
|
+
]
|
|
1657
1960
|
|
|
1658
|
-
|
|
1961
|
+
patient_condition_description2: Annotated[str, PropertyInfo(alias="patientConditionDescription2")]
|
|
1659
1962
|
|
|
1660
1963
|
|
|
1661
1964
|
class ClaimInformation(TypedDict, total=False):
|
|
@@ -1665,14 +1968,6 @@ class ClaimInformation(TypedDict, total=False):
|
|
|
1665
1968
|
|
|
1666
1969
|
claim_charge_amount: Required[Annotated[str, PropertyInfo(alias="claimChargeAmount")]]
|
|
1667
1970
|
|
|
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
1971
|
claim_filing_code: Required[
|
|
1677
1972
|
Annotated[
|
|
1678
1973
|
Literal[
|
|
@@ -1704,116 +1999,173 @@ class ClaimInformation(TypedDict, total=False):
|
|
|
1704
1999
|
]
|
|
1705
2000
|
]
|
|
1706
2001
|
|
|
1707
|
-
claim_frequency_code: Required[Annotated[
|
|
1708
|
-
|
|
1709
|
-
place_of_service_code: Required[Annotated[str, PropertyInfo(alias="placeOfServiceCode")]]
|
|
2002
|
+
claim_frequency_code: Required[Annotated[Literal["1", "7", "8"], PropertyInfo(alias="claimFrequencyCode")]]
|
|
1710
2003
|
|
|
1711
|
-
|
|
2004
|
+
health_care_code_information: Required[
|
|
2005
|
+
Annotated[Iterable[ClaimInformationHealthCareCodeInformation], PropertyInfo(alias="healthCareCodeInformation")]
|
|
2006
|
+
]
|
|
1712
2007
|
|
|
1713
|
-
|
|
1714
|
-
Annotated[
|
|
2008
|
+
place_of_service_code: Required[
|
|
2009
|
+
Annotated[
|
|
2010
|
+
Literal[
|
|
2011
|
+
"01",
|
|
2012
|
+
"02",
|
|
2013
|
+
"03",
|
|
2014
|
+
"04",
|
|
2015
|
+
"05",
|
|
2016
|
+
"06",
|
|
2017
|
+
"07",
|
|
2018
|
+
"08",
|
|
2019
|
+
"09",
|
|
2020
|
+
"10",
|
|
2021
|
+
"11",
|
|
2022
|
+
"12",
|
|
2023
|
+
"13",
|
|
2024
|
+
"14",
|
|
2025
|
+
"15",
|
|
2026
|
+
"16",
|
|
2027
|
+
"17",
|
|
2028
|
+
"18",
|
|
2029
|
+
"19",
|
|
2030
|
+
"20",
|
|
2031
|
+
"21",
|
|
2032
|
+
"22",
|
|
2033
|
+
"23",
|
|
2034
|
+
"24",
|
|
2035
|
+
"25",
|
|
2036
|
+
"26",
|
|
2037
|
+
"27",
|
|
2038
|
+
"31",
|
|
2039
|
+
"32",
|
|
2040
|
+
"33",
|
|
2041
|
+
"34",
|
|
2042
|
+
"41",
|
|
2043
|
+
"42",
|
|
2044
|
+
"49",
|
|
2045
|
+
"50",
|
|
2046
|
+
"51",
|
|
2047
|
+
"52",
|
|
2048
|
+
"53",
|
|
2049
|
+
"54",
|
|
2050
|
+
"55",
|
|
2051
|
+
"56",
|
|
2052
|
+
"57",
|
|
2053
|
+
"58",
|
|
2054
|
+
"60",
|
|
2055
|
+
"61",
|
|
2056
|
+
"62",
|
|
2057
|
+
"65",
|
|
2058
|
+
"66",
|
|
2059
|
+
"71",
|
|
2060
|
+
"72",
|
|
2061
|
+
"81",
|
|
2062
|
+
"99",
|
|
2063
|
+
],
|
|
2064
|
+
PropertyInfo(alias="placeOfServiceCode"),
|
|
2065
|
+
]
|
|
1715
2066
|
]
|
|
1716
2067
|
|
|
2068
|
+
plan_participation_code: Required[Annotated[Literal["A", "B", "C"], PropertyInfo(alias="planParticipationCode")]]
|
|
2069
|
+
|
|
1717
2070
|
release_information_code: Required[Annotated[Literal["I", "Y"], PropertyInfo(alias="releaseInformationCode")]]
|
|
1718
2071
|
|
|
1719
2072
|
service_lines: Required[Annotated[Iterable[ClaimInformationServiceLine], PropertyInfo(alias="serviceLines")]]
|
|
1720
2073
|
|
|
1721
|
-
|
|
2074
|
+
signature_indicator: Required[Annotated[Literal["N", "Y"], PropertyInfo(alias="signatureIndicator")]]
|
|
1722
2075
|
|
|
1723
|
-
|
|
2076
|
+
ambulance_certification: Annotated[
|
|
2077
|
+
Iterable[ClaimInformationAmbulanceCertification], PropertyInfo(alias="ambulanceCertification")
|
|
2078
|
+
]
|
|
1724
2079
|
|
|
1725
|
-
|
|
1726
|
-
|
|
2080
|
+
ambulance_drop_off_location: Annotated[
|
|
2081
|
+
ClaimInformationAmbulanceDropOffLocation, PropertyInfo(alias="ambulanceDropOffLocation")
|
|
1727
2082
|
]
|
|
1728
2083
|
|
|
1729
|
-
|
|
2084
|
+
ambulance_pick_up_location: Annotated[
|
|
2085
|
+
ClaimInformationAmbulancePickUpLocation, PropertyInfo(alias="ambulancePickUpLocation")
|
|
2086
|
+
]
|
|
1730
2087
|
|
|
1731
|
-
|
|
1732
|
-
|
|
2088
|
+
ambulance_transport_information: Annotated[
|
|
2089
|
+
ClaimInformationAmbulanceTransportInformation, PropertyInfo(alias="ambulanceTransportInformation")
|
|
1733
2090
|
]
|
|
1734
2091
|
|
|
1735
|
-
|
|
1736
|
-
|
|
2092
|
+
anesthesia_related_surgical_procedure: Annotated[
|
|
2093
|
+
List[str], PropertyInfo(alias="anesthesiaRelatedSurgicalProcedure")
|
|
1737
2094
|
]
|
|
1738
2095
|
|
|
1739
|
-
|
|
2096
|
+
auto_accident_country_code: Annotated[str, PropertyInfo(alias="autoAccidentCountryCode")]
|
|
1740
2097
|
|
|
1741
|
-
|
|
1742
|
-
Iterable[Iterable[ClaimInformationConditionCodesList]], PropertyInfo(alias="conditionCodesList")
|
|
1743
|
-
]
|
|
2098
|
+
auto_accident_state_code: Annotated[str, PropertyInfo(alias="autoAccidentStateCode")]
|
|
1744
2099
|
|
|
1745
|
-
|
|
1746
|
-
|
|
2100
|
+
claim_contract_information: Annotated[
|
|
2101
|
+
ClaimInformationClaimContractInformation, PropertyInfo(alias="claimContractInformation")
|
|
1747
2102
|
]
|
|
1748
2103
|
|
|
1749
|
-
|
|
1750
|
-
ClaimInformationDiagnosisRelatedGroupInformation, PropertyInfo(alias="diagnosisRelatedGroupInformation")
|
|
1751
|
-
]
|
|
2104
|
+
claim_date_information: Annotated[ClaimInformationClaimDateInformation, PropertyInfo(alias="claimDateInformation")]
|
|
1752
2105
|
|
|
1753
|
-
|
|
2106
|
+
claim_note: Annotated[ClaimInformationClaimNote, PropertyInfo(alias="claimNote")]
|
|
1754
2107
|
|
|
1755
|
-
|
|
1756
|
-
|
|
2108
|
+
claim_pricing_repricing_information: Annotated[
|
|
2109
|
+
ClaimInformationClaimPricingRepricingInformation, PropertyInfo(alias="claimPricingRepricingInformation")
|
|
1757
2110
|
]
|
|
1758
2111
|
|
|
1759
|
-
|
|
1760
|
-
|
|
1761
|
-
occurrence_information_list: Annotated[
|
|
1762
|
-
Iterable[Iterable[ClaimInformationOccurrenceInformationList]], PropertyInfo(alias="occurrenceInformationList")
|
|
2112
|
+
claim_supplemental_information: Annotated[
|
|
2113
|
+
ClaimInformationClaimSupplementalInformation, PropertyInfo(alias="claimSupplementalInformation")
|
|
1763
2114
|
]
|
|
1764
2115
|
|
|
1765
|
-
|
|
1766
|
-
Iterable[
|
|
2116
|
+
condition_information: Annotated[
|
|
2117
|
+
Iterable[ClaimInformationConditionInformation], PropertyInfo(alias="conditionInformation")
|
|
1767
2118
|
]
|
|
1768
2119
|
|
|
1769
|
-
|
|
1770
|
-
|
|
1771
|
-
|
|
2120
|
+
death_date: Annotated[str, PropertyInfo(alias="deathDate")]
|
|
2121
|
+
|
|
2122
|
+
delay_reason_code: Annotated[
|
|
2123
|
+
Literal["1", "2", "3", "4", "5", "6", "7", "8", "9", "10", "11", "15"], PropertyInfo(alias="delayReasonCode")
|
|
1772
2124
|
]
|
|
1773
2125
|
|
|
1774
|
-
|
|
1775
|
-
|
|
1776
|
-
|
|
1777
|
-
|
|
2126
|
+
epsdt_referral: Annotated[ClaimInformationEpsdtReferral, PropertyInfo(alias="epsdtReferral")]
|
|
2127
|
+
|
|
2128
|
+
file_information: Annotated[str, PropertyInfo(alias="fileInformation")]
|
|
2129
|
+
|
|
2130
|
+
file_information_list: Annotated[List[str], PropertyInfo(alias="fileInformationList")]
|
|
2131
|
+
|
|
2132
|
+
homebound_indicator: Annotated[bool, PropertyInfo(alias="homeboundIndicator")]
|
|
1778
2133
|
|
|
1779
2134
|
other_subscriber_information: Annotated[
|
|
1780
|
-
ClaimInformationOtherSubscriberInformation, PropertyInfo(alias="otherSubscriberInformation")
|
|
2135
|
+
Iterable[ClaimInformationOtherSubscriberInformation], PropertyInfo(alias="otherSubscriberInformation")
|
|
1781
2136
|
]
|
|
1782
2137
|
|
|
1783
2138
|
patient_amount_paid: Annotated[str, PropertyInfo(alias="patientAmountPaid")]
|
|
1784
2139
|
|
|
1785
|
-
|
|
1786
|
-
|
|
1787
|
-
|
|
1788
|
-
Iterable[ClaimInformationPatientReasonForVisit], PropertyInfo(alias="patientReasonForVisits")
|
|
2140
|
+
patient_condition_information_vision: Annotated[
|
|
2141
|
+
Iterable[ClaimInformationPatientConditionInformationVision],
|
|
2142
|
+
PropertyInfo(alias="patientConditionInformationVision"),
|
|
1789
2143
|
]
|
|
1790
2144
|
|
|
2145
|
+
patient_signature_source_code: Annotated[bool, PropertyInfo(alias="patientSignatureSourceCode")]
|
|
2146
|
+
|
|
1791
2147
|
patient_weight: Annotated[str, PropertyInfo(alias="patientWeight")]
|
|
1792
2148
|
|
|
1793
|
-
|
|
1794
|
-
ClaimInformationPrincipalProcedureInformation, PropertyInfo(alias="principalProcedureInformation")
|
|
1795
|
-
]
|
|
2149
|
+
pregnancy_indicator: Annotated[Literal["Y"], PropertyInfo(alias="pregnancyIndicator")]
|
|
1796
2150
|
|
|
1797
2151
|
property_casualty_claim_number: Annotated[str, PropertyInfo(alias="propertyCasualtyClaimNumber")]
|
|
1798
2152
|
|
|
2153
|
+
related_causes_code: Annotated[List[Literal["AA", "EM", "OA"]], PropertyInfo(alias="relatedCausesCode")]
|
|
2154
|
+
|
|
1799
2155
|
service_facility_location: Annotated[
|
|
1800
2156
|
ClaimInformationServiceFacilityLocation, PropertyInfo(alias="serviceFacilityLocation")
|
|
1801
2157
|
]
|
|
1802
2158
|
|
|
1803
|
-
|
|
1804
|
-
|
|
1805
|
-
treatment_code_information_list: Annotated[Iterable[List[str]], PropertyInfo(alias="treatmentCodeInformationList")]
|
|
2159
|
+
special_program_code: Annotated[Literal["02", "03", "05", "09"], PropertyInfo(alias="specialProgramCode")]
|
|
1806
2160
|
|
|
1807
|
-
|
|
1808
|
-
|
|
2161
|
+
spinal_manipulation_service_information: Annotated[
|
|
2162
|
+
ClaimInformationSpinalManipulationServiceInformation, PropertyInfo(alias="spinalManipulationServiceInformation")
|
|
1809
2163
|
]
|
|
1810
2164
|
|
|
1811
2165
|
|
|
1812
2166
|
class Receiver(TypedDict, total=False):
|
|
1813
2167
|
organization_name: Required[Annotated[str, PropertyInfo(alias="organizationName")]]
|
|
1814
2168
|
|
|
1815
|
-
tax_id: Annotated[str, PropertyInfo(alias="taxId")]
|
|
1816
|
-
|
|
1817
2169
|
|
|
1818
2170
|
class SubmitterContactInformation(TypedDict, total=False):
|
|
1819
2171
|
email: str
|
|
@@ -1822,17 +2174,23 @@ class SubmitterContactInformation(TypedDict, total=False):
|
|
|
1822
2174
|
|
|
1823
2175
|
name: str
|
|
1824
2176
|
|
|
1825
|
-
|
|
2177
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
1826
2178
|
|
|
1827
|
-
|
|
2179
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
1828
2180
|
|
|
1829
2181
|
|
|
1830
2182
|
class Submitter(TypedDict, total=False):
|
|
1831
2183
|
contact_information: Required[Annotated[SubmitterContactInformation, PropertyInfo(alias="contactInformation")]]
|
|
1832
2184
|
|
|
1833
|
-
|
|
2185
|
+
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2186
|
+
|
|
2187
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2188
|
+
|
|
2189
|
+
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
2190
|
+
|
|
2191
|
+
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
1834
2192
|
|
|
1835
|
-
|
|
2193
|
+
submitter_identification: Annotated[str, PropertyInfo(alias="submitterIdentification")]
|
|
1836
2194
|
|
|
1837
2195
|
|
|
1838
2196
|
class SubscriberAddress(TypedDict, total=False):
|
|
@@ -1851,40 +2209,58 @@ class SubscriberAddress(TypedDict, total=False):
|
|
|
1851
2209
|
state: str
|
|
1852
2210
|
|
|
1853
2211
|
|
|
1854
|
-
class
|
|
1855
|
-
|
|
2212
|
+
class SubscriberContactInformation(TypedDict, total=False):
|
|
2213
|
+
name: Required[str]
|
|
1856
2214
|
|
|
1857
|
-
|
|
2215
|
+
email: str
|
|
1858
2216
|
|
|
1859
|
-
|
|
1860
|
-
|
|
1861
|
-
|
|
1862
|
-
|
|
1863
|
-
|
|
1864
|
-
]
|
|
2217
|
+
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2218
|
+
|
|
2219
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2220
|
+
|
|
2221
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
1865
2222
|
|
|
2223
|
+
|
|
2224
|
+
class Subscriber(TypedDict, total=False):
|
|
1866
2225
|
address: SubscriberAddress
|
|
1867
2226
|
|
|
2227
|
+
contact_information: Annotated[SubscriberContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2228
|
+
|
|
1868
2229
|
date_of_birth: Annotated[str, PropertyInfo(alias="dateOfBirth")]
|
|
1869
2230
|
|
|
2231
|
+
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2232
|
+
|
|
1870
2233
|
gender: Literal["M", "F", "U"]
|
|
1871
2234
|
|
|
1872
2235
|
group_number: Annotated[str, PropertyInfo(alias="groupNumber")]
|
|
1873
2236
|
|
|
2237
|
+
insurance_type_code: Annotated[
|
|
2238
|
+
Literal["12", "13", "14", "15", "16", "41", "42", "43", "47"], PropertyInfo(alias="insuranceTypeCode")
|
|
2239
|
+
]
|
|
2240
|
+
|
|
2241
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2242
|
+
|
|
1874
2243
|
member_id: Annotated[str, PropertyInfo(alias="memberId")]
|
|
1875
2244
|
|
|
1876
2245
|
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
1877
2246
|
|
|
2247
|
+
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2248
|
+
|
|
2249
|
+
payment_responsibility_level_code: Annotated[
|
|
2250
|
+
Literal["A", "B", "C", "D", "E", "F", "G", "H", "P", "S", "T", "U"],
|
|
2251
|
+
PropertyInfo(alias="paymentResponsibilityLevelCode"),
|
|
2252
|
+
]
|
|
2253
|
+
|
|
1878
2254
|
policy_number: Annotated[str, PropertyInfo(alias="policyNumber")]
|
|
1879
2255
|
|
|
1880
2256
|
ssn: str
|
|
1881
2257
|
|
|
1882
|
-
|
|
2258
|
+
subscriber_group_name: Annotated[str, PropertyInfo(alias="subscriberGroupName")]
|
|
1883
2259
|
|
|
1884
2260
|
suffix: str
|
|
1885
2261
|
|
|
1886
2262
|
|
|
1887
|
-
class
|
|
2263
|
+
class DependentAddress(TypedDict, total=False):
|
|
1888
2264
|
address1: Required[str]
|
|
1889
2265
|
|
|
1890
2266
|
city: Required[str]
|
|
@@ -1900,49 +2276,47 @@ class AttendingAddress(TypedDict, total=False):
|
|
|
1900
2276
|
state: str
|
|
1901
2277
|
|
|
1902
2278
|
|
|
1903
|
-
class
|
|
2279
|
+
class DependentContactInformation(TypedDict, total=False):
|
|
1904
2280
|
name: Required[str]
|
|
1905
2281
|
|
|
1906
2282
|
email: str
|
|
1907
2283
|
|
|
1908
2284
|
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
1909
2285
|
|
|
1910
|
-
|
|
1911
|
-
|
|
1912
|
-
valid_contact: Annotated[bool, PropertyInfo(alias="validContact")]
|
|
2286
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
1913
2287
|
|
|
2288
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
1914
2289
|
|
|
1915
|
-
class Attending(TypedDict, total=False):
|
|
1916
|
-
address: AttendingAddress
|
|
1917
2290
|
|
|
1918
|
-
|
|
2291
|
+
class Dependent(TypedDict, total=False):
|
|
2292
|
+
date_of_birth: Required[Annotated[str, PropertyInfo(alias="dateOfBirth")]]
|
|
1919
2293
|
|
|
1920
|
-
|
|
2294
|
+
first_name: Required[Annotated[str, PropertyInfo(alias="firstName")]]
|
|
1921
2295
|
|
|
1922
|
-
|
|
2296
|
+
gender: Required[Literal["M", "F", "U"]]
|
|
1923
2297
|
|
|
1924
|
-
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2298
|
+
last_name: Required[Annotated[str, PropertyInfo(alias="lastName")]]
|
|
1925
2299
|
|
|
1926
|
-
|
|
2300
|
+
relationship_to_subscriber_code: Required[
|
|
2301
|
+
Annotated[
|
|
2302
|
+
Literal["01", "19", "20", "21", "39", "40", "53", "G8"], PropertyInfo(alias="relationshipToSubscriberCode")
|
|
2303
|
+
]
|
|
2304
|
+
]
|
|
1927
2305
|
|
|
1928
|
-
|
|
2306
|
+
address: DependentAddress
|
|
1929
2307
|
|
|
1930
|
-
|
|
2308
|
+
contact_information: Annotated[DependentContactInformation, PropertyInfo(alias="contactInformation")]
|
|
1931
2309
|
|
|
1932
|
-
|
|
2310
|
+
member_id: Annotated[str, PropertyInfo(alias="memberId")]
|
|
1933
2311
|
|
|
1934
|
-
|
|
1935
|
-
Literal["0B", "1G", "G2", "LU"], PropertyInfo(alias="secondaryIdentificationQualifierCode")
|
|
1936
|
-
]
|
|
2312
|
+
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
1937
2313
|
|
|
1938
|
-
|
|
2314
|
+
ssn: str
|
|
1939
2315
|
|
|
1940
2316
|
suffix: str
|
|
1941
2317
|
|
|
1942
|
-
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
1943
|
-
|
|
1944
2318
|
|
|
1945
|
-
class
|
|
2319
|
+
class OrderingAddress(TypedDict, total=False):
|
|
1946
2320
|
address1: Required[str]
|
|
1947
2321
|
|
|
1948
2322
|
city: Required[str]
|
|
@@ -1958,28 +2332,30 @@ class BillingAddress(TypedDict, total=False):
|
|
|
1958
2332
|
state: str
|
|
1959
2333
|
|
|
1960
2334
|
|
|
1961
|
-
class
|
|
1962
|
-
name: Required[str]
|
|
1963
|
-
|
|
2335
|
+
class OrderingContactInformation(TypedDict, total=False):
|
|
1964
2336
|
email: str
|
|
1965
2337
|
|
|
1966
2338
|
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
1967
2339
|
|
|
1968
|
-
|
|
2340
|
+
name: str
|
|
1969
2341
|
|
|
1970
|
-
|
|
2342
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
1971
2343
|
|
|
2344
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
1972
2345
|
|
|
1973
|
-
class Billing(TypedDict, total=False):
|
|
1974
|
-
address: Required[BillingAddress]
|
|
1975
2346
|
|
|
1976
|
-
|
|
2347
|
+
class Ordering(TypedDict, total=False):
|
|
2348
|
+
address: OrderingAddress
|
|
1977
2349
|
|
|
1978
|
-
|
|
2350
|
+
claim_office_number: Annotated[str, PropertyInfo(alias="claimOfficeNumber")]
|
|
1979
2351
|
|
|
1980
2352
|
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
1981
2353
|
|
|
1982
|
-
contact_information: Annotated[
|
|
2354
|
+
contact_information: Annotated[OrderingContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2355
|
+
|
|
2356
|
+
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
2357
|
+
|
|
2358
|
+
employer_identification_number: Annotated[str, PropertyInfo(alias="employerIdentificationNumber")]
|
|
1983
2359
|
|
|
1984
2360
|
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
1985
2361
|
|
|
@@ -1989,17 +2365,19 @@ class Billing(TypedDict, total=False):
|
|
|
1989
2365
|
|
|
1990
2366
|
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
1991
2367
|
|
|
2368
|
+
naic: str
|
|
2369
|
+
|
|
2370
|
+
npi: str
|
|
2371
|
+
|
|
1992
2372
|
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
1993
2373
|
|
|
1994
|
-
|
|
2374
|
+
payer_identification_number: Annotated[str, PropertyInfo(alias="payerIdentificationNumber")]
|
|
2375
|
+
|
|
2376
|
+
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
1995
2377
|
|
|
1996
2378
|
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
1997
2379
|
|
|
1998
|
-
|
|
1999
|
-
Literal["0B", "1G", "G2", "LU"], PropertyInfo(alias="secondaryIdentificationQualifierCode")
|
|
2000
|
-
]
|
|
2001
|
-
|
|
2002
|
-
secondary_identifier: Annotated[str, PropertyInfo(alias="secondaryIdentifier")]
|
|
2380
|
+
ssn: str
|
|
2003
2381
|
|
|
2004
2382
|
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2005
2383
|
|
|
@@ -2008,7 +2386,7 @@ class Billing(TypedDict, total=False):
|
|
|
2008
2386
|
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
2009
2387
|
|
|
2010
2388
|
|
|
2011
|
-
class
|
|
2389
|
+
class PayerAddress(TypedDict, total=False):
|
|
2012
2390
|
address1: Required[str]
|
|
2013
2391
|
|
|
2014
2392
|
city: Required[str]
|
|
@@ -2024,13 +2402,7 @@ class BillingPayToAddressNameAddress(TypedDict, total=False):
|
|
|
2024
2402
|
state: str
|
|
2025
2403
|
|
|
2026
2404
|
|
|
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):
|
|
2405
|
+
class PayToAddress(TypedDict, total=False):
|
|
2034
2406
|
address1: Required[str]
|
|
2035
2407
|
|
|
2036
2408
|
city: Required[str]
|
|
@@ -2046,27 +2418,7 @@ class BillingPayToPlanNameAddress(TypedDict, total=False):
|
|
|
2046
2418
|
state: str
|
|
2047
2419
|
|
|
2048
2420
|
|
|
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):
|
|
2421
|
+
class PayToPlanAddress(TypedDict, total=False):
|
|
2070
2422
|
address1: Required[str]
|
|
2071
2423
|
|
|
2072
2424
|
city: Required[str]
|
|
@@ -2082,63 +2434,68 @@ class DependentAddress(TypedDict, total=False):
|
|
|
2082
2434
|
state: str
|
|
2083
2435
|
|
|
2084
2436
|
|
|
2085
|
-
class
|
|
2086
|
-
|
|
2437
|
+
class PayToPlan(TypedDict, total=False):
|
|
2438
|
+
address: Required[PayToPlanAddress]
|
|
2087
2439
|
|
|
2088
|
-
|
|
2440
|
+
organization_name: Required[Annotated[str, PropertyInfo(alias="organizationName")]]
|
|
2089
2441
|
|
|
2090
|
-
|
|
2442
|
+
primary_identifier: Required[Annotated[str, PropertyInfo(alias="primaryIdentifier")]]
|
|
2091
2443
|
|
|
2092
|
-
|
|
2444
|
+
primary_identifier_type_code: Required[
|
|
2445
|
+
Annotated[Literal["PI", "XV"], PropertyInfo(alias="primaryIdentifierTypeCode")]
|
|
2446
|
+
]
|
|
2093
2447
|
|
|
2094
|
-
|
|
2095
|
-
|
|
2096
|
-
|
|
2097
|
-
|
|
2448
|
+
tax_identification_number: Required[Annotated[str, PropertyInfo(alias="taxIdentificationNumber")]]
|
|
2449
|
+
|
|
2450
|
+
secondary_identifier: Annotated[str, PropertyInfo(alias="secondaryIdentifier")]
|
|
2451
|
+
|
|
2452
|
+
secondary_identifier_type_code: Annotated[
|
|
2453
|
+
Literal["2U", "FY", "NF"], PropertyInfo(alias="secondaryIdentifierTypeCode")
|
|
2098
2454
|
]
|
|
2099
2455
|
|
|
2100
|
-
address: DependentAddress
|
|
2101
2456
|
|
|
2102
|
-
|
|
2457
|
+
class ProviderAddress(TypedDict, total=False):
|
|
2458
|
+
address1: Required[str]
|
|
2103
2459
|
|
|
2104
|
-
|
|
2460
|
+
city: Required[str]
|
|
2105
2461
|
|
|
2106
|
-
|
|
2462
|
+
address2: str
|
|
2107
2463
|
|
|
2464
|
+
country_code: Annotated[str, PropertyInfo(alias="countryCode")]
|
|
2108
2465
|
|
|
2109
|
-
|
|
2110
|
-
received_277_ca: Annotated[str, PropertyInfo(alias="RECEIVED_277CA")]
|
|
2111
|
-
"""A success event ID for the 277CA transaction"""
|
|
2466
|
+
country_sub_division_code: Annotated[str, PropertyInfo(alias="countrySubDivisionCode")]
|
|
2112
2467
|
|
|
2468
|
+
postal_code: Annotated[str, PropertyInfo(alias="postalCode")]
|
|
2113
2469
|
|
|
2114
|
-
|
|
2115
|
-
last_name: Required[Annotated[str, PropertyInfo(alias="lastName")]]
|
|
2470
|
+
state: str
|
|
2116
2471
|
|
|
2117
|
-
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2118
2472
|
|
|
2119
|
-
|
|
2120
|
-
|
|
2121
|
-
]
|
|
2473
|
+
class ProviderContactInformation(TypedDict, total=False):
|
|
2474
|
+
email: str
|
|
2122
2475
|
|
|
2123
|
-
|
|
2476
|
+
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2124
2477
|
|
|
2125
|
-
|
|
2478
|
+
name: str
|
|
2126
2479
|
|
|
2127
|
-
|
|
2480
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2128
2481
|
|
|
2129
|
-
|
|
2482
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2130
2483
|
|
|
2131
|
-
suffix: str
|
|
2132
2484
|
|
|
2485
|
+
class Provider(TypedDict, total=False):
|
|
2486
|
+
address: ProviderAddress
|
|
2133
2487
|
|
|
2134
|
-
|
|
2135
|
-
|
|
2488
|
+
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
2489
|
+
|
|
2490
|
+
contact_information: Annotated[ProviderContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2491
|
+
|
|
2492
|
+
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
2136
2493
|
|
|
2137
2494
|
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2138
2495
|
|
|
2139
|
-
|
|
2140
|
-
|
|
2141
|
-
]
|
|
2496
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2497
|
+
|
|
2498
|
+
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
2142
2499
|
|
|
2143
2500
|
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
2144
2501
|
|
|
@@ -2146,28 +2503,20 @@ class OtherOperatingPhysician(TypedDict, total=False):
|
|
|
2146
2503
|
|
|
2147
2504
|
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2148
2505
|
|
|
2149
|
-
|
|
2150
|
-
|
|
2151
|
-
suffix: str
|
|
2152
|
-
|
|
2153
|
-
|
|
2154
|
-
class PayerAddress(TypedDict, total=False):
|
|
2155
|
-
address1: Required[str]
|
|
2156
|
-
|
|
2157
|
-
city: Required[str]
|
|
2506
|
+
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
2158
2507
|
|
|
2159
|
-
|
|
2508
|
+
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
2160
2509
|
|
|
2161
|
-
|
|
2510
|
+
ssn: str
|
|
2162
2511
|
|
|
2163
|
-
|
|
2512
|
+
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2164
2513
|
|
|
2165
|
-
|
|
2514
|
+
suffix: str
|
|
2166
2515
|
|
|
2167
|
-
|
|
2516
|
+
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
2168
2517
|
|
|
2169
2518
|
|
|
2170
|
-
class
|
|
2519
|
+
class ReferringAddress(TypedDict, total=False):
|
|
2171
2520
|
address1: Required[str]
|
|
2172
2521
|
|
|
2173
2522
|
city: Required[str]
|
|
@@ -2183,31 +2532,24 @@ class ProviderAddress(TypedDict, total=False):
|
|
|
2183
2532
|
state: str
|
|
2184
2533
|
|
|
2185
2534
|
|
|
2186
|
-
class
|
|
2187
|
-
name: Required[str]
|
|
2188
|
-
|
|
2535
|
+
class ReferringContactInformation(TypedDict, total=False):
|
|
2189
2536
|
email: str
|
|
2190
2537
|
|
|
2191
2538
|
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2192
2539
|
|
|
2193
|
-
|
|
2540
|
+
name: str
|
|
2194
2541
|
|
|
2195
|
-
|
|
2542
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2196
2543
|
|
|
2544
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2197
2545
|
|
|
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
2546
|
|
|
2206
|
-
|
|
2547
|
+
class Referring(TypedDict, total=False):
|
|
2548
|
+
address: ReferringAddress
|
|
2207
2549
|
|
|
2208
|
-
|
|
2550
|
+
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
2209
2551
|
|
|
2210
|
-
|
|
2552
|
+
contact_information: Annotated[ReferringContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2211
2553
|
|
|
2212
2554
|
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2213
2555
|
|
|
@@ -2219,18 +2561,18 @@ class Provider(TypedDict, total=False):
|
|
|
2219
2561
|
|
|
2220
2562
|
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2221
2563
|
|
|
2222
|
-
|
|
2223
|
-
Literal["0B", "1G", "G2", "LU"], PropertyInfo(alias="secondaryIdentificationQualifierCode")
|
|
2224
|
-
]
|
|
2564
|
+
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
2225
2565
|
|
|
2226
|
-
|
|
2566
|
+
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
2567
|
+
|
|
2568
|
+
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2227
2569
|
|
|
2228
2570
|
suffix: str
|
|
2229
2571
|
|
|
2230
2572
|
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
2231
2573
|
|
|
2232
2574
|
|
|
2233
|
-
class
|
|
2575
|
+
class RenderingAddress(TypedDict, total=False):
|
|
2234
2576
|
address1: Required[str]
|
|
2235
2577
|
|
|
2236
2578
|
city: Required[str]
|
|
@@ -2246,31 +2588,29 @@ class ReferringAddress(TypedDict, total=False):
|
|
|
2246
2588
|
state: str
|
|
2247
2589
|
|
|
2248
2590
|
|
|
2249
|
-
class
|
|
2250
|
-
name: Required[str]
|
|
2251
|
-
|
|
2591
|
+
class RenderingContactInformation(TypedDict, total=False):
|
|
2252
2592
|
email: str
|
|
2253
2593
|
|
|
2254
2594
|
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2255
2595
|
|
|
2256
|
-
|
|
2596
|
+
name: str
|
|
2257
2597
|
|
|
2258
|
-
|
|
2598
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2259
2599
|
|
|
2600
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2260
2601
|
|
|
2261
|
-
class Referring(TypedDict, total=False):
|
|
2262
|
-
last_name: Required[Annotated[str, PropertyInfo(alias="lastName")]]
|
|
2263
2602
|
|
|
2264
|
-
|
|
2603
|
+
class Rendering(TypedDict, total=False):
|
|
2604
|
+
address: RenderingAddress
|
|
2265
2605
|
|
|
2266
2606
|
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
2267
2607
|
|
|
2268
|
-
contact_information: Annotated[
|
|
2269
|
-
|
|
2270
|
-
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
2608
|
+
contact_information: Annotated[RenderingContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2271
2609
|
|
|
2272
2610
|
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2273
2611
|
|
|
2612
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2613
|
+
|
|
2274
2614
|
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
2275
2615
|
|
|
2276
2616
|
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
@@ -2279,16 +2619,10 @@ class Referring(TypedDict, total=False):
|
|
|
2279
2619
|
|
|
2280
2620
|
organization_name: Annotated[str, PropertyInfo(alias="organizationName")]
|
|
2281
2621
|
|
|
2282
|
-
provider_type: Annotated[
|
|
2622
|
+
provider_type: Annotated[str, PropertyInfo(alias="providerType")]
|
|
2283
2623
|
|
|
2284
2624
|
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
2285
2625
|
|
|
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
2626
|
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2293
2627
|
|
|
2294
2628
|
suffix: str
|
|
@@ -2296,7 +2630,7 @@ class Referring(TypedDict, total=False):
|
|
|
2296
2630
|
taxonomy_code: Annotated[str, PropertyInfo(alias="taxonomyCode")]
|
|
2297
2631
|
|
|
2298
2632
|
|
|
2299
|
-
class
|
|
2633
|
+
class SupervisingAddress(TypedDict, total=False):
|
|
2300
2634
|
address1: Required[str]
|
|
2301
2635
|
|
|
2302
2636
|
city: Required[str]
|
|
@@ -2312,31 +2646,31 @@ class RenderingAddress(TypedDict, total=False):
|
|
|
2312
2646
|
state: str
|
|
2313
2647
|
|
|
2314
2648
|
|
|
2315
|
-
class
|
|
2316
|
-
name: Required[str]
|
|
2317
|
-
|
|
2649
|
+
class SupervisingContactInformation(TypedDict, total=False):
|
|
2318
2650
|
email: str
|
|
2319
2651
|
|
|
2320
2652
|
fax_number: Annotated[str, PropertyInfo(alias="faxNumber")]
|
|
2321
2653
|
|
|
2322
|
-
|
|
2654
|
+
name: str
|
|
2323
2655
|
|
|
2324
|
-
|
|
2656
|
+
phone_extension: Annotated[str, PropertyInfo(alias="phoneExtension")]
|
|
2325
2657
|
|
|
2658
|
+
phone_number: Annotated[str, PropertyInfo(alias="phoneNumber")]
|
|
2326
2659
|
|
|
2327
|
-
class Rendering(TypedDict, total=False):
|
|
2328
|
-
last_name: Required[Annotated[str, PropertyInfo(alias="lastName")]]
|
|
2329
2660
|
|
|
2330
|
-
|
|
2661
|
+
class Supervising(TypedDict, total=False):
|
|
2662
|
+
address: SupervisingAddress
|
|
2331
2663
|
|
|
2332
2664
|
commercial_number: Annotated[str, PropertyInfo(alias="commercialNumber")]
|
|
2333
2665
|
|
|
2334
|
-
contact_information: Annotated[
|
|
2666
|
+
contact_information: Annotated[SupervisingContactInformation, PropertyInfo(alias="contactInformation")]
|
|
2335
2667
|
|
|
2336
2668
|
employer_id: Annotated[str, PropertyInfo(alias="employerId")]
|
|
2337
2669
|
|
|
2338
2670
|
first_name: Annotated[str, PropertyInfo(alias="firstName")]
|
|
2339
2671
|
|
|
2672
|
+
last_name: Annotated[str, PropertyInfo(alias="lastName")]
|
|
2673
|
+
|
|
2340
2674
|
location_number: Annotated[str, PropertyInfo(alias="locationNumber")]
|
|
2341
2675
|
|
|
2342
2676
|
middle_name: Annotated[str, PropertyInfo(alias="middleName")]
|
|
@@ -2349,11 +2683,7 @@ class Rendering(TypedDict, total=False):
|
|
|
2349
2683
|
|
|
2350
2684
|
provider_upin_number: Annotated[str, PropertyInfo(alias="providerUpinNumber")]
|
|
2351
2685
|
|
|
2352
|
-
|
|
2353
|
-
Literal["0B", "1G", "G2", "LU"], PropertyInfo(alias="secondaryIdentificationQualifierCode")
|
|
2354
|
-
]
|
|
2355
|
-
|
|
2356
|
-
secondary_identifier: Annotated[str, PropertyInfo(alias="secondaryIdentifier")]
|
|
2686
|
+
ssn: str
|
|
2357
2687
|
|
|
2358
2688
|
state_license_number: Annotated[str, PropertyInfo(alias="stateLicenseNumber")]
|
|
2359
2689
|
|