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POST
Pre-submission claim validation

Authorizations

X-API-Key
string
header
required

Body

application/json

Pre-submission claim validation — lighter than encounter check.

cpt_codes
string[]
required

Finalized CPT/HCPCS codes on the claim

Required array length: 1 - 25 elements
date_of_service
string
required

Date of service (YYYY-MM-DD)

payer_slug
string
required

Payer slug

billing_provider
ProviderContext · object | null

The rendering / billing provider, for document rules that depend on it.

claim_type
string
default:professional

Claim type: professional, institutional, dental

diagnosis_codes
ClaimDiagnosisCodes · object | null
include_draft_rules
boolean
default:false

Also use draft (unreviewed) rules

locality
string | null

GPCI locality code

member_age
integer | null

Member age in years

place_of_service
string | null

POS code or CMS name, e.g. '22'

plan_type
string | null

Plan type for filing rule overrides

policy_document_ids
string[] | null

Parsed payer policy documents whose approved rules to apply

prior_authorization_numbers
Prior Authorization Numbers · object | null

Authorization number per code, e.g. {'J0897': 'A12345'}

state
string | null

State code for filing rule overrides

type_of_bill
string | null

Institutional type of bill, e.g. '0131' (013x = outpatient, 011x = inpatient)

Response

Successful Response

Pre-submission claim validation result.

codes
string[]
required
date_of_service
string
required
payer_slug
string
required
submit_ready
boolean
required

True when no blockers found (NCCI clean + filing valid)

filing_status
ClaimFilingStatus · object | null

Timely filing status for the claim.

ncci_clean
boolean
default:true
ncci_conflicts
NCCIBatchConflict · object[]
pa_required_count
integer
default:0
pa_results
EncounterPAResult · object[]

PA per code from the requested payer policy documents

payer_name
string | null
payment_estimates
EncounterPaymentEstimate · object[]
total_estimated_payment
number
default:0
warnings
EncounterWarning · object[]