insurance
object format:
Key | Type | POST /PUT request |
Notes |
---|---|---|---|
insurance_claim_office_number |
string | optional | Insurance office phone number. |
insurance_company |
string | optional | |
insurance_group_name |
string | optional | |
insurance_group_number |
string | optional | |
insurance_id_number |
string | optional | |
insurance_payer_id |
string | optional | |
insurance_plan_name |
string | optional | |
insurance_plan_type |
string | optional | One of these choices |
is_subscriber_the_patient |
boolean | optional | Defaults to true . |
patient_relationship_to_subscriber |
string | optional | HCFA/1500 individual relationship code. |
subscriber_address |
string | optional | |
subscriber_city |
string | optional | |
subscriber_country |
string | optional | Two-letter country code. |
subscriber_date_of_birth |
date | optional | |
subscriber_first_name |
string | optional | |
subscriber_gender |
string | optional | One of "Male" or "Female" . |
subscriber_last_name |
string | optional | |
subscriber_middle_name |
string | optional | |
subscriber_social_security |
string | optional | |
subscriber_state |
string | optional | Two-letter state code. |
subscriber_suffix |
string | optional | E.g. "II" or "III" . |
subscriber_zip_code |
string | optional | |
photo_front |
base64encoded file | optional | photo of front of insurance card |
photo_back |
base64encoded file | optional | photo of back of insurance card |
auto_accident_insurance
object format:
Key | Type | POST /PUT request |
Notes |
---|---|---|---|
auto_accident_company |
string | optional | |
auto_accident_payer_id |
string | optional | |
auto_accident_policy_number |
string | optional | |
auto_accident_case_number |
string | optional | |
auto_accident_payer_address |
string | optional | |
auto_accident_payer_zip |
string | optional | |
auto_accident_payer_city |
string | optional | |
auto_accident_payer_state |
string | optional | Two-letter abbreviation |
auto_accident_date_of_accident |
date | optional | |
auto_accident_state_of_occurrence |
string | optional | Two-letter abbreviation |
auto_accident_is_subscriber_the_patient |
boolean | optional | |
auto_accident_patient_relationship_to_subscriber |
string | optional | One of the following, "" , "01" ("Spouse"), "04" ("Grandparent"), "05" ("Grandchild"), "07" ("Nephew or Niece"), "10" ("Foster Child"), "15" ("Ward"), "17" ("Stepson or Stepdaughter"), "19" ("Child"), "20" ("Employee"), "21" ("Unknown"), "22" ("Handicapped Dependent"), "23" ("Sponsored Dependent"), "24" ("Dependent of a Minor Dependent"), "29" ("Significant Other"), "32" ("Mother"), "33" ("Father"), "36" ("Emancipated Minor"), "39" ("Organ Donor"), "40" ("Cadaver Donor"), "41" ("Injured Plaintiff"), "43" ("Child Where Insured Has No Financial Responsibility"), "53" ("Life Partner"), "76" ("Dependent"), "G8" ("Other Relationship") |
auto_accident_subscriber_first_name |
string | optional | |
auto_accident_subscriber_middle_name |
string | optional | |
auto_accident_subscriber_last_name |
string | optional | |
auto_accident_subscriber_suffix |
string | optional | |
auto_accident_subscriber_date_of_birth |
string | optional | |
auto_accident_subscriber_social_security |
string | optional | |
auto_accident_subscriber_phone_number |
string | optional | |
auto_accident_subscriber_address |
string | optional | |
auto_accident_subscriber_city |
string | optional | |
auto_accident_subscriber_zip_code |
string | optional | |
auto_accident_subscriber_state |
string | optional | Two-letter abbreviation |
auto_accident_notes |
string | optional | |
auto_accident_had_similar_condition |
boolean | optional | |
auto_accident_similar_condition_date |
date | optional | |
auto_accident_similar_condition_notes |
string | optional | |
auto_accident_significant_injury |
string | optional | One of the following, 'N\A' (Not determinable at this time), 'Yes' , 'No' |
auto_accident_significant_injury_notes |
string | optional | |
auto_accident_disabled_from_date |
date | optional | |
auto_accident_disabled_to_date |
date | optional | |
auto_accident_return_to_work_date |
date | optional | |
auto_accident_still_under_care |
boolean | optional | |
auto_accident_treatment_duration |
string | optional | |
auto_accident_will_require_therapy |
boolean | optional | |
auto_accident_will_require_therapy_rec |
string | optional | |
auto_accident_claim_rep_is_insurer |
boolean | optional | |
auto_accident_claim_rep_name |
string | optional | |
auto_accident_claim_rep_address |
string | optional | |
auto_accident_claim_rep_zip |
string | optional | |
auto_accident_claim_rep_city |
string | optional | |
auto_accident_claim_rep_state |
string | optional | Two-letter abbreviation |
workers_comp_insurance
object format:
Key | Type | POST /PUT request |
Notes |
---|---|---|---|
workers_comp_company |
string | optional | |
workers_comp_payer_id |
string | optional | |
workers_comp_group_name |
string | optional | |
workers_comp_group_number |
string | optional | |
workers_comp_wcb |
string | optional | |
workers_comp_wcb_rating_code |
string | optional | |
workers_comp_carrier_code |
string | optional | |
workers_comp_case_number |
string | optional | |
workers_comp_payer_address |
string | optional | |
workers_comp_payer_zip |
string | optional | |
workers_comp_payer_city |
string | optional | |
workers_comp_payer_state |
string | optional | Two-letter abbreviation |
workers_comp_date_of_accident |
date | optional | |
workers_comp_state_of_occurrence |
string | optional | Two-letter abbreviation |
property_and_casualty_agency_claim_number |
string | optional | |
workers_comp_notes |
string | optional |