Developers{
"id": "claims",
"type": "array",
"items": {
"$ref": "claim"
}
}
{
"id": "claim",
"type": "object",
"properties": {
"number": {
"type": "string"
},
"diagnosis": {
"type": "array",
"items": {
"$ref": "cda_coded_entry"
}
},
"name": {
"type": "string"
},
"payer": {
"type": "array",
"items": {
"type": "string"
}
},
"date_time": {
"$ref": "cda_date"
},
"service": {
"type": "string"
},
"type": {
"type": "array",
"items": {
"type": "string"
}
},
"phone": {
"type": "array",
"items": {
"$ref": "cda_phone"
}
},
"performers": {
"type": "array",
"items": {
"$ref": "cda_performer"
}
},
"charges": {
"type": "object",
"properties": {
"insurance_paid": {
"type": "string"
},
"negotiated_price": {
"type": "string"
},
"patient_responsibility": {
"type": "string"
},
"price_billed": {
"type": "string"
},
"provider_paid": {
"type": "string"
}
},
"additionalProperties": false
},
"lines": {
"type": "array",
"items": {
"type": "object",
"properties": {
"line": {
"type": "string"
},
"charges": {
"type": "object",
"properties": {
"insurance_paid": {
"type": "string"
},
"negotiated_price": {
"type": "string"
},
"patient_responsibility": {
"type": "string"
},
"price_billed": {
"type": "string"
},
"provider_paid": {
"type": "string"
}
},
"additionalProperties": false
},
"drug": {
"type": "object",
"properties": {
"code": {
"type": "string"
},
"description": {
"type": "string"
},
"name": {
"type": "string"
}
},
"additionalProperties": false
},
"modifier": {
"type": "array",
"items": {
"properties": {
"code": {
"type": "string"
},
"description": {
"type": "string"
},
"name": {
"type": "string"
}
},
"additionalProperties": false
}
},
"number": {
"type": "string"
},
"place_of_service": {
"type": "object",
"properties": {
"code": {
"type": "string"
},
"description": {
"type": "string"
},
"name": {
"type": "string"
}
},
"additionalProperties": false
},
"procedure": {
"type": "object",
"properties": {
"code": {
"type": "string"
},
"description": {
"type": "string"
},
"name": {
"type": "string"
}
},
"additionalProperties": false
},
"quantity": {
"type": "object",
"properties": {
"value": {
"type": "number"
},
"unit": {
"type": "string"
}
},
"additionalProperties": false
},
"performers": {
"type": "array",
"items": {
"$ref": "cda_performer"
}
},
"revenue": {
"type": "object",
"properties": {
"code": {
"type": "string"
},
"description": {
"type": "string"
},
"name": {
"type": "string"
}
},
"additionalProperties": false
},
"date_time": {
"$ref": "cda_date"
},
"type": {
"type": "object",
"properties": {
"code": {
"type": "string"
},
"description": {
"type": "string"
},
"name": {
"type": "string"
}
},
"additionalProperties": false
},
"type_of_service_code": {
"type": "string"
},
"type_of_service": {
"type": "number"
}
},
"additionalProperties": false
}
}
},
"additionalProperties": false
}{
"payer": [
"medicare"
],
"number": "1234567890000",
"date_time": {
"low": {
"date": "2012-10-18T00:00:00.000Z",
"precision": "day"
},
"high": {
"date": "2012-10-18T00:00:00.000Z",
"precision": "day"
}
},
"lines": [
{
"line": "1",
"date_time": {
"low": {
"date": "2012-10-18T00:00:00.000Z",
"precision": "day"
},
"high": {
"date": "2012-10-18T00:00:00.000Z",
"precision": "day"
}
},
"procedure": {
"code": "98941",
"description": "Chiropractic Manipulative Treatment (Cmt); Spinal, Three To Four Regions"
},
"quantity": {
"value": 1,
"unit": "line"
},
"modifier": [
{
"code": "AT",
"description": "Acute Treatment (This Modifier Should Be Used When Reporting Service 98940, 98941, 98942)"
}
],
"charges": {
"price_billed": "$60.00",
"insurance_paid": "$34.00",
"patient_responsibility": "$26.00"
},
"place_of_service": {
"code": "11",
"name": "Office"
},
"type": {
"code": "1",
"name": "Medical Care"
},
"performers": [
{
"type": "rendering provider",
"identifiers": [
{
"identifier": "2.16.840.1.113883.4.6",
"extension": "123456789"
}
]
}
]
}
],
"charges": {
"price_billed": "$60.00",
"insurance_paid": "$34.00",
"provider_paid": "$27.20",
"patient_responsibility": "$6.80"
},
"type": [
"medicare PartB"
],
"diagnosis": [
{
"code": "3534"
},
{
"code": "7393"
},
{
"code": "7392"
},
{
"code": "3533"
}
]
}