Authorization (Orchestration) Response Body
{
"determination": {
"x12": "ISA*00* *00* *ZZ*INQDEMO *ZZ*943207296 *230810*1021*^*00501*633036131*0*P*:~GS*HI*INQDEMO*943207296*20230810*102137*633036131*X*005010X215~ST*278*633036131*005010X215~BHT*0007*49*1402448037*20230810*102137*18~HL*1**20*1~NM1*PR*2*INQDEMO*****PI*INQDEMO~HL*2*1*21*1~NM1*1P*2*Demo Hospital*****XX*1234567890~REF*EI*123456789~HL*3*2*22*1~NM1*IL*1*DOE*JOE****MI*TST1~REF*6P*00000000~DMG*D8*19010101~HL*4*3*EV*0~UM*HS*I*1*11:B~HCR*CT~DTP*AAH*D8*20230802~HI*ABK:C34.32~MSG*System cannot process determination due to missing required fields (procedure code(s))~NM1*SJ*2*Demo Hospital*****XX*1234567890~NM1*DN*2*Demo Hospital*****XX*1234567890~REF*ZH*123456789~SE*21*633036131~GE*1*633036131~IEA*1*633036131~",
"json": {
"submitterTransactionIdentifier": "1402448037",
"payerId": "INQDEMO",
"payerName": "INQDEMO",
"umClearingHouseId": "943207296",
"umRequestValidation": null,
"requester": {
"requesterType": "1P",
"organizationName": "Demo Hospital",
"requesterIdentification": {
"employerIdentificationNumber": "123456789"
},
"npi": "1234567890"
},
"subscriber": {
"lastName": "DOE",
"firstName": "JOE",
"memberId": "TST1",
"dateOfBirth": "19010101",
"supplementalIdentification": {
"groupNumber": "00000000"
}
},
"dependent": {
"supplementalIdentification": {}
},
"patientEventDetail": {
"requestCategoryCode": "HS",
"certificationTypeCode": "I",
"serviceTypeCode": "1",
"facilityTypeCode": "11",
"facilityCodeQualifier": "B",
"certificationActionCode": "CT",
"eventDateBegin": "20230802",
"diagnosisTypeCode": "ABK",
"diagnosisCode": "C34.32",
"freeFormMessageText": "System cannot process determination due to missing required fields (procedure code(s))",
"patientEventProviderName": [
{
"entityIdentifierCode": "SJ",
"organizationName": "Demo Hospital",
"identificationCodeQualifier": "XX",
"identifier": "1234567890",
"providerSupplementalInformation": {}
},
{
"entityIdentifierCode": "DN",
"organizationName": "Demo Hospital",
"identificationCodeQualifier": "XX",
"identifier": "1234567890",
"providerSupplementalInformation": {
"carrierAssignedReferenceNumber": "123456789"
}
}
]
}
},
"payerPaths": [],
"determinationExceptions": []
},
"inquiry": {
"x12": "",
"json": {
"payerId": "",
"payerName": "",
"umClearingHouseId": "",
"umRequestValidation": null,
"requester": {
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},
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},
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}
}
}
{
"determination": {
"x12": "ISA*00* *00* *ZZ*INQDEMO *ZZ*201985AAS *260112*2153*^*00501*878006908*0*P*:~GS*HI*BCBSSC*201985AAS*20260112*215353*878006908*X*005010X215~ST*278*878006908*005010X215~BHT*0007*49*1234567890*20260112*215353*18~HL*1**20*1~NM1*PR*2*South Carolina Blue Cross Blue*****PI*BCBSSC~HL*2*1*21*1~NM1*1P*2*Regional Medical Center*****XX*1234567890~REF*EI*123456789~HL*3*2*22*1~NM1*IL*1*TEST*BRITTANY****MI*ZCS12345678~DMG*D8*19701231~HL*4*3*EV*1~UM*HS*I*1*11:B~HCR*CT~DTP*AAH*RD8*20231017-20231017~MSG*System cannot process determination due to missing required fields (procedure code(s))~NM1*SJ*1*TEST*STEVEN****XX*1234567890~SE*17*878006908~GE*1*878006908~IEA*1*878006908~",
"json": {
"submitterTransactionIdentifier": "1234567890",
"payerId": "BCBSSC",
"payerName": "South Carolina Blue Cross Blue",
"umClearingHouseId": "201985AAS",
"umRequestValidation": null,
"requester": {
"requesterType": "1P",
"organizationName": "Regional Medical Center",
"requesterIdentification": {
"employerIdentificationNumber": "123456789"
},
"npi": "1234567890"
},
"subscriber": {
"lastName": "TEST",
"firstName": "BRITTANY",
"memberId": "ZCS12345678",
"dateOfBirth": "19701231",
"supplementalIdentification": {}
},
"dependent": {
"supplementalIdentification": {}
},
"patientEventDetail": {
"requestCategoryCode": "HS",
"certificationTypeCode": "I",
"serviceTypeCode": "1",
"facilityTypeCode": "11",
"facilityCodeQualifier": "B",
"certificationActionCode": "CT",
"eventDateBegin": "20231017",
"eventDateEnd": "20231017",
"freeFormMessageText": "System cannot process determination due to missing required fields (procedure code(s))",
"patientEventProviderName": [
{
"entityIdentifierCode": "SJ",
"lastName": "TEST",
"firstName": "STEVEN",
"identificationCodeQualifier": "XX",
"identifier": "1234567890",
"providerSupplementalInformation": {}
}
]
}
},
"payerPaths": [],
"determinationExceptions": []
},
"inquiry": {
"x12": "",
"json": {
"payerId": "",
"payerName": "",
"umClearingHouseId": "",
"umRequestValidation": null,
"requester": {
"requesterIdentification": {}
},
"subscriber": {
"supplementalIdentification": {}
},
"dependent": {
"supplementalIdentification": {}
},
"patientEventDetail": {}
}
}
}
Updated 2 days ago