Determination Request Body

{
  "rhPayerId": "UHCDEMODV1",
  "planId": "41",
  "x12": "ISA*00*          *00*          *ZZ*943207296      *ZZ*INQAIMSPECHLTH *160610*1004*^*00501*686014818*0*P*:~GS*HI*943207296*INQAIMSPECHLTH*20160610*100457*306890113*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1201713193*20160610*100457~HL*1**20*1~NM1*PR*2*Health First Health Plan*****PI*HEALTHFIRSTFL~HL*2*1*21*1~NM1*1P*2*Medical Group*****XX*1164474276~REF*EI*461243081~N4*MELBOURNE*FL*32940-7955~PER*IC*ELIZABETH OWEN*EM*[email protected]~HL*3*2*22*1~NM1*IL*1*MYERS*EDWIN****MI*81060103800~REF*SY*285427924~DMG*D8*19450109~HL*4*3*EV*1~UM*HS*I*AG*12:B~DTP*AAH*D8*20160615~HI*BK:I49.3~NM1*SJ*2*MEDICAL CENTER*HOLMES REGIONAL****XX*1295702728~HL*5*4*SS*0~DTP*472*D8*20160615~SV1*HC:93016~HL*6*4*SS*0~DTP*472*D8*20160615~SV1*HC:93306~SE*25*0001~GE*1*306890113~IEA*1*686014818~"
}

{
  "senderId": "201985AAS",
  "submitterTransactionIdentifier": "1234567890",
  "payerId": "BCBSSC",
  "payerName": "South Carolina Blue Cross Blue",
  "umClearingHouseId": "000000000000001",
  "requester": {
    "requesterType": "1P",
    "organizationName": "Regional Medical Center",
    "lastName": "Regional Medical Center",
    "requesterIdentification": {
      "employerIdentificationNumber": "123456789"
    },
    "city": "Orangeburg",
    "state": "SC",
    "postalCode": "12345",
    "npi": "1234567890",
    "contactTelephone": "803-395-2200"
  },
  "subscriber": {
    "lastName": "TEST",
    "firstName": "BRITTANY",
    "memberId": "ZCS12345678",
    "dateOfBirth": "19701231",
    "supplementalIdentification": {
      "groupNumber": "123456789",
      "ssn": "111223333"
    }
  },
  "patientEventDetail": {
    "requestCategoryCode": "HS",
    "certificationTypeCode": "I",
    "serviceTypeCode": "1",
    "facilityTypeCode": "11",
    "facilityCodeQualifier": "B",
    "eventDateBegin": "20231017",
    "eventDateEnd": "20231017",
    "patientEventProviderName": [
      {
        "entityIdentifierCode": "SJ",
        "lastName": "TEST",
        "firstName": "STEVEN",
        "identificationCodeQualifier": "XX",
        "identifier": "1234567890"
      },
      {
        "entityIdentifierCode": "DN",
        "lastName": "TEST",
        "firstName": "STEVEN",
        "identificationCodeQualifier": "XX",
        "identifier": "1234567890"
      }
    ],
    "serviceLevel": [
      {
        "requestCategoryCode": "HS",
        "facilityTypeCode": "11",
        "facilityCodeQualifier": "B",
        "serviceDateBegin": "20231017",
        "serviceDateEnd": "20231017",
        "professionalService": {
          "productOrServiceIDQualifier": "HC",
          "procedureCode": "71260"
        }
      },
      {
        "requestCategoryCode": "HS",
        "facilityTypeCode": "11",
        "facilityCodeQualifier": "B",
        "serviceDateBegin": "20231017",
        "serviceDateEnd": "20231017",
        "professionalService": {
          "productOrServiceIDQualifier": "HC",
          "procedureCode": "74177"
        }
      }
    ]
  }
}