Submission Request Body

{ "portalUsername": "string", "portalPassword": "string", "x12": "ISA*00*4444 *00*5555 *ZZ*6546564 *ZZ*278R_2000E_A1 *0623 *1301*^*00501*000000001*0*T*:~GS*HI*FL0738*PERSEPVS*20090601*040612*1*X*005010X217~ST*278*0001*005010X217~BHT*0007*13*A12345*20050502*1101~HL*1**20*1~NM1*X3*2*MARYLAND CAPITAL INSURANCE COMPANY*****46*789312~HL*2*1*21*1~NM1*1P*1*GARDENER*JAMES****46*8189991234~HL*3*2*22*1~NM1*IL*1*SMITH*JOE****MI*12345678901~HL*4*3*EV*0~TRN*1*111099*9012345678~UM*SC*I*3*11:B*****Y~HI*BF:41090:D8:20050430~HSD*VS*1~NM1*SJ*1*WATSON*SUSAN****34*987654321~PER*IC**TE*4029993456~SE*16*0001~GE*1*1~IEA*1*000000001~" }

{ "senderId": "201985AAS", "submitterTransactionIdentifier": "1234567890", "payerId": "BCBSSC", "payerName": "South Carolina Blue Cross Blue", "umClearingHouseId": "INQNIA", "portalUsername": "portalUsername", "portalPassword": "portalPassword", "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" } } ] } }