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Submission Sandbox Test Responses

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Obtaining Sandbox Credentials 🆕

To access and test our APIs, create a sandbox account.

Receiver/Payer ID Test Responses

To assist testing your integration with the Prior Authorization Submission API, we have provided a number of test responses. To receive these mock responses, simply send your request body with a Clearinghouse ID.

For X12 requests, set a specific value in the ISA:08 element.
For JSON requests, set a specific value in the senderId and umClearingHouseId fields (same value in both fields).

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Important

The sandbox returns a canned response based on the senderId/umClearingHouseId. As such, these responses will not match the information in the request (i.e. different patients, services, etc. will be present in the response).

Below are the umClearingHouseId and their corresponding test responses. If a umClearingHouseId is sent that does not match one of the values below, an Unable to Respond at Current Time/senderId Unavailable response will be returned.

ISA08/umClearingHouseIdResponse
278_217_01_A1Certified in total (Affirmed Decision)
278_217_02_A2Certified - partial (Partially Affirmed Decision)
278_217_03_A3Not Certified (Non-Affirmed Decision)
278_217_04_A4Pended
278_217_05_A5Modified (Affirmed with Changes Decision)
278_217_06_CCanceled
AAA_217_07_73Invalid/Missing Subscriber/Insured Name

Example X12 request with a Certified in Total response (determined by ISA08):

X12

ISA*00*4444      *00*5555      *ZZ*6546564        *ZZ*278_217_01_A1  *0623  *1301*^*00501*000000001*0*T*:~GS*HI*FL0738*PERSEPVS*20090601*040612*1*X*005010X217~ST*278*0001*005010X217~BHT*0007*13*165932*20050502*1525~HL*1**20*1~NM1*X3*2*ABC PAYER*****PI*1234560010~HL*2*1*21*1~NM1*1P*1*XYZ AMBULANCE SVC*****24*7759621873~HL*3*2*22*1~NM1*IL*1*SMITH*JOE****MI*12345689001~REF*EJ*6532214A76~DMG*D8*19580322*M~HL*4*3*EV*1~UM*HS*I*56*41:B~DTP*AAH*D8*20050510~CRC*07*Y*09~CR1***X*D*DH*27***TRIP FROM HOME TO OFFICE VISIT TO DIALYSIS TREATMENT AND BACK HOME~NM1*PW*2*HOME~N3*8652 Starwood Lane~N4*SACRAMENTO*CA*95826~NM1*ND*2*DR. GARDNER OFFICE~N3*1921 FULTON AVENUE~N4*SACRAMENTO*CA*95624~NM1*R3*2*XYZ DIALYSIS CENTER~N3*7622 MORSETOWN ROAD~N4*SACRAMENTO*CA*95826~NM1*FS*2*HOME~N3*8652 STARWOOD LANE~N4*SACRAMENTO*CA*95826~HL*5*4*SS*0~SV1*HC:A0428:RX**UN*5~HL*6*5*SS*0~SV1*HC:A0428:PD**UN*8~HL*7*6*SS*0~SV1*HC:A0428:DR**UN*14~SE*34*0001~GE*1*1~IEA*1*000000001~

Example JSON request with a Not Certified response (determined by umClearingHouseId):

JSON

{
  "senderId": "201985AAS",
  "submitterTransactionIdentifier": "1234567890",
  "payerId": "BCBSSC",
  "payerName": "South Carolina Blue Cross Blue",
  "umClearingHouseId": "278_217_03_A3",
  "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"
        }
      }
    ]
  }
}

Updated about 15 hours ago