{"openapi":"3.0.3","info":{"title":"Prior Authorization v1","description":"","version":"1.1.0","contact":{"email":""}},"servers":[{"url":"https://sandbox-apigw.optum.com"},{"url":"/processor"}],"paths":{"/determination/x12":{"post":{"summary":"278x215 Prior Authorization Determination","description":"Prior authorization determination using 278x215 requests","tags":["Determination"],"parameters":[{"$ref":"#/components/parameters/x-optum-tenant-id"},{"$ref":"#/components/parameters/x-optum-correlation-id"}],"requestBody":{"description":"Authorization request","content":{"application/json":{"schema":{"$ref":"#/components/schemas/DeterminationX12Request"}}}},"responses":{"200":{"description":"Success","headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"},"transaction-id":{"$ref":"#/components/headers/transaction-id"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/DeterminationResponse"}}}},"400":{"$ref":"#/components/responses/400"},"401":{"$ref":"#/components/responses/401"},"403":{"$ref":"#/components/responses/403"},"500":{"$ref":"#/components/responses/500"}}}},"/determination":{"post":{"summary":"JSON Prior Authorization Determination","description":"Prior authorization determination using JSON requests","tags":["Determination"],"parameters":[{"$ref":"#/components/parameters/x-optum-tenant-id"},{"$ref":"#/components/parameters/x-optum-correlation-id"}],"requestBody":{"description":"Determination request","content":{"application/json":{"schema":{"$ref":"#/components/schemas/InquiryJSONRequestWithDetermination"},"examples":{"subscriber":{"$ref":"#/components/examples/UserInquiryRequestSubscriberWithDetermination"},"dependent":{"$ref":"#/components/examples/UserInquiryRequestDependentWithDetermination"}}}}},"responses":{"200":{"description":"Success","headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"},"transaction-id":{"$ref":"#/components/headers/transaction-id"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/DeterminationResponse"}}}},"400":{"$ref":"#/components/responses/400"},"401":{"$ref":"#/components/responses/401"},"403":{"$ref":"#/components/responses/403"},"500":{"$ref":"#/components/responses/500"}}}},"/inquiry/x12":{"post":{"summary":"278x215 Prior Authorization Inquiry","description":"Given a valid X12 278x215 request, the request will be submitted to the payer or clearing house and a 278 response returned.\n","tags":["Inquiry"],"parameters":[{"$ref":"#/components/parameters/x-optum-tenant-id"},{"$ref":"#/components/parameters/x-optum-correlation-id"}],"requestBody":{"description":"Authorization request","content":{"application/json":{"schema":{"$ref":"#/components/schemas/InquiryX12Request"}}}},"responses":{"200":{"description":"Success","headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"},"transaction-id":{"$ref":"#/components/headers/transaction-id"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/InquiryResponse"},"examples":{"subscriber":{"$ref":"#/components/examples/UserInquiryResponseSubscriber"},"dependent":{"$ref":"#/components/examples/UserInquiryResponseDependent"}}}}},"400":{"$ref":"#/components/responses/400"},"401":{"$ref":"#/components/responses/401"},"403":{"$ref":"#/components/responses/403"},"500":{"$ref":"#/components/responses/500"}}}},"/inquiry":{"post":{"summary":"JSON Prior Authorization Inquiry","description":"Given a valid JSON request, the request will be submitted to the payer or clearing house and a JSON response returned.\n","tags":["Inquiry"],"parameters":[{"$ref":"#/components/parameters/x-optum-tenant-id"},{"$ref":"#/components/parameters/x-optum-correlation-id"}],"requestBody":{"description":"Authorization request","content":{"application/json":{"schema":{"$ref":"#/components/schemas/InquiryJSONRequest"},"examples":{"subscriber":{"$ref":"#/components/examples/UserInquiryRequestSubscriber"},"dependent":{"$ref":"#/components/examples/UserInquiryRequestDependent"}}}}},"responses":{"200":{"description":"Success","headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"},"transaction-id":{"$ref":"#/components/headers/transaction-id"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/InquiryResponse"},"examples":{"subscriber":{"$ref":"#/components/examples/UserInquiryResponseSubscriber"},"dependent":{"$ref":"#/components/examples/UserInquiryResponseDependent"}}}}},"400":{"$ref":"#/components/responses/400"},"401":{"$ref":"#/components/responses/401"},"403":{"$ref":"#/components/responses/403"},"500":{"$ref":"#/components/responses/500"}}}},"/submission/x12":{"post":{"summary":"278x217 Prior Authorization Submission","description":"Prior authorization submission using EDI X12 278x217 requests","tags":["Submission"],"parameters":[{"$ref":"#/components/parameters/x-optum-tenant-id"},{"$ref":"#/components/parameters/x-optum-correlation-id"}],"requestBody":{"description":"Authorization Submission request","content":{"application/json":{"schema":{"$ref":"#/components/schemas/SubmissionX12Request"}}}},"responses":{"200":{"description":"Success","headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"},"transaction-id":{"$ref":"#/components/headers/transaction-id"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/SubmissionResponse"},"examples":{"subscriber":{"$ref":"#/components/examples/UserSubmissionResponseSubscriber"},"dependent":{"$ref":"#/components/examples/UserSubmissionResponseDependent"}}}}},"400":{"$ref":"#/components/responses/400"},"401":{"$ref":"#/components/responses/401"},"403":{"$ref":"#/components/responses/403"},"500":{"$ref":"#/components/responses/500"}}}},"/submission":{"post":{"summary":"JSON Prior Authorization Submission","description":"Prior authorization submission using JSON requests","tags":["Submission"],"parameters":[{"$ref":"#/components/parameters/x-optum-tenant-id"},{"$ref":"#/components/parameters/x-optum-correlation-id"}],"requestBody":{"description":"Authorization submission request","content":{"application/json":{"schema":{"$ref":"#/components/schemas/AuthorizationSubmissionJSON"},"examples":{"subscriber":{"$ref":"#/components/examples/UserSubmissionRequestSubscriber"},"dependent":{"$ref":"#/components/examples/UserSubmissionRequestDependent"}}}}},"responses":{"200":{"description":"Success","headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"},"transaction-id":{"$ref":"#/components/headers/transaction-id"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/SubmissionResponse"},"examples":{"subscriber":{"$ref":"#/components/examples/UserSubmissionResponseSubscriber"},"dependent":{"$ref":"#/components/examples/UserSubmissionResponseDependent"}}}}},"400":{"$ref":"#/components/responses/400"},"401":{"$ref":"#/components/responses/401"},"403":{"$ref":"#/components/responses/403"},"500":{"$ref":"#/components/responses/500"}}}},"/noa/x12":{"post":{"summary":"278x216 Prior Authorization Notice Of Admission","description":"Prior authorization noa using EDI X12 278x216 requests","tags":["Noa"],"parameters":[{"$ref":"#/components/parameters/x-optum-tenant-id"},{"$ref":"#/components/parameters/x-optum-correlation-id"}],"requestBody":{"description":"Authorization Noa request","content":{"application/json":{"schema":{"$ref":"#/components/schemas/NoaX12Request"}}}},"responses":{"200":{"description":"Success","headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"},"transaction-id":{"$ref":"#/components/headers/transaction-id"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/NoaResponse"},"examples":{"subscriber":{"$ref":"#/components/examples/UserNoaResponse"}}}}},"400":{"$ref":"#/components/responses/400"},"401":{"$ref":"#/components/responses/401"},"403":{"$ref":"#/components/responses/403"},"500":{"$ref":"#/components/responses/500"}}}},"/noa":{"post":{"summary":"JSON Notice of Admission","description":"Prior authorization notice of admission using JSON requests","tags":["Noa"],"parameters":[{"$ref":"#/components/parameters/x-optum-tenant-id"},{"$ref":"#/components/parameters/x-optum-correlation-id"}],"requestBody":{"description":"Authorization notice of admission request","content":{"application/json":{"schema":{"$ref":"#/components/schemas/AuthorizationNoaJSON"},"examples":{"subscriber":{"$ref":"#/components/examples/UserNoaRequest"}}}}},"responses":{"200":{"description":"Success","headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"},"transaction-id":{"$ref":"#/components/headers/transaction-id"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/NoaResponse"},"examples":{"subscriber":{"$ref":"#/components/examples/UserNoaResponse"}}}}},"400":{"$ref":"#/components/responses/400"},"401":{"$ref":"#/components/responses/401"},"403":{"$ref":"#/components/responses/403"},"500":{"$ref":"#/components/responses/500"}}}},"/authorization/x12":{"post":{"summary":"278x215 Prior Authorization Orchestration","description":"Prior authorization orchestration using EDI X12 278x215 requests","tags":["Authorization (Orchestration)"],"parameters":[{"$ref":"#/components/parameters/x-optum-tenant-id"},{"$ref":"#/components/parameters/x-optum-correlation-id"}],"requestBody":{"description":"Authorization request","content":{"application/json":{"schema":{"$ref":"#/components/schemas/AuthorizationX12Request"},"examples":{"required-and-not-required":{"$ref":"#/components/examples/X12OrchRequestTwoCodesOneRequired"},"required-with-split":{"$ref":"#/components/examples/X12OrchRequestTwoRequiredCodesWithSplit"},"no-procedure-codes":{"$ref":"#/components/examples/X12OrchRequestNoProcedureCodes"}}}}},"responses":{"200":{"description":"Success","headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"},"transaction-id":{"$ref":"#/components/headers/transaction-id"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/AuthorizationResponse"}}}},"400":{"$ref":"#/components/responses/400"},"401":{"$ref":"#/components/responses/401"},"403":{"$ref":"#/components/responses/403"},"500":{"$ref":"#/components/responses/500"}}}},"/authorization":{"post":{"summary":"JSON Prior Authorization Orchestration","description":"Prior authorization orchestration using JSON requests","tags":["Authorization (Orchestration)"],"parameters":[{"$ref":"#/components/parameters/x-optum-tenant-id"},{"$ref":"#/components/parameters/x-optum-correlation-id"}],"requestBody":{"description":"Authorization request","content":{"application/json":{"schema":{"$ref":"#/components/schemas/InquiryJSONRequestWithDetermination"},"examples":{"inquiry-split":{"$ref":"#/components/examples/OrchestrationJSONRequestWithSplit"},"single-requires-pa":{"$ref":"#/components/examples/OrchestrationJSONRequestOneRequired"},"none-require-pa":{"$ref":"#/components/examples/OrchestrationJSONRequestAuthNotRequired"}}}}},"responses":{"200":{"description":"Success","headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"},"transaction-id":{"$ref":"#/components/headers/transaction-id"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/AuthorizationResponse"}}}},"400":{"$ref":"#/components/responses/400"},"401":{"$ref":"#/components/responses/401"},"403":{"$ref":"#/components/responses/403"},"500":{"$ref":"#/components/responses/500"}}}},"/healthcheck":{"get":{"description":"Returns the health of the API","tags":["Health Check"],"summary":"Service heartbeat","responses":{"200":{"description":"Success"},"500":{"description":"Internal Server Error"}}}}},"components":{"headers":{"x-amzn-trace-id":{"description":"Generated traceId of the request","required":true,"example":"Root=1-61d7441a-56e4c77350687b5230e5707","schema":{"type":"string"}},"transaction-id":{"description":"Transaction Id of the request","required":true,"schema":{"type":"string","format":"uuid","example":"c9476bc2-b563-4555-9527-4afe9dccaf9a"}}},"schemas":{"InquiryX12Request":{"type":"object","properties":{"":{"type":"string"},"x12":{"type":"string","description":"EDI X12 278x215 Request","example":"ISA*00*          *00*          *ZZ*943207296      *ZZ*000000000000001*230810*1021*^*00501*916040697*0*P*:~GS*HI*943207296*INQHEALTHHELP*20230810*102137*3294199*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1402448037*20230810*102137~HL*1**20*1~NM1*PR*2*Humana*****PI*HUMANA~HL*2*1*21*1~NM1*1P*2*North Memorial Health*****XX*1851344907~REF*EI*410729979~N4*Robbinsdale*MN*55422~PER*IC**TE*7635814480*FX*7635814480~HL*3*2*22*1~NM1*IL*1*DOE*JOE****MI*H1111111~REF*6P*00000000~DMG*D8*19010101~HL*4*3*EV*0~UM*HS*I*1*11:B~DTP*AAH*D8*20230802~HI*ABK:C34.32~NM1*SJ*2*North Memorial Medical Center*****XX*1851344907~NM1*DN*2*North Memorial Medical Center*****XX*1851344907~REF*ZH*410729979~SE*21*0001~GE*1*3294199~IEA*1*916040697~"}}},"AuthorizationX12Request":{"type":"object","properties":{"rhPayerId":{"type":"string","description":"Global payer identifier used for determination","example":"UHCDEMODV1"},"planId":{"type":"string","description":"Payer plan identifier used for determination","example":41},"x12":{"type":"string","description":"EDI X12 278x215 Request","example":"ISA*00*          *00*          *ZZ*201985AAS      *ZZ*UHCDIRECT      *260220*2231*^*00501*310114548*0*P*:~GS*HI*201985AAS*UHCDIRECT*20260220*223147*549621530*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1234567890*20260220*223147~HL*1**20*1~NM1*PR*2*UHCDIRECT*****PI*UHCDIRECT~HL*2*1*21*1~NM1*1P*2*Regional Medical Center*****XX*1234567890~REF*EI*123456789~N4*Orangeburg*SC*12345~PER*IC**TE*803-555-2200~HL*3*2*22*1~NM1*IL*1*TEST*BRITTANY****MI*multi-01-approved~REF*6P*123456789~REF*SY*111223333~DMG*D8*19701231~HL*4*3*EV*1~UM*HS*I*1*11:B~DTP*AAH*RD8*20231017-20231017~NM1*SJ*1*TEST*STEVEN****XX*1234567890~NM1*DN*1*TEST*STEVEN****XX*1234567890~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:T1000~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:0214T~SE*28*0001~GE*1*549621530~IEA*1*310114548~"}}},"SubmissionX12Request":{"type":"object","properties":{"x12":{"type":"string","description":"EDI X12 278x217 Request","example":"ISA*00*4444      *00*5555      *ZZ*6546564        *ZZ*278_217_01     *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*1234567890~DMG*D8*19700101*M~HL*4*3*EV*1~UM*HS*I*56*41:B~DTP*AAH*D8*20250101~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*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*ND*2*DOCTOR OFFICE~N3*SOME AVENUE~N4*SACRAMENTO*CA*95624~NM1*R3*2*SOME DIALYSIS CENTER~N3*7622 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*FS*2*HOME~N3*123 SOME ROAD~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~"}}},"NoaX12Request":{"type":"object","properties":{"x12":{"type":"string","description":"EDI X12 278x216 Request","example":"ISA*00*          *00*          *ZZ*83825418A      *ZZ*IMNDIRECT      *260203*0815*^*00501*375720525*0*P*:~GS*HI*LRX1210001*MTEXE*20260203*0815*1234*X*005010X216~ST*278*0001*005010X216~BHT*0007*CN*222438911WEB*20260203*0815*NO~HL*1**20*1~NM1*FA*2*Benefis Health System*****XX*1881650737~PER*IC**TE*4064552959~HL*2*1*21*1~NM1*X3*2*AETNA*****PI*60054~HL*3*2*22*1~NM1*IL*1*LNAME*FNAME****MI*NOA-01-SUCCESS~REF*6P*0123456789012~DMG*D8*19700101~HL*4*3*EV*1~UM*AR*I*1*11:A~DTP*435*D8*20260101~HI*ABJ:N1330~MSG*AT=061500;ICD=N1330~NM1*71*1*SLATER*RICHARD****XX*1285928754~NM1*FA*2*Benefis Health System*****XX*1881650737~NM1*AAJ*1*SLATER*RICHARD****XX*1285928754~SE*20*0001~GE*1*1234~IEA*1*375720525~"}}},"DeterminationX12Request":{"type":"object","properties":{"rhPayerId":{"type":"string","description":"Global payer identifier used for determination","example":"UHCDEMODV1"},"planId":{"type":"string","description":"Payer plan identifier used for determination","example":41},"x12":{"type":"string","example":"ISA*00*          *00*          *ZZ*943207296      *ZZ*INQDEMO        *230810*1021*^*00501*916040697*0*P*:~GS*HI*943207296*INQDEMO*20230810*102137*3294199*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1402448037*20230810*102137~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~N4*Nashville*TN*12345~PER*IC**TE*1112223333*FX*2223334444~HL*3*2*22*1~NM1*IL*1*DOE*JOE****MI*TST1~REF*6P*00000000~DMG*D8*19010101~HL*4*3*EV*1~UM*HS*I*1*11:B~DTP*AAH*D8*20230802~HI*ABK:C34.32~NM1*SJ*2*Demo Hospital*****XX*1234567890~NM1*DN*2*Demo Hospital*****XX*1234567890~REF*ZH*123456789~HL*5*4*SS*0~DTP*472*D8*20160615~SV1*HC:70488~SE*24*0001~GE*1*3294199~IEA*1*916040697~"}}},"SimplifiedDeterminationRequest":{"type":"object","properties":{"rhPayerId":{"type":"string","example":"COMM112601"},"planId":{"type":"string","example":"6223"},"procedureCodes":{"type":"string","example":["0042T","Q5127"]}}},"SimplifiedDeterminationResponse":{"type":"array","items":{"$ref":"#/components/schemas/SimplifiedResponse"}},"SimplifiedResponse":{"type":"object","properties":{"authorizationRequired":{"type":"boolean"},"UMVendor":{"type":"string"},"payerCPID":{"type":"string"},"planName":{"type":"string"},"rhPayerId":{"type":"string"},"planId":{"type":"string"},"code":{"type":"string"},"exceptions":{"type":"string"},"externalRoute":{"type":"string"},"payerXrefStatus":{"type":"string"},"UMVendorXrefStatus":{"type":"string"}}},"AuthorizationSubmissionJSON":{"type":"object","properties":{"senderId":{"type":"string"},"submitterTransactionIdentifier":{"type":"string"},"payerId":{"type":"string"},"payerName":{"type":"string"},"umClearingHouseId":{"type":"string"},"requester":{"type":"object","properties":{"requesterType":{"type":"string"},"organizationName":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"requesterIdentification":{"type":"object","properties":{"providerUpinNumber":{"type":"string"},"facilityIdNumber":{"type":"string"},"employerIdentificationNumber":{"type":"string"},"providerSiteNumber":{"type":"string"},"providerPlanNetworkIdNumber":{"type":"string"},"facilityNetworkIdNumber":{"type":"string"},"socialSecurityNumber":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"}}},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"npi":{"type":"string"},"ssn":{"type":"string"},"servicesPlanID":{"type":"string"},"employersId":{"type":"string"},"etin":{"type":"string"},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"contactTelephoneExtension":{"type":"string"},"providerCode":{"type":"string"},"referenceIdentification":{"type":"string"}}},"subscriber":{"type":"object","properties":{"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"suffix":{"type":"string"},"memberId":{"type":"string"},"dateOfBirth":{"type":"string"},"genderCode":{"type":"string"},"supplementalIdentification":{"type":"object","properties":{"policyNumber":{"type":"string"},"branchIdentifier":{"type":"string"},"groupNumber":{"type":"string"},"departmentNumber":{"type":"string"},"patientAccountNumber":{"type":"string"},"healthInsuranceClaimNumber":{"type":"string"},"idCard":{"type":"string"},"insurancePolicyNumber":{"type":"string"},"planNetworkIdentificationNumber":{"type":"string"},"medicaidRecipientIdentificationNumber":{"type":"string"},"ssn":{"type":"string"}}},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"insuredIndicator":{"type":"string"},"militaryRelationship":{"type":"string"}}},"dependent":{"type":"object","properties":{"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"suffix":{"type":"string"},"dateOfBirth":{"type":"string"},"genderCode":{"type":"string"},"supplementalIdentification":{"type":"object","properties":{"patientAccountNumber":{"type":"string"},"ssn":{"type":"string"}}},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"insuredIndicator":{"type":"string"},"relationshipToInsuredCode":{"type":"string"},"birthSequenceNumber":{"type":"string"}}},"patientEventDetail":{"type":"object","properties":{"requestCategoryCode":{"type":"string"},"certificationTypeCode":{"type":"string"},"serviceTypeCode":{"type":"string"},"facilityTypeCode":{"type":"string"},"facilityCodeQualifier":{"type":"string"},"relatedCausesCode1":{"type":"string"},"relatedCausesCode2":{"type":"string"},"relatedCausesCode3":{"type":"string"},"stateCode":{"type":"string"},"countryCode":{"type":"string"},"levelOfServiceCode":{"type":"string"},"currentHealthConditionCode":{"type":"string"},"prognosisCode":{"type":"string"},"releaseOfInformationCode":{"type":"string"},"delayReasonCode":{"type":"string"},"previousReviewAuthorizationNumber":{"type":"string"},"previousAdministrativeReferenceNumber":{"type":"string"},"accidentDate":{"type":"string"},"lastMenstrualPeriodDate":{"type":"string"},"estimatedDateOfBirth":{"type":"string"},"onsetDate":{"type":"string"},"eventDateBegin":{"type":"string"},"eventDateEnd":{"type":"string"},"admissionDateBegin":{"type":"string"},"admissionDateEnd":{"type":"string"},"dischargeDate":{"type":"string"},"diagnosisTypeCode1":{"type":"string"},"diagnosisCode1":{"type":"string"},"diagnosisDate1":{"type":"string"},"diagnosisTypeCode2":{"type":"string"},"diagnosisCode2":{"type":"string"},"diagnosisDate2":{"type":"string"},"diagnosisTypeCode3":{"type":"string"},"diagnosisCode3":{"type":"string"},"diagnosisDate3":{"type":"string"},"diagnosisTypeCode4":{"type":"string"},"diagnosisCode4":{"type":"string"},"diagnosisDate4":{"type":"string"},"diagnosisTypeCode5":{"type":"string"},"diagnosisCode5":{"type":"string"},"diagnosisDate5":{"type":"string"},"diagnosisTypeCode6":{"type":"string"},"diagnosisCode6":{"type":"string"},"diagnosisDate6":{"type":"string"},"diagnosisTypeCode7":{"type":"string"},"diagnosisCode7":{"type":"string"},"diagnosisDate7":{"type":"string"},"diagnosisTypeCode8":{"type":"string"},"diagnosisCode8":{"type":"string"},"diagnosisDate8":{"type":"string"},"diagnosisTypeCode9":{"type":"string"},"diagnosisCode9":{"type":"string"},"diagnosisDate9":{"type":"string"},"diagnosisTypeCode10":{"type":"string"},"diagnosisCode10":{"type":"string"},"diagnosisDate10":{"type":"string"},"diagnosisTypeCode11":{"type":"string"},"diagnosisCode11":{"type":"string"},"diagnosisDate11":{"type":"string"},"diagnosisTypeCode12":{"type":"string"},"diagnosisCode12":{"type":"string"},"diagnosisDate12":{"type":"string"},"quantityQualifier":{"type":"string"},"serviceUnitCount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"sampleSelectionModulus":{"type":"string"},"timePeriodQualifier":{"type":"string"},"periodCount":{"type":"string"},"deliveryFrequencyCode":{"type":"string"},"deliveryPatternTimeCode":{"type":"string"},"ambulanceCertificationConditionIndicator":{"type":"string"},"ambulanceCertificationConditionCode1":{"type":"string"},"ambulanceCertificationConditionCode2":{"type":"string"},"ambulanceCertificationConditionCode3":{"type":"string"},"ambulanceCertificationConditionCode4":{"type":"string"},"ambulanceCertificationConditionCode5":{"type":"string"},"chiropracticCertificationConditionIndicator":{"type":"string"},"chiropracticCertificationConditionCode1":{"type":"string"},"chiropracticCertificationConditionCode2":{"type":"string"},"chiropracticCertificationConditionCode3":{"type":"string"},"chiropracticCertificationConditionCode4":{"type":"string"},"chiropracticCertificationConditionCode5":{"type":"string"},"durableMedicalEquipmentCertificationConditionIndicator":{"type":"string"},"durableMedicalEquipmentCertificationConditionCode1":{"type":"string"},"durableMedicalEquipmentCertificationConditionCode2":{"type":"string"},"durableMedicalEquipmentCertificationConditionCode3":{"type":"string"},"durableMedicalEquipmentCertificationConditionCode4":{"type":"string"},"durableMedicalEquipmentCertificationConditionCode5":{"type":"string"},"oxygenTherapyCertificationConditionIndicator":{"type":"string"},"oxygenTherapyCertificationConditionCode1":{"type":"string"},"oxygenTherapyCertificationConditionCode2":{"type":"string"},"oxygenTherapyCertificationConditionCode3":{"type":"string"},"oxygenTherapyCertificationConditionCode4":{"type":"string"},"oxygenTherapyCertificationConditionCode5":{"type":"string"},"functionalLimitationsCertificationConditionIndicator":{"type":"string"},"functionalLimitationsCertificationConditionCode1":{"type":"string"},"functionalLimitationsCertificationConditionCode2":{"type":"string"},"functionalLimitationsCertificationConditionCode3":{"type":"string"},"functionalLimitationsCertificationConditionCode4":{"type":"string"},"functionalLimitationsCertificationConditionCode5":{"type":"string"},"activitiesPermittedCertificationConditionIndicator":{"type":"string"},"activitiesPermittedCertificationConditionCode1":{"type":"string"},"activitiesPermittedCertificationConditionCode2":{"type":"string"},"activitiesPermittedCertificationConditionCode3":{"type":"string"},"activitiesPermittedCertificationConditionCode4":{"type":"string"},"activitiesPermittedCertificationConditionCode5":{"type":"string"},"mentalStatusCertificationConditionIndicator":{"type":"string"},"mentalStatusCertificationConditionCode1":{"type":"string"},"mentalStatusCertificationConditionCode2":{"type":"string"},"mentalStatusCertificationConditionCode3":{"type":"string"},"mentalStatusCertificationConditionCode4":{"type":"string"},"mentalStatusCertificationConditionCode5":{"type":"string"},"admissionToFacility":{"type":"object","properties":{"admissionTypeCode":{"type":"string"},"admissionSourceCode":{"type":"string"},"patientStatusCode":{"type":"string"},"nursingHomeResidentialStatusCode":{"type":"string"}}},"ambulanceTransport":{"type":"object","properties":{"patientWeight":{"type":"string"},"transportCode":{"type":"string"},"transportReasonCode":{"type":"string"},"transportDistance":{"type":"string"},"roundTripPurposeDescription":{"type":"string"},"stretcherPurposeDescription":{"type":"string"}}},"spinalManipulation":{"type":"object","properties":{"treatmentSeriesNumber":{"type":"string"},"treatmentCount":{"type":"string"},"subluxationBeginningLevelCode":{"type":"string"},"subluxationEndLevelCode":{"type":"string"},"patientConditionCode":{"type":"string"},"complicationIndicator":{"type":"string"},"patientConditionDescription1":{"type":"string"},"patientConditionDescription2":{"type":"string"},"xrayAvailabilityIndicator":{"type":"string"}}},"homeOxygenTherapyInformation":{"type":"object","properties":{"equipmentTypeCode1":{"type":"string"},"equipmentTypeCode2":{"type":"string"},"equipmentTypeCode3":{"type":"string"},"equipmentReasonDescription":{"type":"string"},"flowRate":{"type":"string"},"dailyUseCount":{"type":"string"},"usePeriodHourCount":{"type":"string"},"respiratoryTherapistOrderText":{"type":"string"},"arterialBloodGasQuantity":{"type":"string"},"saturationQuantity":{"type":"string"},"testConditionCode":{"type":"string"},"testFindingsCode1":{"type":"string"},"testFindingsCode2":{"type":"string"},"testFindingsCode3":{"type":"string"},"portableSystemFlowRate":{"type":"string"},"deliverySystemCode":{"type":"string"}}},"homeHealth":{"type":"object","properties":{"prognosisCode":{"type":"string"},"startDate":{"type":"string"},"certificationPeriodStartDate":{"type":"string"},"certificationPeriodEndDate":{"type":"string"},"medicareCoverageIndicator":{"type":"string"},"certificationTypeCode":{"type":"string"},"surgeryDate":{"type":"string"},"productOrServiceQualifier":{"type":"string"},"surgicalProcedureCode":{"type":"string"},"physicalOrderDate":{"type":"string"},"lastVisitDate":{"type":"string"},"physicianContactDate":{"type":"string"},"lastAdmissionPeriodStartDate":{"type":"string"},"lastAdmissionPeriodEndDate":{"type":"string"},"patientLocationCode":{"type":"string"}}},"attachments":{"type":"array","items":{"type":"object","properties":{"reportTypeCode":{"type":"string"},"transmissionCode":{"type":"string"},"controlNumber":{"type":"string"},"description":{"type":"string"}}}},"freeFormMessageText":{"type":"string"},"patientEventProviderName":{"type":"array","items":{"type":"object","properties":{"entityIdentifierCode":{"type":"string"},"organizationName":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"namePrefix":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"providerSupplementalInformation":{"type":"object","properties":{"stateLicenseNumber":{"type":"string"},"licenseNumberStateCode":{"type":"string"},"providerUpinNumber":{"type":"string"},"facilityIdNumber":{"type":"string"},"employersIdentificationNumber":{"type":"string"},"providerPlanNetworkIdentificationNumber":{"type":"string"},"facilityNetworkIdentificationNumber":{"type":"string"},"ssn":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"}}},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"contactTelephoneExtension":{"type":"string"},"providerCode":{"type":"string"},"providerTaxonomyCode":{"type":"string"}}}},"patientEventTransportInformation":{"type":"array","items":{"type":"object","properties":{"entityIdentifierCode":{"type":"string"},"transportLocationName":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"}}}},"patientEventOtherUmoName":{"type":"array","items":{"type":"object","properties":{"entityIdentifierCode":{"type":"string"},"otherUmoName":{"type":"string"},"otherUmoDenialReason1":{"type":"string"},"otherUmoDenialReason2":{"type":"string"},"otherUmoDenialReason3":{"type":"string"},"otherUmoDenialReason4":{"type":"string"},"otherUmoDenialDate":{"type":"string"}}}},"serviceLevel":{"type":"array","items":{"type":"object","properties":{"requestCategoryCode":{"type":"string"},"certificationTypeCode":{"type":"string"},"serviceTypeCode":{"type":"string"},"facilityTypeCode":{"type":"string"},"facilityCodeQualifier":{"type":"string"},"previousReviewAuthorizationNumber":{"type":"string"},"previousAdministrativeReferenceNumber":{"type":"string"},"serviceDateBegin":{"type":"string"},"serviceDateEnd":{"type":"string"},"professionalService":{"type":"object","properties":{"productOrServiceIDQualifier":{"type":"string"},"procedureCode":{"type":"string"},"procedureModifier1":{"type":"string"},"procedureModifier2":{"type":"string"},"procedureModifier3":{"type":"string"},"procedureModifier4":{"type":"string"},"procedureCodeDescription":{"type":"string"},"procedureCode2":{"type":"string"},"serviceLineAmount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"serviceUnitCount":{"type":"string"},"diagnosisCodePointer1":{"type":"string"},"diagnosisCodePointer2":{"type":"string"},"diagnosisCodePointer3":{"type":"string"},"diagnosisCodePointer4":{"type":"string"},"epsdtIndicator":{"type":"string"},"nursingHomeLevelOfCare":{"type":"string"}}},"institutionalService":{"type":"object","properties":{"serviceLineRevenueCode":{"type":"string"},"productOrServiceIDQualifier":{"type":"string"},"procedureCode":{"type":"string"},"procedureModifier1":{"type":"string"},"procedureModifier2":{"type":"string"},"procedureModifier3":{"type":"string"},"procedureModifier4":{"type":"string"},"procedureCodeDescription":{"type":"string"},"procedureCode2":{"type":"string"},"serviceLineAmount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"serviceUnitCount":{"type":"string"},"serviceLineRate":{"type":"string"},"nursingHomeResidentialStatusCode":{"type":"string"},"nursingHomeLevelOfCare":{"type":"string"}}},"dentalService":{"type":"object","properties":{"procedureCode":{"type":"string"},"procedureModifier1":{"type":"string"},"procedureModifier2":{"type":"string"},"procedureModifier3":{"type":"string"},"procedureModifier4":{"type":"string"},"procedureCodeDescription":{"type":"string"},"procedureCode2":{"type":"string"},"serviceLineAmount":{"type":"string"},"oralCavityDesignationCode":{"type":"string"},"oralCavityDesignationCode2":{"type":"string"},"oralCavityDesignationCode3":{"type":"string"},"oralCavityDesignationCode4":{"type":"string"},"oralCavityDesignationCode5":{"type":"string"},"prosthesisCrownOrInlayCode":{"type":"string"},"serviceUnitCount":{"type":"string"},"description":{"type":"string"}}},"toothInformation":{"type":"array","items":{"type":"object","properties":{"toothCode":{"type":"string"},"toothSurfaceCode1":{"type":"string"},"toothSurfaceCode2":{"type":"string"},"toothSurfaceCode3":{"type":"string"},"toothSurfaceCode4":{"type":"string"},"toothSurfaceCode5":{"type":"string"}}}},"healthCareServiceDelivery":{"type":"object","properties":{"quantityQualifier":{"type":"string"},"serviceQuantity":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"sampleSelectionModulus":{"type":"string"},"timePeriodQualifier":{"type":"string"},"periodCount":{"type":"string"},"deliveryFrequencyCode":{"type":"string"},"deliveryPatternTimeCode":{"type":"string"}}},"attachments":{"type":"array","items":{"type":"object","properties":{"reportTypeCode":{"type":"string"},"transmissionCode":{"type":"string"},"controlNumber":{"type":"string"},"description":{"type":"string"}}}},"freeFormMessageText":{"type":"string"},"serviceProviderName":{"type":"array","items":{"type":"object","properties":{"entityIdentifierCode":{"type":"string"},"organizationName":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"namePrefix":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"providerSupplementalInformation":{"type":"object","properties":{"stateLicenseNumber":{"type":"string"},"licenseNumberStateCode":{"type":"string"},"providerUpinNumber":{"type":"string"},"facilityIdNumber":{"type":"string"},"employersIdentificationNumber":{"type":"string"},"providerPlanNetworkIdentificationNumber":{"type":"string"},"facilityNetworkIdentificationNumber":{"type":"string"},"ssn":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"}}},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"providerCode":{"type":"string"},"providerTaxonomyCode":{"type":"string"}}}}}}}}}}},"AuthorizationNoaJSON":{"type":"object","properties":{"senderId":{"type":"string"},"submitterTransactionIdentifier":{"type":"string"},"payerId":{"type":"string"},"payerName":{"type":"string"},"umClearingHouseId":{"type":"string"},"requester":{"type":"object","properties":{"requesterType":{"type":"string"},"organizationName":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"requesterIdentification":{"type":"object","properties":{"providerUpinNumber":{"type":"string"},"facilityIdNumber":{"type":"string"},"employerIdentificationNumber":{"type":"string"},"providerSiteNumber":{"type":"string"},"providerPlanNetworkIdNumber":{"type":"string"},"facilityNetworkIdNumber":{"type":"string"},"socialSecurityNumber":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"}}},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"npi":{"type":"string"},"ssn":{"type":"string"},"servicesPlanID":{"type":"string"},"employersId":{"type":"string"},"etin":{"type":"string"},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"contactTelephoneExtension":{"type":"string"},"providerCode":{"type":"string"},"referenceIdentification":{"type":"string"}}},"subscriber":{"type":"object","properties":{"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"suffix":{"type":"string"},"memberId":{"type":"string"},"dateOfBirth":{"type":"string"},"genderCode":{"type":"string"},"supplementalIdentification":{"type":"object","properties":{"policyNumber":{"type":"string"},"branchIdentifier":{"type":"string"},"groupNumber":{"type":"string"},"departmentNumber":{"type":"string"},"patientAccountNumber":{"type":"string"},"healthInsuranceClaimNumber":{"type":"string"},"idCard":{"type":"string"},"insurancePolicyNumber":{"type":"string"},"planNetworkIdentificationNumber":{"type":"string"},"medicaidRecipientIdentificationNumber":{"type":"string"},"ssn":{"type":"string"}}},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"insuredIndicator":{"type":"string"},"militaryRelationship":{"type":"string"}}},"dependent":{"type":"object","properties":{"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"suffix":{"type":"string"},"dateOfBirth":{"type":"string"},"genderCode":{"type":"string"},"supplementalIdentification":{"type":"object","properties":{"patientAccountNumber":{"type":"string"},"ssn":{"type":"string"}}},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"insuredIndicator":{"type":"string"},"relationshipToInsuredCode":{"type":"string"},"birthSequenceNumber":{"type":"string"}}},"patientEventDetail":{"type":"object","properties":{"requestCategoryCode":{"type":"string"},"certificationTypeCode":{"type":"string"},"serviceTypeCode":{"type":"string"},"facilityTypeCode":{"type":"string"},"facilityCodeQualifier":{"type":"string"},"relatedCausesCode1":{"type":"string"},"relatedCausesCode2":{"type":"string"},"relatedCausesCode3":{"type":"string"},"stateCode":{"type":"string"},"countryCode":{"type":"string"},"levelOfServiceCode":{"type":"string"},"currentHealthConditionCode":{"type":"string"},"prognosisCode":{"type":"string"},"releaseOfInformationCode":{"type":"string"},"delayReasonCode":{"type":"string"},"previousReviewAuthorizationNumber":{"type":"string"},"previousAdministrativeReferenceNumber":{"type":"string"},"accidentDate":{"type":"string"},"lastMenstrualPeriodDate":{"type":"string"},"estimatedDateOfBirth":{"type":"string"},"onsetDate":{"type":"string"},"eventDateBegin":{"type":"string"},"eventDateEnd":{"type":"string"},"admissionDateBegin":{"type":"string"},"admissionDateEnd":{"type":"string"},"dischargeDate":{"type":"string"},"diagnosisTypeCode1":{"type":"string"},"diagnosisCode1":{"type":"string"},"diagnosisDate1":{"type":"string"},"diagnosisTypeCode2":{"type":"string"},"diagnosisCode2":{"type":"string"},"diagnosisDate2":{"type":"string"},"diagnosisTypeCode3":{"type":"string"},"diagnosisCode3":{"type":"string"},"diagnosisDate3":{"type":"string"},"diagnosisTypeCode4":{"type":"string"},"diagnosisCode4":{"type":"string"},"diagnosisDate4":{"type":"string"},"diagnosisTypeCode5":{"type":"string"},"diagnosisCode5":{"type":"string"},"diagnosisDate5":{"type":"string"},"diagnosisTypeCode6":{"type":"string"},"diagnosisCode6":{"type":"string"},"diagnosisDate6":{"type":"string"},"diagnosisTypeCode7":{"type":"string"},"diagnosisCode7":{"type":"string"},"diagnosisDate7":{"type":"string"},"diagnosisTypeCode8":{"type":"string"},"diagnosisCode8":{"type":"string"},"diagnosisDate8":{"type":"string"},"diagnosisTypeCode9":{"type":"string"},"diagnosisCode9":{"type":"string"},"diagnosisDate9":{"type":"string"},"diagnosisTypeCode10":{"type":"string"},"diagnosisCode10":{"type":"string"},"diagnosisDate10":{"type":"string"},"diagnosisTypeCode11":{"type":"string"},"diagnosisCode11":{"type":"string"},"diagnosisDate11":{"type":"string"},"diagnosisTypeCode12":{"type":"string"},"diagnosisCode12":{"type":"string"},"diagnosisDate12":{"type":"string"},"quantityQualifier":{"type":"string"},"serviceUnitCount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"sampleSelectionModulus":{"type":"string"},"timePeriodQualifier":{"type":"string"},"periodCount":{"type":"string"},"deliveryFrequencyCode":{"type":"string"},"deliveryPatternTimeCode":{"type":"string"},"ambulanceCertificationConditionIndicator":{"type":"string"},"ambulanceCertificationConditionCode1":{"type":"string"},"ambulanceCertificationConditionCode2":{"type":"string"},"ambulanceCertificationConditionCode3":{"type":"string"},"ambulanceCertificationConditionCode4":{"type":"string"},"ambulanceCertificationConditionCode5":{"type":"string"},"chiropracticCertificationConditionIndicator":{"type":"string"},"chiropracticCertificationConditionCode1":{"type":"string"},"chiropracticCertificationConditionCode2":{"type":"string"},"chiropracticCertificationConditionCode3":{"type":"string"},"chiropracticCertificationConditionCode4":{"type":"string"},"chiropracticCertificationConditionCode5":{"type":"string"},"durableMedicalEquipmentCertificationConditionIndicator":{"type":"string"},"durableMedicalEquipmentCertificationConditionCode1":{"type":"string"},"durableMedicalEquipmentCertificationConditionCode2":{"type":"string"},"durableMedicalEquipmentCertificationConditionCode3":{"type":"string"},"durableMedicalEquipmentCertificationConditionCode4":{"type":"string"},"durableMedicalEquipmentCertificationConditionCode5":{"type":"string"},"oxygenTherapyCertificationConditionIndicator":{"type":"string"},"oxygenTherapyCertificationConditionCode1":{"type":"string"},"oxygenTherapyCertificationConditionCode2":{"type":"string"},"oxygenTherapyCertificationConditionCode3":{"type":"string"},"oxygenTherapyCertificationConditionCode4":{"type":"string"},"oxygenTherapyCertificationConditionCode5":{"type":"string"},"functionalLimitationsCertificationConditionIndicator":{"type":"string"},"functionalLimitationsCertificationConditionCode1":{"type":"string"},"functionalLimitationsCertificationConditionCode2":{"type":"string"},"functionalLimitationsCertificationConditionCode3":{"type":"string"},"functionalLimitationsCertificationConditionCode4":{"type":"string"},"functionalLimitationsCertificationConditionCode5":{"type":"string"},"activitiesPermittedCertificationConditionIndicator":{"type":"string"},"activitiesPermittedCertificationConditionCode1":{"type":"string"},"activitiesPermittedCertificationConditionCode2":{"type":"string"},"activitiesPermittedCertificationConditionCode3":{"type":"string"},"activitiesPermittedCertificationConditionCode4":{"type":"string"},"activitiesPermittedCertificationConditionCode5":{"type":"string"},"mentalStatusCertificationConditionIndicator":{"type":"string"},"mentalStatusCertificationConditionCode1":{"type":"string"},"mentalStatusCertificationConditionCode2":{"type":"string"},"mentalStatusCertificationConditionCode3":{"type":"string"},"mentalStatusCertificationConditionCode4":{"type":"string"},"mentalStatusCertificationConditionCode5":{"type":"string"},"admissionToFacility":{"type":"object","properties":{"admissionTypeCode":{"type":"string"},"admissionSourceCode":{"type":"string"},"patientStatusCode":{"type":"string"},"nursingHomeResidentialStatusCode":{"type":"string"}}},"ambulanceTransport":{"type":"object","properties":{"patientWeight":{"type":"string"},"transportCode":{"type":"string"},"transportReasonCode":{"type":"string"},"transportDistance":{"type":"string"},"roundTripPurposeDescription":{"type":"string"},"stretcherPurposeDescription":{"type":"string"}}},"spinalManipulation":{"type":"object","properties":{"treatmentSeriesNumber":{"type":"string"},"treatmentCount":{"type":"string"},"subluxationBeginningLevelCode":{"type":"string"},"subluxationEndLevelCode":{"type":"string"},"patientConditionCode":{"type":"string"},"complicationIndicator":{"type":"string"},"patientConditionDescription1":{"type":"string"},"patientConditionDescription2":{"type":"string"},"xrayAvailabilityIndicator":{"type":"string"}}},"homeOxygenTherapyInformation":{"type":"object","properties":{"equipmentTypeCode1":{"type":"string"},"equipmentTypeCode2":{"type":"string"},"equipmentTypeCode3":{"type":"string"},"equipmentReasonDescription":{"type":"string"},"flowRate":{"type":"string"},"dailyUseCount":{"type":"string"},"usePeriodHourCount":{"type":"string"},"respiratoryTherapistOrderText":{"type":"string"},"arterialBloodGasQuantity":{"type":"string"},"saturationQuantity":{"type":"string"},"testConditionCode":{"type":"string"},"testFindingsCode1":{"type":"string"},"testFindingsCode2":{"type":"string"},"testFindingsCode3":{"type":"string"},"portableSystemFlowRate":{"type":"string"},"deliverySystemCode":{"type":"string"}}},"homeHealth":{"type":"object","properties":{"prognosisCode":{"type":"string"},"startDate":{"type":"string"},"certificationPeriodStartDate":{"type":"string"},"certificationPeriodEndDate":{"type":"string"},"medicareCoverageIndicator":{"type":"string"},"certificationTypeCode":{"type":"string"},"surgeryDate":{"type":"string"},"productOrServiceQualifier":{"type":"string"},"surgicalProcedureCode":{"type":"string"},"physicalOrderDate":{"type":"string"},"lastVisitDate":{"type":"string"},"physicianContactDate":{"type":"string"},"lastAdmissionPeriodStartDate":{"type":"string"},"lastAdmissionPeriodEndDate":{"type":"string"},"patientLocationCode":{"type":"string"}}},"attachments":{"type":"array","items":{"type":"object","properties":{"reportTypeCode":{"type":"string"},"transmissionCode":{"type":"string"},"controlNumber":{"type":"string"},"description":{"type":"string"}}}},"freeFormMessageText":{"type":"string"},"patientEventProviderName":{"type":"array","items":{"type":"object","properties":{"entityIdentifierCode":{"type":"string"},"organizationName":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"namePrefix":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"providerSupplementalInformation":{"type":"object","properties":{"stateLicenseNumber":{"type":"string"},"licenseNumberStateCode":{"type":"string"},"providerUpinNumber":{"type":"string"},"facilityIdNumber":{"type":"string"},"employersIdentificationNumber":{"type":"string"},"providerPlanNetworkIdentificationNumber":{"type":"string"},"facilityNetworkIdentificationNumber":{"type":"string"},"ssn":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"}}},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"contactTelephoneExtension":{"type":"string"},"providerCode":{"type":"string"},"providerTaxonomyCode":{"type":"string"}}}},"patientEventTransportInformation":{"type":"array","items":{"type":"object","properties":{"entityIdentifierCode":{"type":"string"},"transportLocationName":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"}}}},"patientEventOtherUmoName":{"type":"array","items":{"type":"object","properties":{"entityIdentifierCode":{"type":"string"},"otherUmoName":{"type":"string"},"otherUmoDenialReason1":{"type":"string"},"otherUmoDenialReason2":{"type":"string"},"otherUmoDenialReason3":{"type":"string"},"otherUmoDenialReason4":{"type":"string"},"otherUmoDenialDate":{"type":"string"}}}},"serviceLevel":{"type":"array","items":{"type":"object","properties":{"requestCategoryCode":{"type":"string"},"certificationTypeCode":{"type":"string"},"serviceTypeCode":{"type":"string"},"facilityTypeCode":{"type":"string"},"facilityCodeQualifier":{"type":"string"},"previousReviewAuthorizationNumber":{"type":"string"},"previousAdministrativeReferenceNumber":{"type":"string"},"serviceDateBegin":{"type":"string"},"serviceDateEnd":{"type":"string"},"professionalService":{"type":"object","properties":{"productOrServiceIDQualifier":{"type":"string"},"procedureCode":{"type":"string"},"procedureModifier1":{"type":"string"},"procedureModifier2":{"type":"string"},"procedureModifier3":{"type":"string"},"procedureModifier4":{"type":"string"},"procedureCodeDescription":{"type":"string"},"procedureCode2":{"type":"string"},"serviceLineAmount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"serviceUnitCount":{"type":"string"},"diagnosisCodePointer1":{"type":"string"},"diagnosisCodePointer2":{"type":"string"},"diagnosisCodePointer3":{"type":"string"},"diagnosisCodePointer4":{"type":"string"},"epsdtIndicator":{"type":"string"},"nursingHomeLevelOfCare":{"type":"string"}}},"institutionalService":{"type":"object","properties":{"serviceLineRevenueCode":{"type":"string"},"productOrServiceIDQualifier":{"type":"string"},"procedureCode":{"type":"string"},"procedureModifier1":{"type":"string"},"procedureModifier2":{"type":"string"},"procedureModifier3":{"type":"string"},"procedureModifier4":{"type":"string"},"procedureCodeDescription":{"type":"string"},"procedureCode2":{"type":"string"},"serviceLineAmount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"serviceUnitCount":{"type":"string"},"serviceLineRate":{"type":"string"},"nursingHomeResidentialStatusCode":{"type":"string"},"nursingHomeLevelOfCare":{"type":"string"}}},"dentalService":{"type":"object","properties":{"procedureCode":{"type":"string"},"procedureModifier1":{"type":"string"},"procedureModifier2":{"type":"string"},"procedureModifier3":{"type":"string"},"procedureModifier4":{"type":"string"},"procedureCodeDescription":{"type":"string"},"procedureCode2":{"type":"string"},"serviceLineAmount":{"type":"string"},"oralCavityDesignationCode":{"type":"string"},"oralCavityDesignationCode2":{"type":"string"},"oralCavityDesignationCode3":{"type":"string"},"oralCavityDesignationCode4":{"type":"string"},"oralCavityDesignationCode5":{"type":"string"},"prosthesisCrownOrInlayCode":{"type":"string"},"serviceUnitCount":{"type":"string"},"description":{"type":"string"}}},"toothInformation":{"type":"array","items":{"type":"object","properties":{"toothCode":{"type":"string"},"toothSurfaceCode1":{"type":"string"},"toothSurfaceCode2":{"type":"string"},"toothSurfaceCode3":{"type":"string"},"toothSurfaceCode4":{"type":"string"},"toothSurfaceCode5":{"type":"string"}}}},"healthCareServiceDelivery":{"type":"object","properties":{"quantityQualifier":{"type":"string"},"serviceQuantity":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"sampleSelectionModulus":{"type":"string"},"timePeriodQualifier":{"type":"string"},"periodCount":{"type":"string"},"deliveryFrequencyCode":{"type":"string"},"deliveryPatternTimeCode":{"type":"string"}}},"attachments":{"type":"array","items":{"type":"object","properties":{"reportTypeCode":{"type":"string"},"transmissionCode":{"type":"string"},"controlNumber":{"type":"string"},"description":{"type":"string"}}}},"freeFormMessageText":{"type":"string"},"serviceProviderName":{"type":"array","items":{"type":"object","properties":{"entityIdentifierCode":{"type":"string"},"organizationName":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"namePrefix":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"providerSupplementalInformation":{"type":"object","properties":{"stateLicenseNumber":{"type":"string"},"licenseNumberStateCode":{"type":"string"},"providerUpinNumber":{"type":"string"},"facilityIdNumber":{"type":"string"},"employersIdentificationNumber":{"type":"string"},"providerPlanNetworkIdentificationNumber":{"type":"string"},"facilityNetworkIdentificationNumber":{"type":"string"},"ssn":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"}}},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"providerCode":{"type":"string"},"providerTaxonomyCode":{"type":"string"}}}}}}}}}}},"RecheckRequest":{"type":"object","properties":{"recheckFrequency":{"description":"(Optional) How often re-checkable records are considered","type":"integer","example":12,"default":12},"recheckPeriodBackoff":{"description":"(Optional) Given a recheck_batch_date, how long has it been since this has last been rechecked","type":"integer","example":2,"default":2},"dosProximity":{"description":"(Optional) When we are within this proximity to date of service, the frequency changes to dos-proximity-recheck-freq","type":"integer","example":3},"dosProximityRecheckFrequency":{"description":"(Optional) This is the frequency at which we recheck when we are within dos-proximity of the date of service","type":"integer","example":3,"default":3}}},"InquiryJSONRequest":{"type":"object","properties":{"senderId":{"type":"string"},"submitterTransactionIdentifier":{"type":"string"},"payerId":{"type":"string"},"payerName":{"type":"string"},"umClearingHouseId":{"type":"string"},"requester":{"type":"object","properties":{"requesterType":{"type":"string"},"organizationName":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"requesterIdentification":{"type":"object","properties":{"providerUpinNumber":{"type":"string"},"facilityIdNumber":{"type":"string"},"employerIdentificationNumber":{"type":"string"},"providerSiteNumber":{"type":"string"},"providerPlanNetworkIdNumber":{"type":"string"},"facilityNetworkIdNumber":{"type":"string"},"socialSecurityNumber":{"type":"string"},"federalTaxpayerIdentificationNumber":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"}}},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"npi":{"type":"string"},"payorId":{"type":"string"},"ssn":{"type":"string"},"servicesPlanID":{"type":"string"},"employersId":{"type":"string"},"etin":{"type":"string"},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"contactTelephoneExtension":{"type":"string"},"providerCode":{"type":"string"},"referenceIdentification":{"type":"string"}}},"subscriber":{"type":"object","properties":{"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"suffix":{"type":"string"},"memberId":{"type":"string"},"dateOfBirth":{"type":"string"},"supplementalIdentification":{"type":"object","properties":{"policyNumber":{"type":"string"},"branchIdentifier":{"type":"string"},"groupNumber":{"type":"string"},"departmentNumber":{"type":"string"},"patientAccountNumber":{"type":"string"},"healthInsuranceClaimNumber":{"type":"string"},"idCard":{"type":"string"},"insurancePolicyNumber":{"type":"string"},"planNetworkIdentificationNumber":{"type":"string"},"medicaidRecipientIdentificationNumber":{"type":"string"},"ssn":{"type":"string"}}}}},"dependent":{"type":"object","properties":{"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"suffix":{"type":"string"},"dateOfBirth":{"type":"string"},"supplementalIdentification":{"type":"object","properties":{"employeeIdentificationNumber":{"type":"string"},"patientAccountNumber":{"type":"string"},"ssn":{"type":"string"}}}}},"patientEventDetail":{"type":"object","properties":{"requestCategoryCode":{"type":"string"},"certificationTypeCode":{"type":"string"},"serviceTypeCode":{"type":"string"},"facilityTypeCode":{"type":"string"},"facilityCodeQualifier":{"type":"string"},"certificationActionCode":{"type":"string"},"previousReviewAuthorizationNumber":{"type":"string"},"previousAdministrativeReferenceNumber":{"type":"string"},"accidentDate":{"type":"string"},"eventDateBegin":{"type":"string"},"eventDateEnd":{"type":"string"},"admissionDateBegin":{"type":"string"},"admissionDateEnd":{"type":"string"},"dischargeDate":{"type":"string"},"certificationIssueDateBegin":{"type":"string"},"certificationIssueDateEnd":{"type":"string"},"certificationExpirationDateBegin":{"type":"string"},"certificationExpirationDateEnd":{"type":"string"},"certificationEffectiveDateBegin":{"type":"string"},"certificationEffectiveDateEnd":{"type":"string"},"healthCareServicesReviewRequestDate":{"type":"string"},"diagnosisTypeCode":{"type":"string"},"diagnosisCode":{"type":"string"},"patientEventProviderName":{"type":"array","items":{"type":"object","properties":{"entityIdentifierCode":{"type":"string"},"organizationName":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"namePrefix":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"providerSupplementalInformation":{"type":"object","properties":{"stateLicenseNumber":{"type":"string"},"licenseNumberStateCode":{"type":"string"},"providerUpinNumber":{"type":"string"},"facilityIdNumber":{"type":"string"},"employersIdentificationNumber":{"type":"string"},"providerPlanNetworkIdentificationNumber":{"type":"string"},"facilityNetworkIdentificationNumber":{"type":"string"},"ssn":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"}}},"providerCode":{"type":"string"},"providerTaxonomyCode":{"type":"string"}}}},"serviceLevel":{"type":"array","items":{"type":"object","properties":{"requestCategoryCode":{"type":"string"},"certificationTypeCode":{"type":"string"},"serviceTypeCode":{"type":"string"},"facilityTypeCode":{"type":"string"},"facilityCodeQualifier":{"type":"string"},"certificationActionCode":{"type":"string"},"previousReviewAuthorizationNumber":{"type":"string"},"previousAdministrativeReferenceNumber":{"type":"string"},"serviceDateBegin":{"type":"string"},"serviceDateEnd":{"type":"string"},"certificationIssueDateBegin":{"type":"string"},"certificationIssueDateEnd":{"type":"string"},"certificationExpirationDateBegin":{"type":"string"},"certificationExpirationDateEnd":{"type":"string"},"certificationEffectiveDateBegin":{"type":"string"},"certificationEffectiveDateEnd":{"type":"string"},"professionalService":{"type":"object","properties":{"productOrServiceIDQualifier":{"type":"string"},"procedureCode":{"type":"string"},"procedureCode2":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"serviceUnitCount":{"type":"string"}}},"institutionalService":{"type":"object","properties":{"serviceLineRevenueCode":{"type":"string"},"productOrServiceIDQualifier":{"type":"string"},"procedureCode":{"type":"string"},"procedureCode2":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"serviceUnitCount":{"type":"string"}}},"dentalService":{"type":"object","properties":{"procedureCode":{"type":"string"},"procedureCode2":{"type":"string"},"americanDentalAssociationCodes":{"type":"string"},"prosthesisCrownOrInlayCode":{"type":"string"},"serviceUnitCount":{"type":"string"}}},"toothInformation":{"type":"object","properties":{"toothCode":{"type":"string"},"toothSurfaceCode":{"type":"string"}}},"serviceProviderName":{"type":"array","items":{"type":"object","properties":{"entityIdentifierCode":{"type":"string"},"organizationName":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"namePrefix":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"providerSupplementalInformation":{"type":"object","properties":{"stateLicenseNumber":{"type":"string"},"licenseNumberStateCode":{"type":"string"},"providerUpinNumber":{"type":"string"},"facilityIdNumber":{"type":"string"},"employersIdentificationNumber":{"type":"string"},"providerSiteNumber":{"type":"string"},"providerPlanNetworkIdentificationNumber":{"type":"string"},"facilityNetworkIdentificationNumber":{"type":"string"},"ssn":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"}}},"providerCode":{"type":"string"},"providerTaxonomyCode":{"type":"string"}}}}}}}}}}},"ExecuteDeterminationRulesRequest":{"type":"object","properties":{"globalPayerId":{"type":"string","example":"UHCDEMODV1"},"filePath":{"type":"string","example":"Authorization/Global"},"payerId":{"type":"string","example":"UHC"},"planId":{"type":"string","example":"41"},"billingFacility":{"type":"string","example":"MED1"},"dateOfService":{"type":"string","example":"2006-01-02"},"dataSource":{"type":"string","example":"EMR"},"groupNumber":{"type":"string","example":"0000000000"},"patientType":{"type":"string","example":"InPatient"},"serviceCode":{"type":"string","example":"86"},"policyNumber":{"type":"string","example":"0000001"},"dateOfBirth":{"type":"string","example":"2001-01-30"},"procedureCodes":{"type":"string","example":["0200T","Q5127"]},"diagnosisCodes":{"type":"string","example":["M80.88XA"]}}},"InquiryJSONRequestWithDetermination":{"allOf":[{"$ref":"#/components/schemas/InquiryJSONRequest"},{"type":"object","properties":{"rhPayerId":{"type":"string","description":"Global payer identifier used for determination","example":"UHCDEMODV1"},"planId":{"type":"string","description":"Payer plan identifier used for determination","example":"41"}}}]},"AuthorizationResponse":{"type":"object","properties":{"authorizationId":{"type":"string"},"determination":{"type":"object","properties":{"x12":{"type":"string"},"json":{"$ref":"#/components/schemas/AuthorizationJSONResponse"}}},"inquiry":{"type":"array","maxItems":100,"items":{"type":"object","properties":{"x12":{"type":"string"},"json":{"$ref":"#/components/schemas/AuthorizationJSONResponse"}}}}}},"DeterminationResponse":{"type":"object","properties":{"determination":{"type":"object","properties":{"x12":{"type":"string"},"json":{"$ref":"#/components/schemas/AuthorizationJSONResponse"}}}}},"InquiryResponse":{"type":"object","properties":{"authorizationId":{"type":"string"},"inquiry":{"type":"object","properties":{"x12":{"type":"string"},"json":{"$ref":"#/components/schemas/AuthorizationJSONResponse"}}}}},"SubmissionResponse":{"type":"object","properties":{"authorizationId":{"type":"string"},"submission":{"type":"object","properties":{"x12":{"type":"string"},"json":{"$ref":"#/components/schemas/SubmissionJSONResponse"}}}}},"SubmissionJSONResponse":{"type":"object","properties":{"requestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"submitterTransactionIdentifier":{"type":"string"},"payerId":{"type":"string"},"payerName":{"type":"string"},"umClearingHouseId":{"type":"string"},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"umRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"requester":{"type":"object","properties":{"requesterRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"requesterType":{"type":"string"},"organizationName":{"type":"string"},"firstName":{"type":"string"},"requesterIdentification":{"type":"object","properties":{"facilityIdNumber":{"type":"string"},"socialSecurityNumber":{"type":"string"}}},"npi":{"type":"string"},"providerCode":{"type":"string"},"referenceIdentification":{"type":"string"}}},"subscriber":{"type":"object","properties":{"subscriberRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"prefix":{"type":"string"},"suffix":{"type":"string"},"memberId":{"type":"string"},"dateOfBirth":{"type":"string"},"genderCode":{"type":"string"},"supplementalIdentification":{"type":"object","properties":{"medicaidRecipientIdentificationNumber":{"type":"string"},"ssn":{"type":"string"}}},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"insuredIndicator":{"type":"string"},"militaryRelationship":{"type":"string"}}},"dependent":{"type":"object","properties":{"dependentRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"suffix":{"type":"string"},"dateOfBirth":{"type":"string"},"genderCode":{"type":"string"},"supplementalIdentification":{"type":"object","properties":{"patientAccountNumber":{"type":"string"},"ssn":{"type":"string"}}},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"insuredIndicator":{"type":"string"},"relationshipToInsuredCode":{"type":"string"},"birthSequenceNumber":{"type":"string"}}},"patientEventDetail":{"type":"object","properties":{"patientEventRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"requestCategoryCode":{"type":"string"},"certificationTypeCode":{"type":"string"},"serviceTypeCode":{"type":"string"},"facilityTypeCode":{"type":"string"},"facilityCodeQualifier":{"type":"string"},"levelOfServiceCode":{"type":"string"},"certificationActionCode":{"type":"string"},"reviewIdentificationNumber":{"type":"string"},"reviewDecisionReasonCode":{"type":"string"},"secondSurgicalOpinionIndicator":{"type":"string"},"administrativeReferenceNumber":{"type":"string"},"previousReviewAuthorizationNumber":{"type":"string"},"accidentDate":{"type":"string"},"lastMenstrualPeriodDate":{"type":"string"},"estimatedDateOfBirth":{"type":"string"},"onsetOfCurrentSymptomsOrIllnessDate":{"type":"string"},"eventDateBegin":{"type":"string"},"eventDateEnd":{"type":"string"},"admissionDateBegin":{"type":"string"},"admissionDateEnd":{"type":"string"},"dischargeDate":{"type":"string"},"certificationIssueDate":{"type":"string"},"certificationExpirationDate":{"type":"string"},"certificationEffectiveDateBegin":{"type":"string"},"certificationEffectiveDateEnd":{"type":"string"},"diagnosisTypeCode1":{"type":"string"},"diagnosisCode1":{"type":"string"},"diagnosisDate1":{"type":"string"},"diagnosisTypeCode2":{"type":"string"},"diagnosisCode2":{"type":"string"},"diagnosisDate2":{"type":"string"},"diagnosisTypeCode3":{"type":"string"},"diagnosisCode3":{"type":"string"},"diagnosisDate3":{"type":"string"},"diagnosisTypeCode4":{"type":"string"},"diagnosisCode4":{"type":"string"},"diagnosisDate4":{"type":"string"},"diagnosisTypeCode5":{"type":"string"},"diagnosisCode5":{"type":"string"},"diagnosisDate5":{"type":"string"},"diagnosisTypeCode6":{"type":"string"},"diagnosisCode6":{"type":"string"},"diagnosisDate6":{"type":"string"},"diagnosisTypeCode7":{"type":"string"},"diagnosisCode7":{"type":"string"},"diagnosisDate7":{"type":"string"},"diagnosisTypeCode8":{"type":"string"},"diagnosisCode8":{"type":"string"},"diagnosisDate8":{"type":"string"},"diagnosisTypeCode9":{"type":"string"},"diagnosisCode9":{"type":"string"},"diagnosisDate9":{"type":"string"},"diagnosisTypeCode10":{"type":"string"},"diagnosisCode10":{"type":"string"},"diagnosisDate10":{"type":"string"},"diagnosisTypeCode11":{"type":"string"},"diagnosisCode11":{"type":"string"},"diagnosisDate11":{"type":"string"},"diagnosisTypeCode12":{"type":"string"},"diagnosisCode12":{"type":"string"},"diagnosisDate12":{"type":"string"},"quantityQualifier":{"type":"string"},"serviceUnitCount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"sampleSelectionModulus":{"type":"string"},"timePeriodQualifier":{"type":"string"},"periodCount":{"type":"string"},"deliveryFrequencyCode":{"type":"string"},"deliveryPatternTimeCode":{"type":"string"},"institutionalAdmissionTypeCode":{"type":"string"},"institutionalAdmissionSourceCode":{"type":"string"},"institutionalPatientStatusCode":{"type":"string"},"ambulanceTransportCode":{"type":"string"},"ambulanceUnitOrBasisForMeasurementCode":{"type":"string"},"ambulanceTransportDistance":{"type":"string"},"spinalManipulationTreatmentSeriesNumber":{"type":"string"},"spinalManipulationTreatmentCount":{"type":"string"},"spinalManipulationSubluxationLevelCode":{"type":"string"},"spinalManipulationSubluxationLevelCode2":{"type":"string"},"oxygenEquipmentTypeCode":{"type":"string"},"oxygenEquipmentTypeCode2":{"type":"string"},"oxygenFlowRate":{"type":"string"},"dailyOxygenUseCount":{"type":"string"},"oxygenUsePeriodHourCount":{"type":"string"},"respiratoryTherapistOrderText":{"type":"string"},"portableOxygenSystemFlowRate":{"type":"string"},"oxygenDeliverySystemCode":{"type":"string"},"oxygenSystemTypeCode":{"type":"string"},"homeHealthPrognosisCode":{"type":"string"},"homeHealthStartDate":{"type":"string"},"homeHealthCertificationPeriodStartDate":{"type":"string"},"homeHealthMedicareCoverageIndicator":{"type":"string"},"homeHealthCertificationTypeCode":{"type":"string"},"attachments":{"type":"array","items":{"type":"object","properties":{"reportTypeCode":{"type":"string"},"transmissionCode":{"type":"string"},"controlNumber":{"type":"string"},"description":{"type":"string"}}}},"freeFormMessageText":{"type":"string"},"patientEventProviderName":{"type":"array","items":{"type":"object","properties":{"patientEventProviderRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"entityIdentifierCode":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"namePrefix":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"providerSupplementalInformation":{"type":"object","properties":{"ssn":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"}}},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"providerCode":{"type":"string"},"providerTaxonomyCode":{"type":"string"}}}},"patientEventAdditionalPatientInformationContactName":{"type":"array","items":{"type":"object","properties":{"organizationName":{"type":"string"},"middleName":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"}}}},"patientEventTransportInformation":{"type":"array","items":{"type":"object","properties":{"patientEventTransportInformationValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"entityIdentifierCode":{"type":"string"},"transportLocationName":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"}}}},"serviceLevel":{"type":"array","items":{"type":"object","properties":{"serviceRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"requestCategoryCode":{"type":"string"},"certificationTypeCode":{"type":"string"},"serviceTypeCode":{"type":"string"},"facilityTypeCode":{"type":"string"},"facilityCodeQualifier":{"type":"string"},"certificationActionCode":{"type":"string"},"reviewIdentificationNumber":{"type":"string"},"reviewDecisionReasonCode":{"type":"string"},"secondSurgicalOpinionIndicator":{"type":"string"},"administrativeReferenceNumber":{"type":"string"},"previousReviewAuthorizationNumber":{"type":"string"},"serviceDateBegin":{"type":"string"},"serviceDateEnd":{"type":"string"},"certificationIssueDate":{"type":"string"},"certificationExpirationDate":{"type":"string"},"certificationEffectiveDateBegin":{"type":"string"},"certificationEffectiveDateEnd":{"type":"string"},"professionalService":{"type":"object","properties":{"productOrServiceIDQualifier":{"type":"string"},"procedureCode":{"type":"string"},"procedureModifier":{"type":"string"},"procedureModifier2":{"type":"string"},"procedureModifier3":{"type":"string"},"procedureModifier4":{"type":"string"},"procedureCodeDescription":{"type":"string"},"procedureCode2":{"type":"string"},"serviceLineAmount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"serviceUnitCount":{"type":"string"},"epsdtIndicator":{"type":"string"},"nursingHomeLevelOfCareCode":{"type":"string"}}},"institutionalService":{"type":"object","properties":{"serviceLineRevenueCode":{"type":"string"},"productOrServiceIDQualifier":{"type":"string"},"procedureCode":{"type":"string"},"procedureModifier":{"type":"string"},"procedureModifier2":{"type":"string"},"procedureModifier3":{"type":"string"},"procedureModifier4":{"type":"string"},"procedureCodeDescription":{"type":"string"},"procedureCode2":{"type":"string"},"serviceLineAmount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"serviceUnitCount":{"type":"string"},"serviceLineRate":{"type":"string"},"nursingHomeLevelOfCare":{"type":"string"}}},"dentalService":{"type":"object","properties":{"procedureCode":{"type":"string"},"procedureModifier":{"type":"string"},"procedureModifier2":{"type":"string"},"procedureModifier3":{"type":"string"},"procedureModifier4":{"type":"string"},"procedureCodeDescription":{"type":"string"},"procedureCode2":{"type":"string"},"serviceLineAmount":{"type":"string"},"americanDentalAssociationCodes":{"type":"string"},"americanDentalAssociationCodes2":{"type":"string"},"americanDentalAssociationCodes3":{"type":"string"},"americanDentalAssociationCodes4":{"type":"string"},"americanDentalAssociationCodes5":{"type":"string"},"prosthesisCrownOrInlayCode":{"type":"string"},"serviceUnitCount":{"type":"string"}}},"toothInformation":{"type":"array","items":{"type":"object","properties":{"toothCode":{"type":"string"},"toothSurfaceCode":{"type":"string"},"toothSurfaceCode2":{"type":"string"},"toothSurfaceCode3":{"type":"string"},"toothSurfaceCode4":{"type":"string"},"toothSurfaceCode5":{"type":"string"}}}},"quantityQualifier":{"type":"string"},"serviceUnitCount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"sampleSelectionModulus":{"type":"string"},"timePeriodQualifier":{"type":"string"},"periodCount":{"type":"string"},"deliveryFrequencyCode":{"type":"string"},"deliveryPatternTimeCode":{"type":"string"},"attachments":{"type":"array","items":{"type":"object","properties":{"reportTypeCode":{"type":"string"},"transmissionCode":{"type":"string"},"controlNumber":{"type":"string"},"description":{"type":"string"}}}},"freeFormMessageText":{"type":"string"},"serviceProviderName":{"type":"array","items":{"type":"object","properties":{"serviceProviderRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"entityIdentifierCode":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"namePrefix":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"providerSupplementalInformation":{"type":"object","properties":{"ssn":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"}}},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"providerCode":{"type":"string"},"providerTaxonomyCode":{"type":"string"}}}},"serviceDetailAdditionalServiceInformationContactName":{"type":"array","items":{"type":"object","properties":{"organizationName":{"type":"string"},"middleName":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"}}}}}}}}}}},"NoaResponse":{"type":"object","properties":{"authorizationId":{"type":"string"},"submission":{"type":"object","properties":{"x12":{"type":"string"},"json":{"$ref":"#/components/schemas/NoaJSONResponse"}}}}},"NoaJSONResponse":{"type":"object","properties":{"requestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"submitterTransactionIdentifier":{"type":"string"},"payerId":{"type":"string"},"payerName":{"type":"string"},"umClearingHouseId":{"type":"string"},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"umRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"requester":{"type":"object","properties":{"requesterRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"requesterType":{"type":"string"},"organizationName":{"type":"string"},"firstName":{"type":"string"},"requesterIdentification":{"type":"object","properties":{"facilityIdNumber":{"type":"string"},"socialSecurityNumber":{"type":"string"}}},"npi":{"type":"string"},"providerCode":{"type":"string"},"referenceIdentification":{"type":"string"}}},"subscriber":{"type":"object","properties":{"subscriberRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"prefix":{"type":"string"},"suffix":{"type":"string"},"memberId":{"type":"string"},"dateOfBirth":{"type":"string"},"genderCode":{"type":"string"},"supplementalIdentification":{"type":"object","properties":{"medicaidRecipientIdentificationNumber":{"type":"string"},"ssn":{"type":"string"}}},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"insuredIndicator":{"type":"string"},"militaryRelationship":{"type":"string"}}},"dependent":{"type":"object","properties":{"dependentRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"suffix":{"type":"string"},"dateOfBirth":{"type":"string"},"genderCode":{"type":"string"},"supplementalIdentification":{"type":"object","properties":{"patientAccountNumber":{"type":"string"},"ssn":{"type":"string"}}},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"insuredIndicator":{"type":"string"},"relationshipToInsuredCode":{"type":"string"},"birthSequenceNumber":{"type":"string"}}},"patientEventDetail":{"type":"object","properties":{"patientEventRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"requestCategoryCode":{"type":"string"},"certificationTypeCode":{"type":"string"},"serviceTypeCode":{"type":"string"},"facilityTypeCode":{"type":"string"},"facilityCodeQualifier":{"type":"string"},"levelOfServiceCode":{"type":"string"},"certificationActionCode":{"type":"string"},"reviewIdentificationNumber":{"type":"string"},"reviewDecisionReasonCode":{"type":"string"},"secondSurgicalOpinionIndicator":{"type":"string"},"administrativeReferenceNumber":{"type":"string"},"previousReviewAuthorizationNumber":{"type":"string"},"accidentDate":{"type":"string"},"lastMenstrualPeriodDate":{"type":"string"},"estimatedDateOfBirth":{"type":"string"},"onsetOfCurrentSymptomsOrIllnessDate":{"type":"string"},"eventDateBegin":{"type":"string"},"eventDateEnd":{"type":"string"},"admissionDateBegin":{"type":"string"},"admissionDateEnd":{"type":"string"},"dischargeDate":{"type":"string"},"certificationIssueDate":{"type":"string"},"certificationExpirationDate":{"type":"string"},"certificationEffectiveDateBegin":{"type":"string"},"certificationEffectiveDateEnd":{"type":"string"},"diagnosisTypeCode1":{"type":"string"},"diagnosisCode1":{"type":"string"},"diagnosisDate1":{"type":"string"},"diagnosisTypeCode2":{"type":"string"},"diagnosisCode2":{"type":"string"},"diagnosisDate2":{"type":"string"},"diagnosisTypeCode3":{"type":"string"},"diagnosisCode3":{"type":"string"},"diagnosisDate3":{"type":"string"},"diagnosisTypeCode4":{"type":"string"},"diagnosisCode4":{"type":"string"},"diagnosisDate4":{"type":"string"},"diagnosisTypeCode5":{"type":"string"},"diagnosisCode5":{"type":"string"},"diagnosisDate5":{"type":"string"},"diagnosisTypeCode6":{"type":"string"},"diagnosisCode6":{"type":"string"},"diagnosisDate6":{"type":"string"},"diagnosisTypeCode7":{"type":"string"},"diagnosisCode7":{"type":"string"},"diagnosisDate7":{"type":"string"},"diagnosisTypeCode8":{"type":"string"},"diagnosisCode8":{"type":"string"},"diagnosisDate8":{"type":"string"},"diagnosisTypeCode9":{"type":"string"},"diagnosisCode9":{"type":"string"},"diagnosisDate9":{"type":"string"},"diagnosisTypeCode10":{"type":"string"},"diagnosisCode10":{"type":"string"},"diagnosisDate10":{"type":"string"},"diagnosisTypeCode11":{"type":"string"},"diagnosisCode11":{"type":"string"},"diagnosisDate11":{"type":"string"},"diagnosisTypeCode12":{"type":"string"},"diagnosisCode12":{"type":"string"},"diagnosisDate12":{"type":"string"},"quantityQualifier":{"type":"string"},"serviceUnitCount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"sampleSelectionModulus":{"type":"string"},"timePeriodQualifier":{"type":"string"},"periodCount":{"type":"string"},"deliveryFrequencyCode":{"type":"string"},"deliveryPatternTimeCode":{"type":"string"},"institutionalAdmissionTypeCode":{"type":"string"},"institutionalAdmissionSourceCode":{"type":"string"},"institutionalPatientStatusCode":{"type":"string"},"ambulanceTransportCode":{"type":"string"},"ambulanceUnitOrBasisForMeasurementCode":{"type":"string"},"ambulanceTransportDistance":{"type":"string"},"spinalManipulationTreatmentSeriesNumber":{"type":"string"},"spinalManipulationTreatmentCount":{"type":"string"},"spinalManipulationSubluxationLevelCode":{"type":"string"},"spinalManipulationSubluxationLevelCode2":{"type":"string"},"oxygenEquipmentTypeCode":{"type":"string"},"oxygenEquipmentTypeCode2":{"type":"string"},"oxygenFlowRate":{"type":"string"},"dailyOxygenUseCount":{"type":"string"},"oxygenUsePeriodHourCount":{"type":"string"},"respiratoryTherapistOrderText":{"type":"string"},"portableOxygenSystemFlowRate":{"type":"string"},"oxygenDeliverySystemCode":{"type":"string"},"oxygenSystemTypeCode":{"type":"string"},"homeHealthPrognosisCode":{"type":"string"},"homeHealthStartDate":{"type":"string"},"homeHealthCertificationPeriodStartDate":{"type":"string"},"homeHealthMedicareCoverageIndicator":{"type":"string"},"homeHealthCertificationTypeCode":{"type":"string"},"attachments":{"type":"array","items":{"type":"object","properties":{"reportTypeCode":{"type":"string"},"transmissionCode":{"type":"string"},"controlNumber":{"type":"string"},"description":{"type":"string"}}}},"freeFormMessageText":{"type":"string"},"patientEventProviderName":{"type":"array","items":{"type":"object","properties":{"patientEventProviderRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"entityIdentifierCode":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"namePrefix":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"providerSupplementalInformation":{"type":"object","properties":{"ssn":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"}}},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"providerCode":{"type":"string"},"providerTaxonomyCode":{"type":"string"}}}},"patientEventAdditionalPatientInformationContactName":{"type":"array","items":{"type":"object","properties":{"organizationName":{"type":"string"},"middleName":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"}}}},"patientEventTransportInformation":{"type":"array","items":{"type":"object","properties":{"patientEventTransportInformationValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"entityIdentifierCode":{"type":"string"},"transportLocationName":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"}}}},"serviceLevel":{"type":"array","items":{"type":"object","properties":{"serviceRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"requestCategoryCode":{"type":"string"},"certificationTypeCode":{"type":"string"},"serviceTypeCode":{"type":"string"},"facilityTypeCode":{"type":"string"},"facilityCodeQualifier":{"type":"string"},"certificationActionCode":{"type":"string"},"reviewIdentificationNumber":{"type":"string"},"reviewDecisionReasonCode":{"type":"string"},"secondSurgicalOpinionIndicator":{"type":"string"},"administrativeReferenceNumber":{"type":"string"},"previousReviewAuthorizationNumber":{"type":"string"},"serviceDateBegin":{"type":"string"},"serviceDateEnd":{"type":"string"},"certificationIssueDate":{"type":"string"},"certificationExpirationDate":{"type":"string"},"certificationEffectiveDateBegin":{"type":"string"},"certificationEffectiveDateEnd":{"type":"string"},"professionalService":{"type":"object","properties":{"productOrServiceIDQualifier":{"type":"string"},"procedureCode":{"type":"string"},"procedureModifier":{"type":"string"},"procedureModifier2":{"type":"string"},"procedureModifier3":{"type":"string"},"procedureModifier4":{"type":"string"},"procedureCodeDescription":{"type":"string"},"procedureCode2":{"type":"string"},"serviceLineAmount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"serviceUnitCount":{"type":"string"},"epsdtIndicator":{"type":"string"},"nursingHomeLevelOfCareCode":{"type":"string"}}},"institutionalService":{"type":"object","properties":{"serviceLineRevenueCode":{"type":"string"},"productOrServiceIDQualifier":{"type":"string"},"procedureCode":{"type":"string"},"procedureModifier":{"type":"string"},"procedureModifier2":{"type":"string"},"procedureModifier3":{"type":"string"},"procedureModifier4":{"type":"string"},"procedureCodeDescription":{"type":"string"},"procedureCode2":{"type":"string"},"serviceLineAmount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"serviceUnitCount":{"type":"string"},"serviceLineRate":{"type":"string"},"nursingHomeLevelOfCare":{"type":"string"}}},"dentalService":{"type":"object","properties":{"procedureCode":{"type":"string"},"procedureModifier":{"type":"string"},"procedureModifier2":{"type":"string"},"procedureModifier3":{"type":"string"},"procedureModifier4":{"type":"string"},"procedureCodeDescription":{"type":"string"},"procedureCode2":{"type":"string"},"serviceLineAmount":{"type":"string"},"americanDentalAssociationCodes":{"type":"string"},"americanDentalAssociationCodes2":{"type":"string"},"americanDentalAssociationCodes3":{"type":"string"},"americanDentalAssociationCodes4":{"type":"string"},"americanDentalAssociationCodes5":{"type":"string"},"prosthesisCrownOrInlayCode":{"type":"string"},"serviceUnitCount":{"type":"string"}}},"toothInformation":{"type":"array","items":{"type":"object","properties":{"toothCode":{"type":"string"},"toothSurfaceCode":{"type":"string"},"toothSurfaceCode2":{"type":"string"},"toothSurfaceCode3":{"type":"string"},"toothSurfaceCode4":{"type":"string"},"toothSurfaceCode5":{"type":"string"}}}},"quantityQualifier":{"type":"string"},"serviceUnitCount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"sampleSelectionModulus":{"type":"string"},"timePeriodQualifier":{"type":"string"},"periodCount":{"type":"string"},"deliveryFrequencyCode":{"type":"string"},"deliveryPatternTimeCode":{"type":"string"},"attachments":{"type":"array","items":{"type":"object","properties":{"reportTypeCode":{"type":"string"},"transmissionCode":{"type":"string"},"controlNumber":{"type":"string"},"description":{"type":"string"}}}},"freeFormMessageText":{"type":"string"},"serviceProviderName":{"type":"array","items":{"type":"object","properties":{"serviceProviderRequestValidation":{"type":"array","items":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}}},"entityIdentifierCode":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"namePrefix":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"providerSupplementalInformation":{"type":"object","properties":{"ssn":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"}}},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"providerCode":{"type":"string"},"providerTaxonomyCode":{"type":"string"}}}},"serviceDetailAdditionalServiceInformationContactName":{"type":"array","items":{"type":"object","properties":{"organizationName":{"type":"string"},"middleName":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"}}}}}}}}}}},"DeterminationExecuteRuleResponse":{"type":"array","items":{"$ref":"#/components/schemas/ExecuteRulesResponse"}},"ExecuteRulesResponse":{"type":"object","properties":{"authorizationRequired":{"type":"boolean"},"umVendor":{"type":"string"},"payerCpid":{"type":"string"},"planName":{"type":"string"},"rhPayerId":{"type":"string"},"planId":{"type":"string"},"code":{"type":"string"},"exceptions":{"type":"string"},"externalRoute":{"type":"string"},"payerXrefStatus":{"type":"string"},"umVendorXrefStatus":{"type":"string"},"rule":{"type":"string"},"canSubmit":{"type":"boolean"},"vendor":{"type":"string"},"lob":{"type":"string"},"isGlobal":{"type":"boolean"}}},"AuthorizationJSONResponse":{"type":"object","properties":{"requestValidation":{"type":"array","items":{"$ref":"#/components/schemas/AuthorizationJSONResponseRequestValidation"}},"submitterTransactionIdentifier":{"type":"string"},"payerId":{"type":"string"},"payerName":{"type":"string"},"umClearingHouseId":{"type":"string"},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"contactTelephoneExtension":{"type":"string"},"contactUrl":{"type":"string"},"umRequestValidation":{"type":"array","items":{"$ref":"#/components/schemas/AuthorizationJSONResponseRequestValidation"}},"requester":{"$ref":"#/components/schemas/AuthorizationJSONResponseRequester"},"subscriber":{"$ref":"#/components/schemas/AuthorizationJSONResponseSubscriber"},"dependent":{"$ref":"#/components/schemas/AuthorizationJSONResponseDependent"},"patientEventDetail":{"$ref":"#/components/schemas/AuthorizationJSONResponsePatientEventDetail"}}},"AuthorizationJSONResponseDependent":{"type":"object","properties":{"dependentRequestValidation":{"type":"array","items":{"$ref":"#/components/schemas/AuthorizationJSONResponseRequestValidation"}},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"suffix":{"type":"string"},"dateOfBirth":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"supplementalIdentification":{"$ref":"#/components/schemas/AuthorizationJSONResponseDependentSupplementalIdentification"}}},"AuthorizationJSONResponseRequestValidation":{"type":"object","properties":{"responseCode":{"type":"string"},"rejectReasonCode":{"type":"string"},"followupActionCode":{"type":"string"}}},"AuthorizationJSONResponseDependentSupplementalIdentification":{"type":"object","additionalProperties":false,"properties":{"employeeIdentificationNumber":{"type":"string"},"patientAccountNumber":{"type":"string"},"ssn":{"type":"string"}}},"AuthorizationJSONResponsePatientEventDetail":{"type":"object","properties":{"dependentRequestValidation":{"type":"array","items":{"$ref":"#/components/schemas/AuthorizationJSONResponseRequestValidation"}},"requestCategoryCode":{"type":"string"},"certificationTypeCode":{"type":"string"},"serviceTypeCode":{"type":"string"},"facilityTypeCode":{"type":"string"},"facilityCodeQualifier":{"type":"string"},"certificationActionCode":{"type":"string"},"reviewIdentificationNumber":{"type":"string"},"reviewDecisionReasonCode":{"type":"string"},"secondSurgicalOpinionIndicator":{"type":"string"},"previousReviewAuthorizationNumber":{"type":"string"},"previousAdministrativeReferenceNumber":{"type":"string"},"eventDateBegin":{"type":"string"},"eventDateEnd":{"type":"string"},"admissionDateBegin":{"type":"string"},"admissionDateEnd":{"type":"string"},"dischargeDate":{"type":"string"},"certificationIssueDate":{"type":"string"},"certificationExpirationDate":{"type":"string"},"certificationEffectiveDateBegin":{"type":"string"},"certificationEffectiveDateEnd":{"type":"string"},"healthCareServicesReviewRequestDateBegin":{"type":"string"},"healthCareServicesReviewRequestDateEnd":{"type":"string"},"diagnosisTypeCode":{"type":"string"},"diagnosisCode":{"type":"string"},"quantityQualifier":{"type":"string"},"serviceUnitCount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"sampleSelectionModulus":{"type":"string"},"timePeriodQualifier":{"type":"string"},"periodCount":{"type":"string"},"deliveryFrequencyCode":{"type":"string"},"deliveryPatternTimeCode":{"type":"string"},"institutionalAdmissionTypeCode":{"type":"string"},"institutionalAdmissionSourceCode":{"type":"string"},"institutionalPatientStatusCode":{"type":"string"},"ambulanceTransportCode":{"type":"string"},"ambulanceUnitOrBasisForMeasurementCode":{"type":"string"},"ambulanceTransportDistance":{"type":"string"},"spinalManipulationTreatmentSeriesNumber":{"type":"string"},"spinalManipulationTreatmentCount":{"type":"string"},"spinalManipulationSubluxationLevelCode":{"type":"string"},"spinalManipulationSubluxationLevelCode2":{"type":"string"},"oxygenEquipmentTypeCode":{"type":"string"},"oxygenEquipmentTypeCode2":{"type":"string"},"oxygenFlowRate":{"type":"string"},"dailyOxygenUseCount":{"type":"string"},"oxygenUsePeriodHourCount":{"type":"string"},"respiratoryTherapistOrderText":{"type":"string"},"portableOxygenSystemFlowRate":{"type":"string"},"oxygenDeliverySystemCode":{"type":"string"},"oxygenSystemTypeCode":{"type":"string"},"homeHealthPrognosisCode":{"type":"string"},"homeHealthStartDate":{"type":"string"},"homeHealthCertificationPeriod":{"type":"string"},"homeHealthMedicareCoverageIndicator":{"type":"string"},"homeHealthCertificationTypeCode":{"type":"string"},"freeFormMessageText":{"type":"string"},"patientEventProviderName":{"type":"array","items":{"$ref":"#/components/schemas/AuthorizationJSONResponsePatientEventProviderName"}},"patientEventTransportInformation":{"type":"array","items":{"$ref":"#/components/schemas/AuthorizationJSONResponsePatientEventTransportInformation"}},"serviceLevel":{"type":"array","items":{"$ref":"#/components/schemas/AuthorizationJSONResponseServiceLevel"}}}},"AuthorizationJSONResponsePatientEventProviderName":{"type":"object","properties":{"patientEventProviderRequestValidation":{"type":"array","items":{"$ref":"#/components/schemas/AuthorizationJSONResponseRequestValidation"}},"entityIdentifierCode":{"type":"string"},"organizationName":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"namePrefix":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"providerSupplementalInformation":{"$ref":"#/components/schemas/AuthorizationJSONResponseProviderSupplementalInformation"},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"contactTelephoneExtension":{"type":"string"},"contactUrl":{"type":"string"},"providerCode":{"type":"string"},"providerTaxonomyCode":{"type":"string"}}},"AuthorizationJSONResponseProviderSupplementalInformation":{"type":"object","properties":{"stateLicenseNumber":{"type":"string"},"licenseNumberStateCode":{"type":"string"},"providerUpinNumber":{"type":"string"},"facilityIdNumber":{"type":"string"},"employersIdentificationNumber":{"type":"string"},"providerPlanNetworkIdentificationNumber":{"type":"string"},"facilityNetworkIdentificationNumber":{"type":"string"},"ssn":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"},"providerSiteNumber":{"type":"string"}}},"AuthorizationJSONResponsePatientEventTransportInformation":{"type":"object","properties":{"entityIdentifierCode":{"type":"string"},"organizationName":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"}}},"AuthorizationJSONResponseServiceLevel":{"type":"object","properties":{"serviceRequestValidation":{"type":"array","items":{"$ref":"#/components/schemas/AuthorizationJSONResponseRequestValidation"}},"requestCategoryCode":{"type":"string"},"certificationTypeCode":{"type":"string"},"serviceTypeCode":{"type":"string"},"facilityTypeCode":{"type":"string"},"facilityCodeQualifier":{"type":"string"},"certificationActionCode":{"type":"string"},"reviewIdentificationNumber":{"type":"string"},"reviewDecisionReasonCode":{"type":"string"},"secondSurgicalOpinionIndicator":{"type":"string"},"previousReviewAuthorizationNumber":{"type":"string"},"previousAdministrativeReferenceNumber":{"type":"string"},"serviceDateBegin":{"type":"string"},"serviceDateEnd":{"type":"string"},"certificationIssueDate":{"type":"string"},"certificationExpirationDate":{"type":"string"},"certificationEffectiveDateBegin":{"type":"string"},"certificationEffectiveDateEnd":{"type":"string"},"professionalService":{"$ref":"#/components/schemas/AuthorizationJSONResponseIonalService"},"institutionalService":{"$ref":"#/components/schemas/AuthorizationJSONResponseIonalService"},"dentalService":{"$ref":"#/components/schemas/AuthorizationJSONResponseDentalService"},"toothInformation":{"type":"array","items":{"$ref":"#/components/schemas/AuthorizationJSONResponseToothInformation"}},"quantityQualifier":{"type":"string"},"serviceUnitCount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"sampleSelectionModulus":{"type":"string"},"timePeriodQualifier":{"type":"string"},"periodCount":{"type":"string"},"deliveryFrequencyCode":{"type":"string"},"deliveryPatternTimeCode":{"type":"string"},"freeFormMessageText":{"type":"string"},"serviceProviderName":{"type":"array","items":{"$ref":"#/components/schemas/AuthorizationJSONResponseServiceProviderName"}}}},"AuthorizationJSONResponseDentalService":{"type":"object","properties":{"procedureCode":{"type":"string"},"procedureModifier":{"type":"string"},"procedureModifier2":{"type":"string"},"procedureModifier3":{"type":"string"},"procedureModifier4":{"type":"string"},"procedureCodeDescription":{"type":"string"},"procedureCode2":{"type":"string"},"serviceLineAmount":{"type":"string"},"americanDentalAssociationCodes":{"type":"string"},"americanDentalAssociationCodes2":{"type":"string"},"americanDentalAssociationCodes3":{"type":"string"},"americanDentalAssociationCodes4":{"type":"string"},"americanDentalAssociationCodes5":{"type":"string"},"prosthesisCrownOrInlayCode":{"type":"string"},"serviceUnitCount":{"type":"string"}}},"AuthorizationJSONResponseIonalService":{"type":"object","properties":{"serviceLineRevenueCode":{"type":"string"},"productOrServiceIDQualifier":{"type":"string"},"procedureCode":{"type":"string"},"procedureModifier":{"type":"string"},"procedureModifier2":{"type":"string"},"procedureModifier3":{"type":"string"},"procedureModifier4":{"type":"string"},"procedureCodeDescription":{"type":"string"},"procedureCode2":{"type":"string"},"serviceLineAmount":{"type":"string"},"unitOrBasisForMeasurementCode":{"type":"string"},"serviceUnitCount":{"type":"string"},"serviceLineRate":{"type":"string"},"epsdtIndicator":{"type":"string"}}},"AuthorizationJSONResponseServiceProviderName":{"type":"object","properties":{"serviceProviderRequestValidation":{"type":"array","items":{"$ref":"#/components/schemas/AuthorizationJSONResponseRequestValidation"}},"entityIdentifierCode":{"type":"string"},"organizationName":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"namePrefix":{"type":"string"},"nameSuffix":{"type":"string"},"identificationCodeQualifier":{"type":"string"},"identifier":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"providerSupplementalInformation":{"$ref":"#/components/schemas/AuthorizationJSONResponseProviderSupplementalInformation"},"contactName":{"type":"string"},"contactElectronicMail":{"type":"string"},"contactFacsimile":{"type":"string"},"contactTelephone":{"type":"string"},"contactTelephoneExtension":{"type":"string"},"contactUrl":{"type":"string"},"providerCode":{"type":"string"},"providerTaxonomyCode":{"type":"string"}}},"AuthorizationJSONResponseToothInformation":{"type":"object","properties":{"toothCode":{"type":"string"},"toothSurfaceCode":{"type":"string"},"toothSurfaceCode2":{"type":"string"},"toothSurfaceCode3":{"type":"string"},"toothSurfaceCode4":{"type":"string"},"toothSurfaceCode5":{"type":"string"}}},"AuthorizationJSONResponseRequester":{"type":"object","properties":{"requesterRequestValidation":{"type":"array","items":{"$ref":"#/components/schemas/AuthorizationJSONResponseRequestValidation"}},"requesterType":{"type":"string"},"organizationName":{"type":"string"},"lastName":{"type":"string"},"firstName":{"type":"string"},"requesterIdentification":{"$ref":"#/components/schemas/AuthorizationJSONResponseRequesterIdentification"},"npi":{"type":"string"},"payorId":{"type":"string"},"ssn":{"type":"string"},"servicesPlanID":{"type":"string"},"employersId":{"type":"string"},"etin":{"type":"string"},"providerCode":{"type":"string"},"referenceIdentification":{"type":"string"}}},"AuthorizationJSONResponseRequesterIdentification":{"type":"object","properties":{"providerUpinNumber":{"type":"string"},"facilityIdNumber":{"type":"string"},"employerIdentificationNumber":{"type":"string"},"providerSiteNumber":{"type":"string"},"providerPlanNetworkIdNumber":{"type":"string"},"facilityNetworkIdNumber":{"type":"string"},"socialSecurityNumber":{"type":"string"},"carrierAssignedReferenceNumber":{"type":"string"}}},"AuthorizationJSONResponseSubscriber":{"type":"object","properties":{"subscriberRequestValidation":{"type":"array","items":{"$ref":"#/components/schemas/AuthorizationJSONResponseRequestValidation"}},"lastName":{"type":"string"},"firstName":{"type":"string"},"middleName":{"type":"string"},"suffix":{"type":"string"},"memberId":{"type":"string"},"dateOfBirth":{"type":"string"},"address1":{"type":"string"},"address2":{"type":"string"},"city":{"type":"string"},"state":{"type":"string"},"postalCode":{"type":"string"},"countryCode":{"type":"string"},"countrySubDivisionCode":{"type":"string"},"supplementalIdentification":{"$ref":"#/components/schemas/AuthorizationJSONResponseSubscriberSupplementalIdentification"}}},"AuthorizationJSONResponseSubscriberSupplementalIdentification":{"type":"object","properties":{"policyNumber":{"type":"string"},"branchIdentifier":{"type":"string"},"groupNumber":{"type":"string"},"departmentNumber":{"type":"string"},"patientAccountNumber":{"type":"string"},"healthInsuranceClaimNumber":{"type":"string"},"idCard":{"type":"string"},"insurancePolicyNumber":{"type":"string"},"planNetworkIdentificationNumber":{"type":"string"},"medicaidRecipientIdentificationNumber":{"type":"string"},"ssn":{"type":"string"}}},"TradingPartnerResponseAll":{"type":"array","items":{"$ref":"#/components/schemas/TradingPartnerResponse"}},"TradingPartnerResponse":{"type":"object","properties":{"payerId":{"type":"string","example":"HUMAN2"},"cicPayerId":{"type":"string","example":"HUMANA"},"cicInterchangeReceiverId":{"type":"string","example":"INQHEALTHHELP"},"cicPayerName":{"type":"string","example":"HUMANA"}}},"SmokeTestResult":{"type":"object","properties":{"failureReason":{"type":"string"},"status":{"type":"string"}}},"Errors":{"type":"array","items":{"type":"string","example":"This is an example error string"}}},"parameters":{"x-optum-integrator":{"description":"The integrator that the invoking user belongs to.","in":"header","name":"x-optum-integrator","schema":{"type":"string","example":"Clearance"}},"x-optum-user-id":{"description":"The unique ID of the user that invoked the request.","in":"header","name":"x-optum-user-id","schema":{"type":"string","format":"uuid","example":"c9476bc2-b563-4555-9527-4afe9dccaf9a"},"required":true},"x-optum-user-email":{"description":"The email of the user that invoked the request.","in":"header","name":"x-optum-user-email","schema":{"type":"string","example":"firstName.lastName@company.com"},"required":true},"x-optum-tenant-id":{"description":"The unique ID of the tenant that the invoking user belongs to.","in":"header","name":"x-optum-tenant-id","schema":{"type":"string","format":"uuid","example":"9fb77454-8c58-4345-aa50-43f133e06d20"},"required":true},"x-optum-tenant-id2":{"description":"The unique ID of the tenant that the invoking user belongs to.","in":"header","name":"x-optum-tenant-id","schema":{"type":"string","format":"uuid","example":"bc5dfbfb-376d-49fb-b42c-40e39b6f4b39"},"required":true},"x-optum-correlation-id":{"description":"A unique identifier assigned to each request.","in":"header","name":"x-optum-correlation-id","schema":{"type":"string","format":"uuid","example":"c9476bc2-b563-4555-9527-4afe9dccaf9a"}},"x-optum-customer-indicator":{"description":"The customer identifier clearance uses to identify a database.","in":"header","name":"x-optum-customer-indicator","schema":{"type":"string","example":"CorrelationId:StagingInputRegEligibilityId:VisitId:BatchId"}},"x-optum-tundro-mock-external-response":{"description":"(Optional) A comma-delimited list of controlled scenarios that influence the evaluation of a submitted transaction. The structure should follow the pattern of `{destination}:{scenario}`. For example, `imn-auth:timeout`. See the Mock API for more information and a list of available mock responses.","in":"header","name":"x-optum-tundro-mock-external-response","schema":{"type":"string"}}},"responses":{"200":{"headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"}},"description":"Success"},"400":{"headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"}},"description":"Bad Request. The request body is malformed or missing required information.","content":{"application/json":{"schema":{"$ref":"#/components/schemas/Errors"}}}},"401":{"description":"Unauthorized. No or invalid authentication details are provided","headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"}},"content":{"application/json":{"schema":{"$ref":"#/components/schemas/Errors"}}}},"403":{"headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"}},"description":"Forbidden. Authentication succeeded but authenticated user doesn't have access to the resource","content":{"application/json":{"schema":{"$ref":"#/components/schemas/Errors"}}}},"404":{"headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"}},"description":"Not Found. Non-existent resource was requested","content":{"application/json":{"schema":{"$ref":"#/components/schemas/Errors"}}}},"405":{"headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"}},"description":"Method Not Allowed. HTTP method is being requested that isn't allowed for the authenticated user","content":{"application/json":{"schema":{"$ref":"#/components/schemas/Errors"}}}},"409":{"headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"}},"description":"Conflict with current state of the target source.","content":{"application/json":{"schema":{"$ref":"#/components/schemas/Errors"}}}},"415":{"headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"}},"description":"Unsupported media type. Only application/json supported","content":{"application/json":{"schema":{"$ref":"#/components/schemas/Errors"}}}},"422":{"headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"}},"description":"Unprocessable Entity. Validation errors have occurred","content":{"application/json":{"schema":{"$ref":"#/components/schemas/Errors"}}}},"500":{"headers":{"x-amzn-trace-id":{"$ref":"#/components/headers/x-amzn-trace-id"}},"description":"Internal Server Error. An unexpected error has occurred.","content":{"application/json":{"schema":{"$ref":"#/components/schemas/Errors"}}}}},"examples":{"UserSubmissionRequestSubscriber":{"summary":"Submission Request Subscriber Only","value":{"senderId":"201985AAS","submitterTransactionIdentifier":"165932","payerId":"UHC","payerName":"ABC PAYER","umClearingHouseId":"278_217_01","requester":{"requesterType":"1P","organizationName":"XYZ AMBULANCE SVC","lastName":"XYZ AMBULANCE SVC","npi":"1234567890"},"subscriber":{"lastName":"SMITH","firstName":"JOE","memberId":"12345689001","dateOfBirth":"19700101","genderCode":"M","supplementalIdentification":{"patientAccountNumber":"1234567890"}},"patientEventDetail":{"requestCategoryCode":"HS","certificationTypeCode":"I","serviceTypeCode":"56","facilityTypeCode":"41","facilityCodeQualifier":"B","eventDateBegin":"20250101","ambulanceCertificationConditionIndicator":"Y","ambulanceCertificationConditionCode1":"09","ambulanceTransport":{"transportCode":"X","transportReasonCode":"D","transportDistance":"27","roundTripPurposeDescription":"TRIP FROM HOME TO OFFICE VISIT TO DIALYSIS TREATMENT AND BACK HOME"},"patientEventTransportInformation":[{"entityIdentifierCode":"PW","transportLocationName":"HOME","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"},{"entityIdentifierCode":"ND","transportLocationName":"DOCTOR OFFICE","address1":"123 SOME AVENUE","city":"SACRAMENTO","state":"CA","postalCode":"95624"},{"entityIdentifierCode":"R3","transportLocationName":"SOME DIALYSIS CENTER","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"},{"entityIdentifierCode":"FS","transportLocationName":"HOME","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"}],"serviceLevel":[{"professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"A0428","procedureModifier1":"DR","unitOrBasisForMeasurementCode":"UN","serviceUnitCount":"14"}}]}}},"UserSubmissionRequestDependent":{"summary":"Submission Request Dependent","value":{"senderId":"201985AAS","submitterTransactionIdentifier":"165932","payerId":"UHC","payerName":"ABC PAYER","umClearingHouseId":"278_217_01","requester":{"requesterType":"1P","organizationName":"XYZ AMBULANCE SVC","lastName":"XYZ AMBULANCE SVC","npi":"1234567890"},"subscriber":{"lastName":"SMITH","firstName":"JOE","memberId":"12345689001","dateOfBirth":"19700101","genderCode":"M","supplementalIdentification":{"patientAccountNumber":"1234567890"}},"dependent":{"lastName":"SMITH","firstName":"JUNE","dateOfBirth":"19700101","genderCode":"F","supplementalIdentification":{"ssn":"123121234"}},"patientEventDetail":{"requestCategoryCode":"HS","certificationTypeCode":"I","serviceTypeCode":"56","facilityTypeCode":"41","facilityCodeQualifier":"B","eventDateBegin":"20250101","ambulanceCertificationConditionIndicator":"Y","ambulanceCertificationConditionCode1":"09","ambulanceTransport":{"transportCode":"X","transportReasonCode":"D","transportDistance":"27","roundTripPurposeDescription":"TRIP FROM HOME TO OFFICE VISIT TO DIALYSIS TREATMENT AND BACK HOME"},"patientEventTransportInformation":[{"entityIdentifierCode":"PW","transportLocationName":"HOME","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"},{"entityIdentifierCode":"ND","transportLocationName":"DOCTOR OFFICE","address1":"123 SOME AVENUE","city":"SACRAMENTO","state":"CA","postalCode":"95624"},{"entityIdentifierCode":"R3","transportLocationName":"SOME DIALYSIS CENTER","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"},{"entityIdentifierCode":"FS","transportLocationName":"HOME","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"}],"serviceLevel":[{"professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"A0428","procedureModifier1":"DR","unitOrBasisForMeasurementCode":"UN","serviceUnitCount":"14"}}]}}},"UserNoaRequest":{"summary":"Notice of admission Request (JSON)","value":{"senderId":"201985AAS","submitterTransactionIdentifier":"222438911WEB","payerId":"60054","payerName":"AETNA","umClearingHouseId":"IMNDIRECT","source":{"sourceType":"FA","organizationName":"B'enefits Health System'","lastName":"Benefits Health System","npi":"1881650737","contactTelephone":"4064552959"},"subscriber":{"lastName":"LNAME","firstName":"FNAME","memberId":"NOA-01-SUCCESS","supplementalIdentification":{"groupNumber":"0123456789012"},"dateOfBirth":"19700101"},"patientEventDetail":{"requestCategoryCode":"AR","certificationTypeCode":"I","serviceTypeCode":"1","facilityTypeCode":"11","facilityCodeQualifier":"A","accidentDate":"20260101","lastMenstrualPeriodDate":"20260101","estimatedDateOfBirth":"20260101","onsetDate":"20260101","eventDateBegin":"20260101","admissionDateBegin":"20260101","admissionDateEnd":"20260101","dischargeDate":"20260101","certificationIssueDateBegin":"20260101","certificationExpirationDateBegin":"20260101","certificationEffectiveDateBegin":"20260101","diagnosisTypeCode1":"ABJ","diagnosisCode1":"N1330","freeFormMessageText":"AT=061500;ICD=N1330","patientEventProviderName":[{"entityIdentifierCode":"71","organizationName":"Benefits Health System","lastName":"SLATER","firstName":"RICHARD","identificationCodeQualifier":"XX","identifier":"1285928754"}]}}},"X12OrchRequestNoProcedureCodes":{"summary":"X12 Orchestration - No procedure codes require auth","value":{"rhPayerId":"UHCDEMODV1","planId":"41","x12":"ISA*00*          *00*          *ZZ*201985AAS      *ZZ*UHCDIRECT      *260220*2231*^*00501*310114548*0*P*:~GS*HI*201985AAS*UHCDIRECT*20260220*223147*549621530*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1234567890*20260220*223147~HL*1**20*1~NM1*PR*2*UHCDIRECT*****PI*UHCDIRECT~HL*2*1*21*1~NM1*1P*2*Regional Medical Center*****XX*1234567890~REF*EI*123456789~N4*Orangeburg*SC*12345~PER*IC**TE*803-555-2200~HL*3*2*22*1~NM1*IL*1*TEST*BRITTANY****MI*multi-01-approved~REF*6P*123456789~REF*SY*111223333~DMG*D8*19701231~HL*4*3*EV*1~UM*HS*I*1*11:B~DTP*AAH*RD8*20231017-20231017~NM1*SJ*1*TEST*STEVEN****XX*1234567890~NM1*DN*1*TEST*STEVEN****XX*1234567890~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:6789T~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:9876T~SE*28*0001~GE*1*549621530~IEA*1*310114548~"}},"X12OrchRequestTwoCodesOneRequired":{"summary":"X12 Orchestration - Two procedure codes; one requires auth","value":{"rhPayerId":"UHCDEMODV1","planId":"41","x12":"ISA*00*          *00*          *ZZ*201985AAS      *ZZ*UHCDIRECT      *260220*2231*^*00501*310114548*0*P*:~GS*HI*201985AAS*UHCDIRECT*20260220*223147*549621530*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1234567890*20260220*223147~HL*1**20*1~NM1*PR*2*UHCDIRECT*****PI*UHCDIRECT~HL*2*1*21*1~NM1*1P*2*Regional Medical Center*****XX*1234567890~REF*EI*123456789~N4*Orangeburg*SC*12345~PER*IC**TE*803-555-2200~HL*3*2*22*1~NM1*IL*1*TEST*BRITTANY****MI*multi-01-approved~REF*6P*123456789~REF*SY*111223333~DMG*D8*19701231~HL*4*3*EV*1~UM*HS*I*1*11:B~DTP*AAH*RD8*20231017-20231017~NM1*SJ*1*TEST*STEVEN****XX*1234567890~NM1*DN*1*TEST*STEVEN****XX*1234567890~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:T1000~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:9876T~SE*28*0001~GE*1*549621530~IEA*1*310114548~"}},"X12OrchRequestTwoRequiredCodesWithSplit":{"summary":"X12 Orchestration - Two procedure codes require auth with split","value":{"rhPayerId":"UHCDEMODV1","planId":"41","x12":"ISA*00*          *00*          *ZZ*201985AAS      *ZZ*UHCDIRECT      *260220*2231*^*00501*310114548*0*P*:~GS*HI*201985AAS*UHCDIRECT*20260220*223147*549621530*X*005010X215~ST*278*0001*005010X215~BHT*0007*28*1234567890*20260220*223147~HL*1**20*1~NM1*PR*2*UHCDIRECT*****PI*UHCDIRECT~HL*2*1*21*1~NM1*1P*2*Regional Medical Center*****XX*1234567890~REF*EI*123456789~N4*Orangeburg*SC*12345~PER*IC**TE*803-555-2200~HL*3*2*22*1~NM1*IL*1*TEST*BRITTANY****MI*multi-01-approved~REF*6P*123456789~REF*SY*111223333~DMG*D8*19701231~HL*4*3*EV*1~UM*HS*I*1*11:B~DTP*AAH*RD8*20231017-20231017~NM1*SJ*1*TEST*STEVEN****XX*1234567890~NM1*DN*1*TEST*STEVEN****XX*1234567890~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:T1000~HL*5*4*SS*0~UM*HS***11:B~DTP*472*RD8*20231017-20231017~SV1*HC:0214T~SE*28*0001~GE*1*549621530~IEA*1*310114548~"}},"UserInquiryRequestSubscriber":{"summary":"Inquiry Request Subscriber Only","value":{"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":"8033952200"},"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"}}]}}},"UserInquiryRequestDependent":{"summary":"Inquiry Request with Dependent","value":{"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":"8033952200"},"subscriber":{"lastName":"TEST","firstName":"BRITTANY","memberId":"ZCS12345678","dateOfBirth":"19701231","supplementalIdentification":{"groupNumber":"123456789","ssn":"111223333"}},"dependent":{"lastName":"TEST","firstName":"MARY","dateOfBirth":"201001231","supplementalIdentification":{"ssn":"444556666"}},"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"}}]}}},"UserInquiryResponseDependent":{"summary":"Inquiry Response with Dependent","value":{"authorizationId":"a14081f3-b463-449e-a9dc-7ee21aef4552","inquiry":{"x12":"ISA*00*          *00*          *ZZ*INQMEDSOLUTIONS*ZZ*123456789      *240220*2059*^*00501*709893603*0*P*:~GS*HI*INQMEDSOLUTIONS*123456789*20240220*205925*148363198*X*005010X215~ST*278*0001*005010X215~BHT*0007*49*1234567890*20240220*205925*RD~HL*1**20*1~NM1*PR*2*MEDSOLUTIONS*****PI*CIGNA~PER*IC**UR*https//www.evicore.com/provider#login~HL*2*1*21*1~NM1*1P*2*WESTCHESTER MEDICAL CENTER*****XX*1234567890~REF*EI*123456789~HL*3*2*22*1~NM1*IL*1*SMITH*TOM****MI* U1234567890~REF*SY*123121234~REF*3L*12345-1702~REF*1L*CIGNA SI-PPO/OAP~N3*SOME ROAD~N4*BEDFORD*NY*12345~DMG*D8*19700101~HL*4*3*EV*1~HCR*A1*A12345678~REF*BB*A12345678~REF*NT*52598960~DTP*102*D8*20240220~DTP*036*D8*20240818~DTP*007*D8*20240220~DTP*881*D8*20240220~HI*ABK:R07.9~MSG*APPROVED~NM1*FA*2*TEST, DOMINICA*****XX*1234567890~N3*100 DEMO RD~N4*VALHALLA*NY*12345~PER*IC**TE*2223334444*FX*1112223333~NM1*DN*1*TEST*DOMINICA****XX*1234567890~N3*100 DEMO RD~N4*VALHALLA*NY*12345~PER*IC**TE*3334445555~HL*5*4*SS*0~HCR*A1*A12345678~SV1*HC:78452**UN*1~MSG*MYOCARDIAL PERFUSION IMAGING (SPECT); MULTIPLE STUDIES~SE*39*0001~GE*1*148363198~IEA*1*709893603~","json":{"submitterTransactionIdentifier":"1234567890","payerId":"CIGNA","payerName":"MEDSOLUTIONS","umClearingHouseId":"123456789","contactUrl":"https//www.evicore.com/provider#login","umRequestValidation":null,"requester":{"requesterType":"1P","organizationName":"WESTCHESTER MEDICAL CENTER","requesterIdentification":{"employerIdentificationNumber":"123456789"},"npi":"1234567890"},"subscriber":{"lastName":"SMITH","firstName":"TOM","memberId":" U1234567890","dateOfBirth":"19700101","address1":"SOME ROAD","city":"BEDFORD","state":"NY","postalCode":"12345","supplementalIdentification":{"policyNumber":"CIGNA SI-PPO/OAP","branchIdentifier":"12345-1702","ssn":"123121234"}},"dependent":{"lastName":"SMITH","firstName":"JANE","dateOfBirth":"19700101","address1":"SOME ROAD","city":"BEDFORD","state":"NY","postalCode":"12345","supplementalIdentification":{"ssn":"123984321"}},"patientEventDetail":{"certificationActionCode":"A1","reviewIdentificationNumber":"A12345678","previousReviewAuthorizationNumber":"A12345678","previousAdministrativeReferenceNumber":"52598960","certificationIssueDate":"20240220","certificationExpirationDate":"20240818","certificationEffectiveDateBegin":"20240220","healthCareServicesReviewRequestDateBegin":"20240220","diagnosisTypeCode":"ABK","diagnosisCode":"R07.9","freeFormMessageText":"APPROVED","patientEventProviderName":[{"entityIdentifierCode":"FA","organizationName":"TEST, DOMINICA","identificationCodeQualifier":"XX","identifier":"1234567890","address1":"100 DEMO RD","city":"VALHALLA","state":"NY","postalCode":"12345","providerSupplementalInformation":{},"contactFacsimile":"1112223333","contactTelephone":"2223334444"},{"entityIdentifierCode":"DN","lastName":"TEST","firstName":"DOMINICA","identificationCodeQualifier":"XX","identifier":"1234567890","address1":"100 DEMO RD","city":"VALHALLA","state":"NY","postalCode":"12345","providerSupplementalInformation":{},"contactTelephone":"3334445555"}],"serviceLevel":[{"certificationActionCode":"A1","reviewIdentificationNumber":"A12345678","professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"78452","unitOrBasisForMeasurementCode":"UN","serviceUnitCount":"1"},"institutionalService":{},"dentalService":{},"freeFormMessageText":"MYOCARDIAL PERFUSION IMAGING (SPECT); MULTIPLE STUDIES"}]}}}}},"UserInquiryRequestSubscriberWithDetermination":{"summary":"Inquiry Request Subscriber Only","value":{"senderId":"201985AAS","submitterTransactionIdentifier":"1234567890","payerId":"BCBSSC","payerName":"South Carolina Blue Cross Blue","rhPayerId":"UHCDEMODV1","planId":"41","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":"8033952200"},"subscriber":{"lastName":"TEST","firstName":"BRITTANY","memberId":"TST1","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":"0200T"}}]}}},"UserInquiryRequestDependentWithDetermination":{"summary":"Inquiry Request with Dependent","value":{"senderId":"201985AAS","submitterTransactionIdentifier":"1234567890","payerId":"BCBSSC","payerName":"South Carolina Blue Cross Blue","rhPayerId":"UHCDEMODV1","planId":"41","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":"8033952200"},"subscriber":{"lastName":"TEST","firstName":"BRITTANY","memberId":"TST1","dateOfBirth":"19701231","supplementalIdentification":{"groupNumber":"123456789","ssn":"111223333"}},"dependent":{"lastName":"TEST","firstName":"MARY","dateOfBirth":"201001231","supplementalIdentification":{"ssn":"444556666"}},"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":"0200T"}}]}}},"SimplifiedDeterminationRequest":{"summary":"Simplified Determination Request","value":{"rhPayerId":"RH Payer ID","planId":"Plan ID","procedureCodes":"Procedure Code 1"}},"UserInquiryResponseSubscriber":{"summary":"Inquiry Response Subscriber Only","value":{"authorizationId":"a14081f3-b463-449e-a9dc-7ee21aef4552","inquiry":{"x12":"ISA*00*          *00*          *ZZ*INQMEDSOLUTIONS*ZZ*123456789      *240220*2059*^*00501*709893603*0*P*:~GS*HI*INQMEDSOLUTIONS*123456789*20240220*205925*148363198*X*005010X215~ST*278*0001*005010X215~BHT*0007*49*1234567890*20240220*205925*RD~HL*1**20*1~NM1*PR*2*MEDSOLUTIONS*****PI*CIGNA~PER*IC**UR*https//www.evicore.com/provider#login~HL*2*1*21*1~NM1*1P*2*WESTCHESTER MEDICAL CENTER*****XX*1234567890~REF*EI*123456789~HL*3*2*22*1~NM1*IL*1*SMITH*TOM****MI* U1234567890~REF*SY*123121234~REF*3L*12345-1702~REF*1L*CIGNA SI-PPO/OAP~N3*SOME ROAD~N4*BEDFORD*NY*12345~DMG*D8*19700101~HL*4*3*EV*1~HCR*A1*A12345678~REF*BB*A12345678~REF*NT*52598960~DTP*102*D8*20240220~DTP*036*D8*20240818~DTP*007*D8*20240220~DTP*881*D8*20240220~HI*ABK:R07.9~MSG*APPROVED~NM1*FA*2*TEST, DOMINICA*****XX*1234567890~N3*100 DEMO RD~N4*VALHALLA*NY*12345~PER*IC**TE*2223334444*FX*1112223333~NM1*DN*1*TEST*DOMINICA****XX*1234567890~N3*100 DEMO RD~N4*VALHALLA*NY*12345~PER*IC**TE*3334445555~HL*5*4*SS*0~HCR*A1*A12345678~SV1*HC:78452**UN*1~MSG*MYOCARDIAL PERFUSION IMAGING (SPECT); MULTIPLE STUDIES~SE*39*0001~GE*1*148363198~IEA*1*709893603~","json":{"submitterTransactionIdentifier":"1234567890","payerId":"CIGNA","payerName":"MEDSOLUTIONS","umClearingHouseId":"123456789","contactUrl":"https//www.evicore.com/provider#login","umRequestValidation":null,"requester":{"requesterType":"1P","organizationName":"WESTCHESTER MEDICAL CENTER","requesterIdentification":{"employerIdentificationNumber":"123456789"},"npi":"1234567890"},"subscriber":{"lastName":"SMITH","firstName":"TOM","memberId":" U1234567890","dateOfBirth":"19700101","address1":"SOME ROAD","city":"BEDFORD","state":"NY","postalCode":"12345","supplementalIdentification":{"policyNumber":"CIGNA SI-PPO/OAP","branchIdentifier":"12345-1702","ssn":"123121234"}},"patientEventDetail":{"certificationActionCode":"A1","reviewIdentificationNumber":"A12345678","previousReviewAuthorizationNumber":"A12345678","previousAdministrativeReferenceNumber":"52598960","certificationIssueDate":"20240220","certificationExpirationDate":"20240818","certificationEffectiveDateBegin":"20240220","healthCareServicesReviewRequestDateBegin":"20240220","diagnosisTypeCode":"ABK","diagnosisCode":"R07.9","freeFormMessageText":"APPROVED","patientEventProviderName":[{"entityIdentifierCode":"FA","organizationName":"TEST, DOMINICA","identificationCodeQualifier":"XX","identifier":"1234567890","address1":"100 DEMO RD","city":"VALHALLA","state":"NY","postalCode":"12345","providerSupplementalInformation":{},"contactFacsimile":"1112223333","contactTelephone":"2223334444"},{"entityIdentifierCode":"DN","lastName":"TEST","firstName":"DOMINICA","identificationCodeQualifier":"XX","identifier":"1234567890","address1":"100 DEMO RD","city":"VALHALLA","state":"NY","postalCode":"12345","providerSupplementalInformation":{},"contactTelephone":"3334445555"}],"serviceLevel":[{"certificationActionCode":"A1","reviewIdentificationNumber":"A12345678","professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"78452","unitOrBasisForMeasurementCode":"UN","serviceUnitCount":"1"},"institutionalService":{},"dentalService":{},"freeFormMessageText":"MYOCARDIAL PERFUSION IMAGING (SPECT); MULTIPLE STUDIES"}]}}}}},"UserSubmissionResponseDependent":{"summary":"Submission Response with Dependent","value":{"authorizationId":"16665bb7-3040-4d4d-a889-123a27b29789","submission":{"x12":"ISA*00*6666      *00*5555      *ZZ*6546564        *ZZ*6546564        *0623  *1301*^*00501*000000001*0*T*:~GS*HI*FL0738*PERSEPVS*20090601*040612*1*X*005010X217~ST*278*0001*005010X217~BHT*0007*11*165932*20055002*0815*18~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*1234567890~DMG*D8*19700101*M~HL*4*3*EV*1~UM*HS*I*56*41:B~HCR*A1*1234567890123~DTP*AAH*D8*20250101~CR1***X**DH*27~NM1*PW*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*ND*2*DOCTOR OFFICE~N3*123 SOME AVENUE~N4*SACRAMENTO*CA*95624~NM1*R3*2*SOME DIALYSIS CENTER~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*FS*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~HL*5*4*SS*0~SV1*HC:A0428:RX**UN*5~HL*6*4*SS*0~SV1*HC:A0428:PD**UN*8~HL*7*4*SS*0~SV1*HC:A0428:DR**UN*14~SE*34*0001~GE*1*1~IEA*1*000000001~","json":{"submitterTransactionIdentifier":"165932","payerId":"1234560010","payerName":"ABC PAYER","umClearingHouseId":"PERSEPVS","umRequestValidation":null,"requester":{"requesterType":"1P","lastName":"XYZ AMBULANCE SVC","requesterIdentification":{},"employersId":"7759621873"},"subscriber":{"lastName":"SMITH","firstName":"JOE","memberId":"12345689001","dateOfBirth":"19700101","genderCode":"M","supplementalIdentification":{"patientAccountNumber":"1234567890"}},"dependent":{"lastName":"SMITH","firstName":"JANE","dateOfBirth":"19700101","genderCode":"F","address1":"SOME ROAD","city":"BEDFORD","state":"NY","postalCode":"12345","supplementalIdentification":{"ssn":"123456789"}},"patientEventDetail":{"requestCategoryCode":"HS","certificationTypeCode":"I","serviceTypeCode":"56","facilityTypeCode":"41","facilityCodeQualifier":"B","certificationActionCode":"A1","reviewIdentificationNumber":"1234567890123","eventDateBegin":"20250101","ambulanceTransportCode":"X","ambulanceUnitOrBasisForMeasurementCode":"DH","ambulanceTransportDistance":"27","patientEventAdditionalPatientInformationContactName":[{}],"patientEventTransportInformation":[{"entityIdentifierCode":"PW","transportLocationName":"HOME","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"},{"entityIdentifierCode":"ND","transportLocationName":"DOCTOR OFFICE","address1":"123 SOME AVENUE","city":"SACRAMENTO","state":"CA","postalCode":"95624"},{"entityIdentifierCode":"R3","transportLocationName":"SOME DIALYSIS CENTER","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"},{"entityIdentifierCode":"FS","transportLocationName":"HOME","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"}],"serviceLevel":[{"professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"A0428","procedureModifier":"RX","unitOrBasisForMeasurementCode":"UN","serviceUnitCount":"5"},"institutionalService":{},"dentalService":{},"serviceDetailAdditionalServiceInformationContactName":[{}]},{"professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"A0428","procedureModifier":"PD","unitOrBasisForMeasurementCode":"UN","serviceUnitCount":"8"},"institutionalService":{},"dentalService":{},"serviceDetailAdditionalServiceInformationContactName":[{}]},{"professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"A0428","procedureModifier":"DR","unitOrBasisForMeasurementCode":"UN","serviceUnitCount":"14"},"institutionalService":{},"dentalService":{},"serviceDetailAdditionalServiceInformationContactName":[{}]}]}}}}},"UserSubmissionResponseSubscriber":{"summary":"Submission Response Subscriber Only","value":{"authorizationId":"16665bb7-3040-4d4d-a889-123a27b29789","submission":{"x12":"ISA*00*6666      *00*5555      *ZZ*6546564        *ZZ*6546564        *0623  *1301*^*00501*000000001*0*T*:~GS*HI*FL0738*PERSEPVS*20090601*040612*1*X*005010X217~ST*278*0001*005010X217~BHT*0007*11*165932*20055002*0815*18~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*1234567890~DMG*D8*19700101*M~HL*4*3*EV*1~UM*HS*I*56*41:B~HCR*A1*1234567890123~DTP*AAH*D8*20250101~CR1***X**DH*27~NM1*PW*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*ND*2*DOCTOR OFFICE~N3*123 SOME AVENUE~N4*SACRAMENTO*CA*95624~NM1*R3*2*SOME DIALYSIS CENTER~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*FS*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~HL*5*4*SS*0~SV1*HC:A0428:RX**UN*5~HL*6*4*SS*0~SV1*HC:A0428:PD**UN*8~HL*7*4*SS*0~SV1*HC:A0428:DR**UN*14~SE*34*0001~GE*1*1~IEA*1*000000001~","json":{"submitterTransactionIdentifier":"165932","payerId":"1234560010","payerName":"ABC PAYER","umClearingHouseId":"PERSEPVS","umRequestValidation":null,"requester":{"requesterType":"1P","lastName":"XYZ AMBULANCE SVC","requesterIdentification":{},"employersId":"7759621873"},"subscriber":{"lastName":"SMITH","firstName":"JOE","memberId":"12345689001","dateOfBirth":"19700101","genderCode":"M","supplementalIdentification":{"patientAccountNumber":"1234567890"}},"dependent":{"supplementalIdentification":{}},"patientEventDetail":{"requestCategoryCode":"HS","certificationTypeCode":"I","serviceTypeCode":"56","facilityTypeCode":"41","facilityCodeQualifier":"B","certificationActionCode":"A1","reviewIdentificationNumber":"1234567890123","eventDateBegin":"20250101","ambulanceTransportCode":"X","ambulanceUnitOrBasisForMeasurementCode":"DH","ambulanceTransportDistance":"27","patientEventAdditionalPatientInformationContactName":[{}],"patientEventTransportInformation":[{"entityIdentifierCode":"PW","transportLocationName":"HOME","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"},{"entityIdentifierCode":"ND","transportLocationName":"DOCTOR OFFICE","address1":"123 SOME AVENUE","city":"SACRAMENTO","state":"CA","postalCode":"95624"},{"entityIdentifierCode":"R3","transportLocationName":"SOME DIALYSIS CENTER","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"},{"entityIdentifierCode":"FS","transportLocationName":"HOME","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"}],"serviceLevel":[{"professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"A0428","procedureModifier":"RX","unitOrBasisForMeasurementCode":"UN","serviceUnitCount":"5"},"institutionalService":{},"dentalService":{},"serviceDetailAdditionalServiceInformationContactName":[{}]},{"professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"A0428","procedureModifier":"PD","unitOrBasisForMeasurementCode":"UN","serviceUnitCount":"8"},"institutionalService":{},"dentalService":{},"serviceDetailAdditionalServiceInformationContactName":[{}]},{"professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"A0428","procedureModifier":"DR","unitOrBasisForMeasurementCode":"UN","serviceUnitCount":"14"},"institutionalService":{},"dentalService":{},"serviceDetailAdditionalServiceInformationContactName":[{}]}]}}}}},"UserNoaResponse":{"summary":"Noa Response Subscriber Only","value":{"authorizationId":"16665bb7-3040-4d4d-a889-123a27b29789","noa":{"x12":"ISA*00*6666      *00*5555      *ZZ*6546564        *ZZ*6546564        *0623  *1301*^*00501*000000001*0*T*:~GS*HI*FL0738*PERSEPVS*20090601*040612*1*X*005010X216~ST*278*0001*005010X216~BHT*0007*11*165932*20055002*0815*18~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*1234567890~DMG*D8*19700101*M~HL*4*3*EV*1~UM*HS*I*56*41:B~HCR*A1*1234567890123~DTP*AAH*D8*20250101~CR1***X**DH*27~NM1*PW*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*ND*2*DOCTOR OFFICE~N3*123 SOME AVENUE~N4*SACRAMENTO*CA*95624~NM1*R3*2*SOME DIALYSIS CENTER~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~NM1*FS*2*HOME~N3*123 SOME ROAD~N4*SACRAMENTO*CA*95826~HL*5*4*SS*0~SV1*HC:A0428:RX**UN*5~HL*6*4*SS*0~SV1*HC:A0428:PD**UN*8~HL*7*4*SS*0~SV1*HC:A0428:DR**UN*14~SE*34*0001~GE*1*1~IEA*1*000000001~","json":{"submitterTransactionIdentifier":"165932","payerId":"1234560010","payerName":"ABC PAYER","umClearingHouseId":"PERSEPVS","umRequestValidation":null,"requester":{"requesterType":"1P","lastName":"XYZ AMBULANCE SVC","requesterIdentification":{},"employersId":"7759621873"},"subscriber":{"lastName":"SMITH","firstName":"JOE","memberId":"12345689001","dateOfBirth":"19700101","genderCode":"M","supplementalIdentification":{"patientAccountNumber":"1234567890"}},"dependent":{"supplementalIdentification":{}},"patientEventDetail":{"requestCategoryCode":"HS","certificationTypeCode":"I","serviceTypeCode":"56","facilityTypeCode":"41","facilityCodeQualifier":"B","certificationActionCode":"A1","reviewIdentificationNumber":"1234567890123","eventDateBegin":"20250101","ambulanceTransportCode":"X","ambulanceUnitOrBasisForMeasurementCode":"DH","ambulanceTransportDistance":"27","patientEventAdditionalPatientInformationContactName":[{}],"patientEventTransportInformation":[{"entityIdentifierCode":"PW","transportLocationName":"HOME","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"},{"entityIdentifierCode":"ND","transportLocationName":"DOCTOR OFFICE","address1":"123 SOME AVENUE","city":"SACRAMENTO","state":"CA","postalCode":"95624"},{"entityIdentifierCode":"R3","transportLocationName":"SOME DIALYSIS CENTER","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"},{"entityIdentifierCode":"FS","transportLocationName":"HOME","address1":"123 SOME ROAD","city":"SACRAMENTO","state":"CA","postalCode":"95826"}],"serviceLevel":[{"professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"A0428","procedureModifier":"RX","unitOrBasisForMeasurementCode":"UN","serviceUnitCount":"5"},"institutionalService":{},"dentalService":{},"serviceDetailAdditionalServiceInformationContactName":[{}]},{"professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"A0428","procedureModifier":"PD","unitOrBasisForMeasurementCode":"UN","serviceUnitCount":"8"},"institutionalService":{},"dentalService":{},"serviceDetailAdditionalServiceInformationContactName":[{}]},{"professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"A0428","procedureModifier":"DR","unitOrBasisForMeasurementCode":"UN","serviceUnitCount":"14"},"institutionalService":{},"dentalService":{},"serviceDetailAdditionalServiceInformationContactName":[{}]}]}}}}},"OrchestrationJSONRequestWithSplit":{"summary":"JSON Orchestration - Two procedure codes require auth with split","value":{"senderId":"201985AAS","submitterTransactionIdentifier":"1234567890","payerId":"BCBSSC","payerName":"South Carolina Blue Cross Blue","rhPayerId":"UHCDEMODV1","planId":"41","umClearingHouseId":"UHCDIRECT","requester":{"requesterType":"1P","organizationName":"Regional Medical Center","lastName":"Regional Medical Center","requesterIdentification":{"employerIdentificationNumber":"123456789"},"city":"Orangeburg","state":"SC","postalCode":"12345","npi":"1234567890","contactTelephone":"8033952200"},"subscriber":{"lastName":"TEST","firstName":"BRITTANY","memberId":"multi-01-approved","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":"T1000"}},{"requestCategoryCode":"HS","facilityTypeCode":"11","facilityCodeQualifier":"B","serviceDateBegin":"20231017","serviceDateEnd":"20231017","professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"0214T"}}]}}},"OrchestrationJSONRequestOneRequired":{"summary":"JSON Orchestration - Two procedure codes; one requires auth","value":{"senderId":"201985AAS","submitterTransactionIdentifier":"1234567890","payerId":"BCBSSC","payerName":"South Carolina Blue Cross Blue","rhPayerId":"UHCDEMODV1","planId":"41","umClearingHouseId":"UHCDIRECT","requester":{"requesterType":"1P","organizationName":"Regional Medical Center","lastName":"Regional Medical Center","requesterIdentification":{"employerIdentificationNumber":"123456789"},"city":"Orangeburg","state":"SC","postalCode":"12345","npi":"1234567890","contactTelephone":"8033952200"},"subscriber":{"lastName":"TEST","firstName":"BRITTANY","memberId":"multi-01-approved","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":"T1000"}},{"requestCategoryCode":"HS","facilityTypeCode":"11","facilityCodeQualifier":"B","serviceDateBegin":"20231017","serviceDateEnd":"20231017","professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"9876T"}}]}}},"OrchestrationJSONRequestAuthNotRequired":{"summary":"JSON Orchestration - No procedure codes require auth","value":{"senderId":"201985AAS","submitterTransactionIdentifier":"1234567890","payerId":"BCBSSC","payerName":"South Carolina Blue Cross Blue","rhPayerId":"UHCDEMODV1","planId":"41","umClearingHouseId":"UHCDIRECT","requester":{"requesterType":"1P","organizationName":"Regional Medical Center","lastName":"Regional Medical Center","requesterIdentification":{"employerIdentificationNumber":"123456789"},"city":"Orangeburg","state":"SC","postalCode":"12345","npi":"1234567890","contactTelephone":"8033952200"},"subscriber":{"lastName":"TEST","firstName":"BRITTANY","memberId":"multi-01-approved","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":"6789T"}},{"requestCategoryCode":"HS","facilityTypeCode":"11","facilityCodeQualifier":"B","serviceDateBegin":"20231017","serviceDateEnd":"20231017","professionalService":{"productOrServiceIDQualifier":"HC","procedureCode":"9876T"}}]}}}},"securitySchemes":{"bearerAuth":{"type":"http","scheme":"bearer","bearerFormat":"JWT"}}},"security":[{"bearerAuth":[]}],"x-readme":{"explorer-enabled":true,"proxy-enabled":true}}