Overview
Cair Health provides a webhook system that allows you to receive real-time notifications when a claim is processed by the Cair Scrubbing AI. This enables you to integrate your systems with Cair Health and synchronize your information with Cair. When a claim is finished scrubbing, whether through automated scrub or a scrub triggered manually, the webhook will automatically post the results to your endpoint.Setup
To enable webhook delivery for patient chart analysis:- Navigate to your Developer Settings
- Go to the Webhooks section
- Create a new webhook with the following information:
- URL: The endpoint where you want to receive webhook payloads
- Event Type: Select
CLAIMS_AI_OPTIMIZER - Description: A description for your reference
- Credentials: Your preferred credentials set
Event Types
You can subscribe to the following event type for patient chart analysis:| Event Type | Description |
|---|---|
CLAIMS_AI_OPTIMIZER | Receive scrub results when complete |
Authentication
For security, webhooks can be authenticated using API keys. When setting up your webhook, you can configure:- Authentication Type: Currently supports
API_SECRET,HMAC-256 - Header Name: The HTTP header that will contain your secret (e.g.,
X-API-KEY) - Secret: The secret value that will be sent with each webhook request
Payload Format
The webhook payload contains the complete analysis results in JSON format. Below is an example the structure of the response:Copy
{
"output": {
"claim_id": "58ba229f-b35c-4e46-9af5-e54df39b6e48",
"optimizer_run_id": "ba757342-2a29-4972-ab3a-341a04a4bd9b",
"ai_generated_claim_extended": "**Patient:** Jane Doe, Date of Birth: October 10, 1970, Gender: Male\n\n**Billing Provider:** Chicago Healthcare Alliance, NPI: 2538929880\n\n**Rendering Provider:** Ethan Wilson, NPI: 1995116984\n\n**Payer:** Aetna\n\n**Encounter Details:**\n\nThis claim is for a professional service encounter for Jane Doe, a male patient born on October 10, 1970. The encounter took place on November 17, 2025. The patient was diagnosed with Obesity, class 1, and Other specified anxiety disorders. The services rendered included an office or other outpatient visit for evaluation and management, along with an additional service related to obesity management. The total charge for the services is $225.00.\n\n**Medical Codes:**\n\n* **Diagnosis:**\n * **Principal Diagnosis:** \"E66.811\" - \"Obesity, Class 1\". This ICD-10-CM code is selected as it directly reflects the patient's primary diagnosis of obesity, as stated in the encounter details.\n * **Secondary Diagnosis:** \"F41.8\" - \"Other Specified Anxiety Disorders\". This ICD-10-CM code is selected as it represents the patient's secondary diagnosis of anxiety, as stated in the encounter details.\n\n* **Procedure:**\n * **CPT Code:** \"99214\" - \"Office or other outpatient visit for the evaluation and management of an established patient\". This code is selected as it accurately describes the E/M service provided for an established patient, as indicated in the encounter summary.\n * **HCPCS Code:** \"3008F\" - This code is added as per the specific rule: \"If the patient is diagnosed with Obesity (any diagnosis code with (EXX), add service line item 3008F with 1 unit and a cost of 75.00\". The patient has a diagnosis of E66.811 (Obesity, class 1), which triggers this rule.\n\n* **Modifiers:**\n * **Modifier:** \"RT\" - \"Right side\". This modifier is applied to CPT code 99214 as specified in the encounter details.\n\n**Notes:**\n\n* **Place of Service:** The place of service code \"11\" (Office) has been applied to all service lines as per the rule: \"All Aetna claims should be billed with place of service code 11\".\n* **Diagnosis Sequencing:** The diagnosis codes have been sequenced with E66.811 as principal (sequence 1) and F41.8 as secondary (sequence 2) to ensure proper claim processing, as multiple diagnoses cannot share the same sequence number or principal type.\n* **Supporting Documentation:** No specific supporting documentation is explicitly mentioned as required for this claim beyond standard medical records. However, clinical notes detailing the evaluation and management of both obesity and anxiety, as well as the specific intervention related to code 3008F, should be maintained by the provider.\n* **Optional Claim Fields:** The \"Accept Assignment\" field is included with a value of 'Y' (Yes) as per the general requirement to always include it. The \"Claim Filing Indicator Code\" is included as 'CI' (Commercial Insurance Co.) as specified in the encounter details.",
"ai_generated_encounter_description": "**Claim Summary**\n\n**Complete Encounter Description:**\nThe provided FHIR Claim resource details a professional service encounter for a patient diagnosed with Obesity, class 1 (E66.811) and Other specified anxiety disorders (F41.8). A CPT code 99214 with modifier RT was performed on November 17, 2025, with a charge of $150.00. The claim indicates that the provider accepts assignment. No further clinical narrative or treatment details are explicitly stated in the provided notes.\n\n**Patient Information:**\n* Name: Jane Doe\n* DOB: 10-10-1970\n* Gender: male\n* Address: 891 Cedar Street, Minneapolis, MN 55401\n* Patient ID/Account Number: OV7444602\n\n**Insurance Information:**\n* Primary Insurance Provider: Aetna\n* Payer ID/EDI Number: 60054\n* Insurance Plan: Not specified in notes.\n* Subscriber Name: Jane Doe\n* Subscriber ID: OV7444602\n* Group Number: OV7444602\n* Relationship to Subscriber: Self\n* Claim Filing Indicator Code: CI (Commercial Insurance Co.)\n\n**Billing Provider Information:**\n* Name: Chicago Healthcare Alliance\n* NPI: 2538929880\n* Tax ID: 52-6769967\n* Address: 221 North LaSalle Street, Chicago, IL 60601\n* Contact: Not specified in notes.\n* Taxonomy Code: 282N00000X\n\n**Rendering Provider Information:**\n* Name: Ethan Wilson\n* NPI: 1995116984\n* Taxonomy Code: 208D00000X\n\n**Submitter Information:**\n* Name: Not specified in notes.\n* ID: Not specified in notes.\n* Contact: Not specified in notes.\n\n**Service Information:**\n* Date of Service: 11-17-2025\n* Place of Service: Not specified in notes.\n* Procedures:\n * 99214 - Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Typically, 25 minutes are spent face-to-face with the patient and/or family.\n * Modifier: RT (Right side)\n* Diagnoses:\n * E66.811 - Obesity, class 1\n * F41.8 - Other specified anxiety disorders\n* Charges: $150.00\n* Service Units: 1\n* Diagnosis Pointers: 1, 2 (Both diagnoses apply to the procedure)\n\n**Claim Details:**\n* Assignment of Benefits: Not specified in notes.\n* Accept Assignment: Yes\n* Release of Information: Not specified in notes.\n* Provider Signature on File: Not specified in notes.\n* Prior Authorization Numbers: Not specified in notes.\n* Referral Number: Not specified in notes.\n* Special Billing Notes: Not specified in notes.\n* Related to: Not specified in notes.\n\n**Missing Information:**\n* Insurance Plan\n* Billing Provider Contact\n* Submitter Name\n* Submitter ID\n* Submitter Contact\n* Place of Service\n* Assignment of Benefits\n* Release of Information\n* Provider Signature on File\n* Prior Authorization Numbers\n* Referral Number\n* Special Billing Notes\n* Related to (Employment, Auto Accident, Other Accident)",
"ai_generated_x12_837": "{\n \"resourceType\": \"Claim\",\n \"id\": \"58ba229f-b35c-4e46-9af5-e54df39b6e48\",\n \"status\": \"active\",\n \"type\": {\n \"coding\": [\n {\n \"code\": \"professional\",\n \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\"\n }\n ]\n },\n \"patient\": {\n \"type\": \"Patient\",\n \"reference\": \"Patient/79c87bbd-9de4-41bb-a25f-0f78bfb41c4c\"\n },\n \"use\": \"claim\",\n \"created\": \"2025-11-21\",\n \"insurer\": {\n \"type\": \"Organization\",\n \"reference\": \"Organization/c9060e87-15c0-4b82-8a7d-f0faee2d456d\"\n },\n \"provider\": {\n \"type\": \"Organization\",\n \"reference\": \"Organization/7e294528-4edb-40df-ad50-9da07d05d195\"\n },\n \"priority\": {\n \"coding\": [\n {\n \"code\": \"normal\",\n \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n \"display\": \"Normal\"\n }\n ]\n },\n \"supportingInfo\": [\n {\n \"code\": {\n \"coding\": [\n {\n \"code\": \"Y\",\n \"system\": \"https://bluebutton.cms.gov/assets/ig/CodeSystem-asgmntcd\",\n \"display\": \"Yes\"\n }\n ]\n },\n \"category\": {\n \"coding\": [\n {\n \"code\": \"acceptassignment\",\n \"system\": \"http://terminology.hl7.org/CodeSystem/claiminformationcategory\",\n \"display\": \"Accept Assignment\"\n }\n ]\n },\n \"sequence\": 1\n },\n {\n \"code\": {\n \"coding\": [\n {\n \"code\": \"CI\",\n \"system\": \"https://x12.org/codes/claim-filing-indicator-code\",\n \"display\": \"Commercial Insurance Co.\"\n }\n ]\n },\n \"category\": {\n \"coding\": [\n {\n \"code\": \"claim-filing-indicator\",\n \"system\": \"https://fhir.cairhealth.com/fhir/CodeSystem/claim-additional-information-category\",\n \"display\": \"Claim Filing Indicator Code\"\n }\n ]\n },\n \"sequence\": 2\n }\n ],\n \"careTeam\": [\n {\n \"sequence\": 1,\n \"provider\": {\n \"type\": \"Organization\",\n \"reference\": \"Organization/7e294528-4edb-40df-ad50-9da07d05d195\"\n },\n \"role\": {\n \"coding\": [\n {\n \"code\": \"primary\",\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"display\": \"Billing Provider\"\n }\n ]\n },\n \"responsible\": true,\n \"qualification\": {\n \"coding\": [\n {\n \"code\": \"282N00000X\",\n \"system\": \"http://nucc.org/provider-taxonomy\",\n \"display\": \"General Acute Care Hospital\"\n }\n ]\n }\n },\n {\n \"sequence\": 2,\n \"provider\": {\n \"type\": \"Practitioner\",\n \"reference\": \"Practitioner/95a40f30-9bf2-4030-ad46-b655a654d33a\"\n },\n \"role\": {\n \"coding\": [\n {\n \"code\": \"rendering\",\n \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n \"display\": \"Rendering Provider\"\n }\n ]\n },\n \"responsible\": false,\n \"qualification\": {\n \"coding\": [\n {\n \"code\": \"208D00000X\",\n \"system\": \"http://nucc.org/provider-taxonomy\",\n \"display\": \"General Practice Physician\"\n }\n ]\n }\n }\n ],\n \"diagnosis\": [\n {\n \"sequence\": 1,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"code\": \"E66.811\",\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"display\": \"Obesity, class 1\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"code\": \"principal\",\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-diagnosistype\"\n }\n ]\n }\n ]\n },\n {\n \"sequence\": 2,\n \"diagnosisCodeableConcept\": {\n \"coding\": [\n {\n \"code\": \"F41.8\",\n \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n \"display\": \"Other specified anxiety disorders\"\n }\n ]\n },\n \"type\": [\n {\n \"coding\": [\n {\n \"code\": \"secondary\",\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-diagnosistype\"\n }\n ]\n }\n ]\n }\n ],\n \"insurance\": [\n {\n \"coverage\": {\n \"type\": \"Coverage\",\n \"reference\": \"Coverage/c81bb743-734c-4663-81b5-34329058cfb7\"\n },\n \"focal\": true,\n \"sequence\": 1\n }\n ],\n \"item\": [\n {\n \"sequence\": 1,\n \"careTeamSequence\": [\n 2\n ],\n \"diagnosisSequence\": [\n 1,\n 2\n ],\n \"productOrService\": {\n \"coding\": [\n {\n \"code\": \"99214\",\n \"system\": \"http://www.ama-assn.org/go/cpt\"\n }\n ]\n },\n \"modifier\": [\n {\n \"coding\": [\n {\n \"code\": \"RT\",\n \"system\": \"https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n \"display\": \"Right side\"\n }\n ]\n }\n ],\n \"servicedDate\": \"2025-11-17\",\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-serviceplace\",\n \"code\": \"11\",\n \"display\": \"Office\"\n }\n ]\n },\n \"quantity\": {\n \"value\": 1\n },\n \"unitPrice\": {\n \"value\": 150.0,\n \"currency\": \"USD\"\n },\n \"net\": {\n \"value\": 150.0,\n \"currency\": \"USD\"\n }\n },\n {\n \"sequence\": 2,\n \"careTeamSequence\": [\n 2\n ],\n \"diagnosisSequence\": [\n 1\n ],\n \"productOrService\": {\n \"coding\": [\n {\n \"code\": \"3008F\",\n \"system\": \"http://www.ama-assn.org/go/cpt\"\n }\n ]\n },\n \"servicedDate\": \"2025-11-17\",\n \"locationCodeableConcept\": {\n \"coding\": [\n {\n \"system\": \"http://terminology.hl7.org/CodeSystem/ex-serviceplace\",\n \"code\": \"11\",\n \"display\": \"Office\"\n }\n ]\n },\n \"quantity\": {\n \"value\": 1\n },\n \"unitPrice\": {\n \"value\": 75.0,\n \"currency\": \"USD\"\n },\n \"net\": {\n \"value\": 75.0,\n \"currency\": \"USD\"\n }\n }\n ],\n \"total\": {\n \"value\": 225.0,\n \"currency\": \"USD\"\n },\n \"identifier\": [\n {\n \"value\": \"52343746129383\",\n \"system\": \"https://fhir.cairhealth.com/fhir/identifier/claim-id\",\n \"assigner\": {\n \"type\": \"Organization\",\n \"reference\": \"Organization/7e294528-4edb-40df-ad50-9da07d05d195\"\n }\n }\n ],\n \"extension\": [\n {\n \"url\": \"https://fhir.cairhealth.com/StructureDefinition/claim-patient-paid\",\n \"valueMoney\": {\n \"value\": 0,\n \"currency\": \"USD\"\n }\n }\n ],\n \"meta\": {\n \"extension\": [\n {\n \"url\": \"https://aidbox.app/tenant-organization-id\",\n \"valueReference\": {\n \"reference\": \"Organization/cair-health\"\n }\n },\n {\n \"url\": \"https://aidbox.app/ex/createdAt\",\n \"valueInstant\": \"2025-12-19T15:43:39.855972Z\"\n }\n ],\n \"lastUpdated\": \"2025-12-19T15:43:39.855972Z\",\n \"versionId\": \"16515281\"\n }\n}",
"relevant_rules_report": "{\n \"rules_flagged\": [],\n \"rules_applied\": [\n {\n \"id\": \"35924ec9-d150-4955-852f-4773b92243ad\",\n \"text\": \"If the patient is diagnosed with Obesity (any diagnosis code with (EXX), add service line item 3008F with 1 unit and a cost of 75.00\",\n \"tags\": \"\"\n },\n {\n \"id\": \"c0327e2a-4cbc-43c9-9571-9de5fb3419d7\",\n \"text\": \"All Aetna claims should be billed with place of service code 11\",\n \"tags\": null\n }\n ]\n}",
"edits": [
{
"difference": "The patient, coverage, insurer, provider, and care team elements in the generated claim are represented as references, while the uploaded claim included full resource objects for these elements.",
"rationale": "The system instructions explicitly require that these elements be represented as references only, omitting the full resource details, to ensure compliance with FHIR schema for references."
},
{
"difference": "The second diagnosis's sequence was changed from 1 to 2.",
"rationale": "Diagnosis sequence numbers must be unique for each diagnosis entry."
},
{
"difference": "The type of the second diagnosis (F41.8) was changed from 'principal' to 'secondary'.",
"rationale": "Typically, a claim should only have one principal diagnosis. The second diagnosis was reclassified as secondary."
},
{
"difference": "A second service line item was added to the claim.",
"rationale": "The rule \"If the patient is diagnosed with Obesity (any diagnosis code with (EXX), add service line item 3008F with 1 unit and a cost of 75.00\" and the enforcement criteria explicitly required the inclusion of procedure code 3008F for the patient's obesity diagnosis."
}
],
"additional_info": {
"organization_id": "ca12ca12-f9e0-4467-b55f-78874bd1468e",
"user_id": "ca12ca12-f9e0-4467-b55f-78874bd1468e",
"custom_guidelines": "",
"eligibility_check_info": ""
}
}
}
ai_generated_x12_837 will be a stringified-JSON of the FHIR Claim resource representing the encounter. edits will contain AI-generated modifications from the original claim including rationales.