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POST
/
api
/
claim
/
professional
/
v1
cURL
curl --request POST \
  --url https://forecaster.cairhealth.com/api/claim/professional/v1 \
  --header 'Authorization: Bearer <token>' \
  --header 'Content-Type: application/json' \
  --data '
{
  "accept_assignment": true,
  "id": "12345",
  "date_of_service": "2025-03-15",
  "total_charge": "250.00",
  "patient": {
    "id": "P98765",
    "first_name": "John",
    "last_name": "Doe",
    "name": "John Doe",
    "gender": "male",
    "dob": "1980-05-15",
    "location": {
      "city": "San Francisco",
      "country": "USA",
      "line1": "123 Main St",
      "line2": "Apt 4B",
      "state": "CA",
      "zip": "94105"
    },
    "policies": [
      {
        "id": "POL123",
        "group_num": "GRP456",
        "name": "Premium Health Plan",
        "holder_first": "John",
        "holder_last": "Doe",
        "holder_relationship": "self",
        "claim_filing_indicator": "CI",
        "priority_type": "primary",
        "insurance_plan": {
          "payer_name": "Blue Cross",
          "payer_id": "BCBS123",
          "name_and_id": "Blue Cross (BCBS123)"
        }
      }
    ]
  },
  "billing_provider": {
    "name": "Medical Group Inc",
    "npi": "1234567890",
    "tax_id": "12-3456789",
    "taxonomy_code": "207Q00000X",
    "location": {
      "city": "San Francisco",
      "country": "USA",
      "line1": "456 Health Ave",
      "state": "CA",
      "zip": "94107"
    }
  },
  "rendering_provider": {
    "id": "DR12345",
    "first_name": "Jane",
    "last_name": "Smith",
    "npi": "5432167890",
    "taxonomy_code": "207Q00000X",
    "name": "Jane Smith, MD"
  },
  "referring_provider": {
    "first_name": "Robert",
    "last_name": "Johnson",
    "npi": "1111222233",
    "name": "Robert Johnson, MD"
  },
  "ordering_provider": {
    "first_name": "Emily",
    "last_name": "Chen",
    "npi": "4444555566",
    "taxonomy_code": "207Q00000X",
    "name": "Emily Chen, MD"
  },
  "service_location": {
    "city": "San Francisco",
    "state": "CA",
    "zip": "94107",
    "name": "Medical Group Inc",
    "place_of_service": {
      "code": "11",
      "name": "Office",
      "code_name": "11 - Office"
    }
  },
  "cpt_codes_cms1500s": [
    {
      "cpt_code": {
        "code": "99213"
      },
      "fee": "150.00",
      "units": "1"
    },
    {
      "cpt_code": {
        "code": "85025"
      },
      "fee": "100.00",
      "units": "1",
      "ndc_information": {
        "ndc_code": "00071015527",
        "ndc_quantity": "2",
        "ndc_quantity_unit": "ML"
      }
    }
  ],
  "icd_codes_cms1500s": [
    {
      "icd_code": {
        "code": "J20.9"
      }
    },
    {
      "icd_code": {
        "code": "R50.9"
      }
    }
  ],
  "claim_condition_codes": [
    {
      "code": "01"
    }
  ],
  "claim_additional_information": [
    {
      "code": "A1",
      "text": "Additional information"
    }
  ],
  "injury_cause_reasons": {
    "employment_related": false,
    "auto_accident": false,
    "other": false
  },
  "patient_paid_amount": 50,
  "clia_number": "12D3456789"
}
'
{
  "resourceType": "OperationOutcome",
  "issue": [
    {
      "severity": "information",
      "code": "informational",
      "details": {
        "text": "All OK"
      }
    }
  ]
}

Authorizations

​
Authorization
string
header
required

Bearer authentication header of the form Bearer <token>, where <token> is your auth token.

Query Parameters

​
attachmentId
string

Optional ID of document references to associate with the claim. Can be specified multiple times. This id will be returned from the Create Claim Attachment endpoint.

​
primaryPcn
string

Optional primary PCN to associate with the claim. You should ONLY use this in cases of submitting a secondary or tertiary claim, or in some specific denial resubmission scenarios.

Body

application/json

CMS 1500 professional claim data

​
accept_assignment
boolean
required

Whether the provider agrees to accept assignment

​
id
string
required

Unique identifier for the CMS 1500 form

​
date_of_service
string
required

Date when the service was provided

​
total_charge
string
required

Total charge amount for the claim

​
patient
object
required

Information about the patient

​
billing_provider
object
required

Information about the billing provider

​
rendering_provider
object
required

Information about the rendering provider

​
cpt_codes_cms1500s
object[]
required

CPT codes associated with the claim

​
icd_codes_cms1500s
object[]
required

ICD diagnosis codes associated with the claim

​
referring_provider
object

Information about the referring provider.

​
ordering_provider
object

Information about the ordering provider.

​
service_location
object

Location of the service

​
claim_condition_codes
object[]

Claim condition codes

​
claim_additional_information
object[]

Additional information codes for the claim

​
injury_cause_reasons
object

Information about injury cause and reasons. If all are false, omit this field.

​
patient_paid_amount
number

Amount paid by the patient

​
clia_number
string

Clinical Laboratory Improvement Amendment (CLIA) number for CLIA-certified facilities performing CLIA-covered laboratory services.

Response

Claim created successfully

A FHIR standard response format for operations

​
resourceType
enum<string>
required

Type of resource

Available options:
OperationOutcome
​
issue
object[]
required

A list of issues with the operation

​
id
string

Logical id of this artifact