> ## Documentation Index > Fetch the complete documentation index at: https://docs.cairhealth.com/llms.txt > Use this file to discover all available pages before exploring further. # Create Professional Claim > Creates a professional claim from a CMS 1500 file. This schema is an augmentation of the Healthie CMS 1500 schema to support the full CMS-1500 claim format. ## OpenAPI ````yaml POST /api/claim/professional/v1 openapi: 3.1.0 info: title: Cair Health APIs description: APIs for the Cair Health platform license: name: MIT version: 1.0.0 servers: - url: https://forecaster.cairhealth.com security: - bearerAuth: [] paths: /api/claim/professional/v1: post: description: >- Creates a professional claim from a CMS 1500 file. This schema is an augmentation of the Healthie CMS 1500 schema to support the full CMS-1500 claim format. parameters: - name: attachmentId in: query description: >- 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](../claims/create-claim-attachment) endpoint. required: false schema: type: string - name: primaryPcn in: query description: >- 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. required: false schema: type: string requestBody: description: CMS 1500 professional claim data content: application/json: schema: type: object properties: accept_assignment: type: boolean description: Whether the provider agrees to accept assignment id: type: string description: Unique identifier for the CMS 1500 form date_of_service: type: string description: Date when the service was provided total_charge: type: string description: Total charge amount for the claim patient: type: object description: Information about the patient properties: id: type: string description: Patient identifier first_name: type: string description: Patient's first name last_name: type: string description: Patient's last name name: type: string description: Patient's full name gender: type: string description: Patient's gender dob: type: string description: Patient's date of birth location: type: object description: Patient's address information properties: city: type: string description: City country: type: string description: Country line1: type: string description: Address line 1 line2: type: string description: Address line 2 name: type: string description: Location name state: type: string description: State to_oneline: type: string description: Single line address representation zip: type: string description: ZIP/Postal code place_of_service: type: object description: Place of service details properties: code: type: string description: Code of the place of service name: type: string description: Name of the place of service code_name: type: string description: Code name of the place of service policies: type: array description: Patient's insurance policies items: type: object properties: id: type: string description: Policy identifier num: type: string description: Policy number group_num: type: string description: Insurance group number name: type: string description: Policy name holder_first: type: string description: Policy holder's first name holder_last: type: string description: Policy holder's last name holder_relationship: type: string description: Relationship between patient and policy holder claim_filing_indicator: type: string description: Claim filing indicator code insurance_type_code: type: string description: >- Insurance type code for Medicare secondary claims. Required when claim_filing_indicator is MA or MB and the policy is secondary. enum: - '12' - '13' - '14' - '15' - '16' - '41' - '42' - '43' - '47' priority_type: type: string description: Priority type of the insurance policy prior_authorization: type: string description: >- Prior authorization reference number for the policy. insurance_plan: type: object description: Insurance plan details properties: payer_name: type: string description: Name of the insurance payer payer_id: type: string description: Identifier for the insurance payer name_and_id: type: string description: Combined name and ID of the insurance plan required: - payer_name - payer_id billing_provider: type: object description: Information about the billing provider properties: name: type: string description: Provider name npi: type: string description: National Provider Identifier tax_id: type: string description: Provider tax ID taxonomy_code: type: string description: Provider taxonomy code location: type: object description: Provider's address information properties: city: type: string description: City country: type: string description: Country line1: type: string description: Address line 1 line2: type: string description: Address line 2 name: type: string description: Location name state: type: string description: State to_oneline: type: string description: Single line address representation zip: type: string description: ZIP/Postal code place_of_service: type: object description: Place of service details properties: code: type: string description: Code of the place of service name: type: string description: Name of the place of service code_name: type: string description: Code name of the place of service required: - name - npi - tax_id - location rendering_provider: type: object description: Information about the rendering provider properties: id: type: string description: Provider identifier first_name: type: string description: Provider's first name last_name: type: string description: Provider's last name name: type: string description: Provider's full name npi: type: string description: Provider's NPI taxonomy_code: type: string description: Provider's taxonomy code gender: type: string description: Provider's gender dob: type: string description: Provider's date of birth location: type: object description: Provider's address information properties: city: type: string description: City country: type: string description: Country line1: type: string description: Address line 1 line2: type: string description: Address line 2 name: type: string description: Location name state: type: string description: State to_oneline: type: string description: Single line address representation zip: type: string description: ZIP/Postal code place_of_service: type: object description: Place of service details properties: code: type: string description: Code of the place of service name: type: string description: Name of the place of service code_name: type: string description: Code name of the place of service required: - npi referring_provider: type: object description: Information about the referring provider. properties: id: type: string description: Provider identifier first_name: type: string description: Provider's first name last_name: type: string description: Provider's last name name: type: string description: Provider's full name npi: type: string description: Provider's NPI gender: type: string description: Provider's gender dob: type: string description: Provider's date of birth required: - npi ordering_provider: type: object description: Information about the ordering provider. properties: id: type: string description: Provider identifier first_name: type: string description: Provider's first name last_name: type: string description: Provider's last name name: type: string description: Provider's full name npi: type: string description: Provider's NPI taxonomy_code: type: string description: Provider's taxonomy code gender: type: string description: Provider's gender dob: type: string description: Provider's date of birth location: type: object description: Provider's address information properties: city: type: string description: City country: type: string description: Country line1: type: string description: Address line 1 line2: type: string description: Address line 2 name: type: string description: Location name state: type: string description: State to_oneline: type: string description: Single line address representation zip: type: string description: ZIP/Postal code place_of_service: type: object description: Place of service details properties: code: type: string description: Code of the place of service name: type: string description: Name of the place of service code_name: type: string description: Code name of the place of service required: - npi service_location: type: object description: Location of the service properties: id: type: string description: >- Location identifier. If provided, will be used to match the location. city: type: string description: City country: type: string description: Country line1: type: string description: >- Address line 1. If id is not provided, this field will be used to match the location in conjunction with the name. line2: type: string description: Address line 2 name: type: string description: >- Location name. If id is not provided, this field will be used to match the location in conjunction with the address. state: type: string description: State to_oneline: type: string description: Single line address representation zip: type: string description: ZIP/Postal code place_of_service: type: object description: Place of service details properties: code: type: string description: Code of the place of service name: type: string description: Name of the place of service code_name: type: string description: Code name of the place of service cpt_codes_cms1500s: type: array description: CPT codes associated with the claim items: type: object properties: fee: type: string description: Billed amount for this service units: type: string description: Number of units for this service mod1: type: string description: Modifier 1 mod2: type: string description: Modifier 2 mod3: type: string description: Modifier 3 mod4: type: string description: Modifier 4 ndc_information: type: object description: >- Optional NDC drug identification for the service line. When present, all fields are required. properties: ndc_code: type: string description: National Drug Code for the service line ndc_quantity: type: string description: Drug quantity for the NDC on this service line ndc_quantity_unit: type: string description: Unit of measure. enum: - F2 - GR - ME - ML - UN required: - ndc_code - ndc_quantity - ndc_quantity_unit cpt_code: type: object properties: code: type: string description: CPT code value required: - code required: - cpt_code icd_codes_cms1500s: type: array description: ICD diagnosis codes associated with the claim items: type: object properties: icd_code: type: object properties: code: type: string description: ICD code value required: - code required: - icd_code claim_condition_codes: type: array description: Claim condition codes items: type: object properties: code: type: string description: Condition code value required: - code claim_additional_information: type: array description: Additional information codes for the claim items: type: object properties: code: type: string description: Additional information code text: type: string description: Additional information text required: - code injury_cause_reasons: type: object description: >- Information about injury cause and reasons. If all are false, omit this field. properties: employment_related: type: boolean description: Whether the injury is employment related auto_accident: type: boolean description: Whether the injury is from an auto accident other: type: boolean description: Whether the injury is from another cause state: type: string description: State where the accident occurred required: - employment_related - auto_accident - other patient_paid_amount: type: number description: Amount paid by the patient clia_number: type: string description: >- Clinical Laboratory Improvement Amendment (CLIA) number for CLIA-certified facilities performing CLIA-covered laboratory services. required: - accept_assignment - id - date_of_service - total_charge - patient - billing_provider - rendering_provider - cpt_codes_cms1500s - icd_codes_cms1500s example: 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 required: true responses: '200': description: Claim created successfully content: application/json: schema: $ref: '#/components/schemas/OperationOutcome' example: resourceType: OperationOutcome issue: - severity: information code: informational details: text: All OK '400': description: Invalid request body or validation error content: application/json: schema: $ref: '#/components/schemas/OperationOutcome' example: resourceType: OperationOutcome issue: - severity: error code: invalid expression: - Cms1500.total_charge details: text: Expected string, received number '401': description: Unauthorized access or invalid organization ID content: application/json: schema: $ref: '#/components/schemas/OperationOutcome' example: resourceType: OperationOutcome issue: - severity: error code: security details: text: Unauthorized access or invalid organization ID security: - bearerAuth: [] components: schemas: OperationOutcome: type: object description: A FHIR standard response format for operations properties: resourceType: type: string description: Type of resource enum: - OperationOutcome id: type: string description: Logical id of this artifact issue: type: array description: A list of issues with the operation items: type: object properties: severity: type: string description: Severity of the issue enum: - fatal - error - warning - information code: type: string description: Error or warning code enum: - invalid - structure - required - value - invariant - security - login - unknown - expired - forbidden - suppressed - processing - not-supported - duplicate - multiple-matches - not-found - deleted - too-long - code-invalid - extension - too-costly - business-rule - conflict - transient - lock-error - no-store - exception - timeout - incomplete - throttled - informational diagnostics: type: string description: Additional diagnostic information about the issue details: type: object properties: text: type: string description: Text description of the issue coding: type: array description: Coding of the issue items: type: object location: type: array description: Locations in the resource where the issue occurred items: type: string expression: type: array description: FHIRPath of element(s) causing the issue items: type: string required: - severity - code required: - resourceType - issue securitySchemes: bearerAuth: type: http scheme: bearer bearerFormat: JWT ````