Candid Health

Candid Health Insurance Adjudications API

The Insurance Adjudications API from Candid Health — 1 operation(s) for insurance adjudications.

GitHub OpenAPI

Operations 1

GET /api/insurance-adjudications/v1/{insurance_adjudication_id} Get insurance adjudication #

Documentation

📖
Documentation
https://docs.joincandidhealth.com/api-reference/eligibility/v-2
📖
Documentation
https://docs.joincandidhealth.com/api-reference/encounters/v-4
📖
Documentation
https://docs.joincandidhealth.com/api-reference/encounters/v-4/get-all
📖
APIReference
https://docs.joincandidhealth.com/api-reference/encounters/v-4/create
📖
Documentation
https://docs.joincandidhealth.com/api-reference/eligibility/v-2/submit-eligibility-check
📖
APIReference
https://docs.joincandidhealth.com/api-reference/pre-encounter/coverages/v-1/check-eligibility
📖
Documentation
https://docs.joincandidhealth.com/api-reference/charge-capture/v-1/create
📖
Documentation
https://docs.joincandidhealth.com/api-reference/payers/v-3/get
📖
APIReference
https://docs.joincandidhealth.com/api-reference/fee-schedules/v-3/get-match
📖
Documentation
https://docs.joincandidhealth.com/api-reference/insurance-adjudications/v-1/get
📖
Documentation
https://docs.joincandidhealth.com/api-reference/events/v-1/get

Specifications

⚙
OpenAPI
https://raw.githubusercontent.com/api-evangelist/candid-health/refs/heads/main/openapi/candid-health-insurance-adjudications-api-openapi.yml

Other Resources

🔗
PostmanCollection
https://raw.githubusercontent.com/api-evangelist/candid-health/refs/heads/main/collections/candidhealth.postman_collection.json
🔗
OpenCollection
https://raw.githubusercontent.com/api-evangelist/candid-health/refs/heads/main/collections/candidhealth.opencollection.json

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OpenAPI Specification

candid-health-insurance-adjudications-api-openapi.yml Raw ↑ 
openapi: 3.2.0
info:
  title: Reference Insurance Adjudications API
  version: 1.0.0
servers:
- url: https://pre-api.joincandidhealth.com
  description: Production
- url: https://pre-api-staging.joincandidhealth.com
  description: Staging
- url: https://sandbox-pre-api.joincandidhealth.com
  description: CandidSandbox
- url: https://staging-pre-api.joincandidhealth.com
  description: CandidStaging
- url: http://localhost:4000
  description: Local
- url: https://api.joincandidhealth.com
  description: Production
- url: https://api-staging.joincandidhealth.com
  description: Staging
- url: https://sandbox-api.joincandidhealth.com
  description: CandidSandbox
- url: https://staging-api.joincandidhealth.com
  description: CandidStaging
- url: http://localhost:5050
  description: Local
tags:
- name: Insurance Adjudications
paths:
  /api/insurance-adjudications/v1/{insurance_adjudication_id}:
    get:
      operationId: get
      summary: Get insurance adjudication
      description: Retrieves a previously created insurance adjudication by its `insurance_adjudication_id`.
      tags:
      - Insurance Adjudications
      parameters:
      - name: insurance_adjudication_id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_insurance-adjudications_v1_InsuranceAdjudicationId'
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Response with status 200
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/type_insurance-adjudications_v1_InsuranceAdjudication'
        '403':
          description: Error response with status 403
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - UnauthorizedError
                  content:
                    $ref: '#/components/schemas/type_commons_UnauthorizedErrorMessage'
                required:
                - errorName
                - content
components:
  schemas:
    type_x12_v1_ClaimAdjustmentReasonCode:
      type: object
      properties:
        group_code:
          $ref: '#/components/schemas/type_commons_ClaimAdjustmentGroupCodes'
        reason_code:
          $ref: '#/components/schemas/type_x12_v1_Carc'
        amount_cents:
          type: integer
      required:
      - group_code
      - reason_code
      - amount_cents
      title: ClaimAdjustmentReasonCode
    type_insurance-adjudications_v1_ServiceLineAdjudicationId:
      type: string
      format: uuid
      title: ServiceLineAdjudicationId
    type_x12_v1_Carc:
      type: string
      enum:
      - '1'
      - '2'
      - '3'
      - '4'
      - '5'
      - '6'
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      - W1
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      - W5
      - W6
      - W7
      - W8
      - W9
      - Y1
      - Y2
      - Y3
      - UNKNOWN
      title: Carc
    type_insurance-adjudications_v1_InsuranceAdjudicationId:
      type: string
      format: uuid
      title: InsuranceAdjudicationId
    type_insurance-adjudications_v1_ClaimAdjudication:
      type: object
      properties:
        claim_id:
          $ref: '#/components/schemas/type_commons_ClaimId'
        insurance_allowed_amount_cents:
          type: integer
        insurance_paid_amount_cents:
          type: integer
        charge_amount_cents:
          type: integer
        service_lines:
          type: object
          additionalProperties:
            type: array
            items:
              $ref: '#/components/schemas/type_insurance-adjudications_v1_ServiceLineAdjudication'
        payer_claim_number:
          type: string
        carcs:
          type: array
          items:
            $ref: '#/components/schemas/type_x12_v1_ClaimAdjustmentReasonCode'
      required:
      - claim_id
      - service_lines
      - carcs
      title: ClaimAdjudication
    type_commons_UnauthorizedErrorMessage:
      type: object
      properties:
        message:
          type: string
      title: UnauthorizedErrorMessage
    type_commons_ClaimId:
      type: string
      format: uuid
      title: ClaimId
    type_insurance-adjudications_v1_ServiceLineAdjudication:
      type: object
      properties:
        service_line_adjudication_id:
          $ref: '#/components/schemas/type_insurance-adjudications_v1_ServiceLineAdjudicationId'
        denial_reason:
          $ref: '#/components/schemas/type_service-lines_v2_DenialReasonContent'
          description: Will be treated as a denial if present
        insurance_allowed_amount_cents:
          type: integer
        insurance_paid_amount_cents:
          type: integer
        deductible_amount_cents:
          type: integer
        coinsurance_amount_cents:
          type: integer
        copay_amount_cents:
          type: integer
        carcs:
          type: array
          items:
            $ref: '#/components/schemas/type_x12_v1_ClaimAdjustmentReasonCode'
        rarcs:
          type: array
          items:
            $ref: '#/components/schemas/type_x12_v1_RemittanceAdviceRemarkCode'
      required:
      - service_line_adjudication_id
      - carcs
      - rarcs
      title: ServiceLineAdjudication
    type_x12_v1_Rarc:
      type: string
      enum:
      - M1
      - M2
      - M3
      - M4
      - M5
      - M6
      - M7
      - M8
      - M9
      - M10
      - M11
      - M12
      - M13
      - M14
      - M15
      - M16
      - M17
      - M18
      - M19
      - M20
      - M21
      - M22
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      - UNKNOWN
      title: Rarc
    type_service-lines_v2_DenialReasonContent:
      type: string
      enum:
      - Authorization Required
      - Referral Required
      - Medical Records Requested
      - Timely Filing
      - Duplicate Claim
      - Full Contractual Adjustment
      - Incorrect Place of Service
      - Incorrect Patient Gender
      - Incorrect Patient Info
      - Bundled
      - Exceeded Billable Time
      - Invalid Provider Information
      - Invalid Diagnosis Code
      - Incorrect Procedure Code
      - Invalid Modifier
      - Missing NDC Code
      - Invalid Insurance Data
      - No Active Coverage
      - Coordination of Benefits
      - Incorrect Payer
      - Credentialing
      - No Effective Contract
      - Missing W-9
      - Missing Contract Linkage
      - Non-Covered Benefit
      - Experimental Procedure
      - Not Medically Necessary
      - Info Requested from Provider
      - Info Requested from Patient
      - Billing Error
      - Unknown
      - Max Benefit Reached
      title: DenialReasonContent
    type_payers_v3_PayerUuid:
      type: string
      format: uuid
      title: PayerUuid
    type_x12_v1_RemittanceAdviceRemarkCode:
      type: object
      properties:
        reason_code:
          $ref: '#/components/schemas/type_x12_v1_Rarc'
      required:
      - reason_code
      title: RemittanceAdviceRemarkCode
    type_insurance-adjudications_v1_InsuranceAdjudication:
      type: object
      properties:
        insurance_adjudication_id:
          $ref: '#/components/schemas/type_insurance-adjudications_v1_InsuranceAdjudicationId'
        payer_uuid:
          $ref: '#/components/schemas/type_payers_v3_PayerUuid'
        post_date:
          type: string
          format: date
        check_number:
          type: string
        check_date:
          type: string
          format: date
        note:
          type: string
        claims:
          type: object
          additionalProperties:
            type: array
            items:
              $ref: '#/components/schemas/type_insurance-adjudications_v1_ClaimAdjudication'
      required:
      - insurance_adjudication_id
      - payer_uuid
      - check_date
      - claims
      title: InsuranceAdjudication
    type_commons_ClaimAdjustmentGroupCodes:
      type: string
      enum:
      - CO
      - CR
      - DE
      - MA
      - OA
      - PI
      - PR
      - RR
      - NC
      - UNKNOWN
      title: ClaimAdjustmentGroupCodes
  securitySchemes:
    OAuthScheme:
      type: http
      scheme: bearer
      description: OAuth 2.0 authentication