Candid Health Insurance Refunds API

The Insurance Refunds API from Candid Health — 2 operation(s) for insurance refunds.

Operations 5

GET /api/insurance-refunds/v1 Get insurance refunds #
POST /api/insurance-refunds/v1 Create insurance refund #
GET /api/insurance-refunds/v1/{insurance_refund_id} Get insurance refund #
PATCH /api/insurance-refunds/v1/{insurance_refund_id} Update #
DELETE /api/insurance-refunds/v1/{insurance_refund_id} Delete insurance refund #

Documentation

Specifications

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OpenAPI Specification

candid-health-insurance-refunds-api-openapi.yml Raw ↑
openapi: 3.2.0
info:
  title: Reference Insurance Refunds 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 Refunds
paths:
  /api/insurance-refunds/v1:
    get:
      operationId: get_multi
      summary: Get insurance refunds
      description: 'Returns all insurance refunds satisfying the search criteria AND whose organization_id matches

        the current organization_id of the authenticated user.'
      tags:
      - Insurance Refunds
      parameters:
      - name: limit
        in: query
        description: Defaults to 100. The value must be greater than 0 and less than 1000.
        required: false
        schema:
          type: integer
      - name: payer_uuid
        in: query
        required: false
        schema:
          $ref: '#/components/schemas/type_payers_v3_PayerUuid'
      - name: claim_id
        in: query
        required: false
        schema:
          $ref: '#/components/schemas/type_commons_ClaimId'
      - name: service_line_id
        in: query
        required: false
        schema:
          $ref: '#/components/schemas/type_commons_ServiceLineId'
      - name: billing_provider_id
        in: query
        required: false
        schema:
          $ref: '#/components/schemas/type_commons_ProviderId'
      - name: sort
        in: query
        description: Defaults to refund_timestamp
        required: false
        schema:
          $ref: '#/components/schemas/type_insurance-refunds_v1_InsuranceRefundSortField'
      - name: sort_direction
        in: query
        description: Sort direction. Defaults to descending order if not provided.
        required: false
        schema:
          $ref: '#/components/schemas/type_commons_SortDirection'
      - name: page_token
        in: query
        required: false
        schema:
          $ref: '#/components/schemas/type_commons_PageToken'
      - 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-refunds_v1_InsuranceRefundsPage'
        '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
        '422':
          description: Error response with status 422
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - UnprocessableEntityError
                  content:
                    $ref: '#/components/schemas/type_commons_UnprocessableEntityErrorMessage'
                required:
                - errorName
                - content
    post:
      operationId: create
      summary: Create insurance refund
      description: 'Creates a new insurance refund record and returns the newly created `InsuranceRefund` object.

        The allocations can describe whether the refund is being applied toward a specific service line,

        claim, or billing provider.'
      tags:
      - Insurance Refunds
      parameters:
      - 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-refunds_v1_InsuranceRefund'
        '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
        '404':
          description: Error response with status 404
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - EntityNotFoundError
                  content:
                    $ref: '#/components/schemas/type_commons_EntityNotFoundErrorMessage'
                required:
                - errorName
                - content
        '422':
          description: Error response with status 422
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - UnprocessableEntityError
                  content:
                    $ref: '#/components/schemas/type_commons_UnprocessableEntityErrorMessage'
                required:
                - errorName
                - content
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/type_insurance-refunds_v1_InsuranceRefundCreate'
  /api/insurance-refunds/v1/{insurance_refund_id}:
    get:
      operationId: get
      summary: Get insurance refund
      description: 'Retrieves a previously created insurance refund by its `insurance_refund_id`.

        If the refund does not exist, a `403` will be thrown.'
      tags:
      - Insurance Refunds
      parameters:
      - name: insurance_refund_id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_insurance-refunds_v1_InsuranceRefundId'
      - 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-refunds_v1_InsuranceRefund'
        '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
        '404':
          description: Error response with status 404
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - EntityNotFoundError
                  content:
                    $ref: '#/components/schemas/type_commons_EntityNotFoundErrorMessage'
                required:
                - errorName
                - content
    patch:
      operationId: update
      summary: Update
      description: 'Updates the patient refund record matching the provided insurance_refund_id. If updating the refund amount,

        then the allocations must be appropriately updated as well.'
      tags:
      - Insurance Refunds
      parameters:
      - name: insurance_refund_id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_insurance-refunds_v1_InsuranceRefundId'
      - 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-refunds_v1_InsuranceRefund'
        '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
        '404':
          description: Error response with status 404
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - EntityNotFoundError
                  content:
                    $ref: '#/components/schemas/type_commons_EntityNotFoundErrorMessage'
                required:
                - errorName
                - content
        '422':
          description: Error response with status 422
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - UnprocessableEntityError
                  content:
                    $ref: '#/components/schemas/type_commons_UnprocessableEntityErrorMessage'
                required:
                - errorName
                - content
      requestBody:
        content:
          application/json:
            schema:
              type: object
              properties:
                refund_timestamp:
                  type: string
                  format: date-time
                refund_note:
                  $ref: '#/components/schemas/type_financials_NoteUpdate'
                refund_reason:
                  $ref: '#/components/schemas/type_financials_RefundReasonUpdate'
    delete:
      operationId: delete
      summary: Delete insurance refund
      description: 'Deletes the insurance refund record matching the provided `insurance_refund_id`.

        If the matching record''s organization_id does not match the authenticated user''s

        current organization_id, then a response code of `403` will be returned.'
      tags:
      - Insurance Refunds
      parameters:
      - name: insurance_refund_id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_insurance-refunds_v1_InsuranceRefundId'
      - name: Authorization
        in: header
        description: OAuth authentication
        required: true
        schema:
          type: string
      responses:
        '200':
          description: Successful response
        '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
        '404':
          description: Error response with status 404
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - EntityNotFoundError
                  content:
                    $ref: '#/components/schemas/type_commons_EntityNotFoundErrorMessage'
                required:
                - errorName
                - content
        '422':
          description: Error response with status 422
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - UnprocessableEntityError
                  content:
                    $ref: '#/components/schemas/type_commons_UnprocessableEntityErrorMessage'
                required:
                - errorName
                - content
components:
  schemas:
    type_commons_PageToken:
      type: string
      title: PageToken
    type_financials_RefundReason:
      type: string
      enum:
      - OVERCHARGED
      - ENTERED_IN_ERROR
      - TRANSFER
      title: RefundReason
    type_commons_ClaimId:
      type: string
      format: uuid
      title: ClaimId
    type_commons_PatientExternalId:
      type: string
      title: PatientExternalId
    type_insurance-refunds_v1_InsuranceRefund:
      type: object
      properties:
        insurance_refund_id:
          $ref: '#/components/schemas/type_insurance-refunds_v1_InsuranceRefundId'
        payer:
          $ref: '#/components/schemas/type_payers_v3_Payer'
        amount_cents:
          type: integer
        refund_timestamp:
          type: string
          format: date-time
        refund_note:
          type: string
        allocations:
          type: array
          items:
            $ref: '#/components/schemas/type_financials_Allocation'
        refund_reason:
          $ref: '#/components/schemas/type_financials_RefundReason'
      required:
      - insurance_refund_id
      - payer
      - amount_cents
      - allocations
      title: InsuranceRefund
    type_financials_RefundReasonUpdate:
      oneOf:
      - type: object
        properties:
          type:
            type: string
            enum:
            - set
            description: 'Discriminator value: set'
          value:
            $ref: '#/components/schemas/type_financials_RefundReason'
        required:
        - type
        - value
      - type: object
        properties:
          type:
            type: string
            enum:
            - remove
            description: 'Discriminator value: remove'
        required:
        - type
      discriminator:
        propertyName: type
      title: RefundReasonUpdate
    type_insurance-refunds_v1_InsuranceRefundCreate:
      type: object
      properties:
        payer_identifier:
          $ref: '#/components/schemas/type_payers_v3_PayerIdentifier'
        amount_cents:
          type: integer
        refund_timestamp:
          type: string
          format: date-time
        refund_note:
          type: string
        allocations:
          type: array
          items:
            $ref: '#/components/schemas/type_financials_AllocationCreate'
        refund_reason:
          $ref: '#/components/schemas/type_financials_RefundReason'
      required:
      - payer_identifier
      - amount_cents
      - allocations
      title: InsuranceRefundCreate
    type_insurance-refunds_v1_InsuranceRefundSortField:
      type: string
      enum:
      - amount_cents
      - refund_timestamp
      - refund_note
      - refund_reason
      title: InsuranceRefundSortField
    type_financials_AllocationEarmarkType:
      oneOf:
      - type: object
        properties:
          type:
            type: string
            enum:
            - date_of_service
            description: 'Discriminator value: date_of_service'
          value:
            $ref: '#/components/schemas/type_commons_Date'
        required:
        - type
        - value
        description: Earmark for auto-allocation to an encounter with this specific date of service
      - type: object
        properties:
          type:
            type: string
            enum:
            - external_encounter_id
            description: 'Discriminator value: external_encounter_id'
          value:
            $ref: '#/components/schemas/type_commons_EncounterExternalId'
        required:
        - type
        - value
        description: Earmark for auto-allocation to an encounter with this specific external ID (more specific than date of service)
      discriminator:
        propertyName: type
      description: 'If enabled for your organization, defines how a patient prepayment allocation should be earmarked for future auto-allocation.

        Earmarks hold the allocation until a matching encounter is created, then attempt to allocate to that encounter.

        Only applicable for unattributed allocations.'
      title: AllocationEarmarkType
    type_financials_AllocationTarget:
      oneOf:
      - type: object
        properties:
          type:
            type: string
            enum:
            - service_line
            description: 'Discriminator value: service_line'
          service_line_id:
            $ref: '#/components/schemas/type_commons_ServiceLineId'
          claim_id:
            $ref: '#/components/schemas/type_commons_ClaimId'
          encounter_id:
            $ref: '#/components/schemas/type_commons_EncounterId'
        required:
        - type
        - service_line_id
        - claim_id
        - encounter_id
      - type: object
        properties:
          type:
            type: string
            enum:
            - claim
            description: 'Discriminator value: claim'
          claim_id:
            $ref: '#/components/schemas/type_commons_ClaimId'
          encounter_id:
            $ref: '#/components/schemas/type_commons_EncounterId'
        required:
        - type
        - claim_id
        - encounter_id
      - type: object
        properties:
          type:
            type: string
            enum:
            - billing_provider_id
            description: 'Discriminator value: billing_provider_id'
          billing_provider_id:
            $ref: '#/components/schemas/type_commons_ProviderId'
        required:
        - type
        - billing_provider_id
      - type: object
        properties:
          type:
            type: string
            enum:
            - appointment
            description: 'Discriminator value: appointment'
          appointment_id:
            $ref: '#/components/schemas/type_commons_AppointmentId'
          patient_external_id:
            $ref: '#/components/schemas/type_commons_PatientExternalId'
        required:
        - type
        - appointment_id
        - patient_external_id
      - type: object
        properties:
          type:
            type: string
            enum:
            - unattributed
            description: 'Discriminator value: unattributed'
        required:
        - type
      discriminator:
        propertyName: type
      description: 'Allocation targets describe whether the portion of a payment is being applied toward a specific service line,

        claim, billing provider, or is unallocated.'
      title: AllocationTarget
    type_payers_v3_PayerName:
      type: string
      title: PayerName
    type_commons_EncounterExternalId:
      type: string
      title: EncounterExternalId
    type_commons_UnprocessableEntityErrorMessage:
      type: object
      properties:
        message:
          type: string
      title: UnprocessableEntityErrorMessage
    type_commons_EntityNotFoundErrorMessage:
      type: object
      properties:
        id:
          type: string
      required:
      - id
      title: EntityNotFoundErrorMessage
    type_insurance-refunds_v1_InsuranceRefundsPage:
      type: object
      properties:
        prev_page_token:
          $ref: '#/components/schemas/type_commons_PageToken'
        next_page_token:
          $ref: '#/components/schemas/type_commons_PageToken'
        items:
          type: array
          items:
            $ref: '#/components/schemas/type_insurance-refunds_v1_InsuranceRefund'
      required:
      - items
      title: InsuranceRefundsPage
    type_financials_BalanceEarmark:
      type: object
      properties:
        id:
          type: string
          format: uuid
        target:
          $ref: '#/components/schemas/type_financials_AllocationEarmarkType'
          description: The target for this earmark (date of service or external encounter ID)
        amount_earmarked_cents:
          type: integer
          description: The amount earmarked in cents for future allocation
        created_by_allocation_id:
          $ref: '#/components/schemas/type_commons_AllocationId'
          description: The ID of the allocation that created this earmark
      required:
      - id
      - target
      description: 'Represents an active balance earmarking record that holds allocated funds for future auto-allocation.

        Earmarks are created when funds are allocated but should be held for a specific encounter or date of service.

        Only active (non-deleted) earmarks are returned.'
      title: BalanceEarmark
    type_commons_EncounterId:
      type: string
      format: uuid
      title: EncounterId
    type_financials_NoteUpdate:
      oneOf:
      - type: object
        properties:
          type:
            type: string
            enum:
            - set
            description: 'Discriminator value: set'
          value:
            type: string
        required:
        - type
        - value
      - type: object
        properties:
          type:
            type: string
            enum:
            - remove
            description: 'Discriminator value: remove'
        required:
        - type
      discriminator:
        propertyName: type
      title: NoteUpdate
    type_financials_AllocationCreate:
      type: object
      properties:
        amount_cents:
          type: integer
        target:
          $ref: '#/components/schemas/type_financials_AllocationTargetCreate'
        earmark:
          $ref: '#/components/schemas/type_financials_AllocationEarmarkType'
          description: 'If enabled for your organization, optional earmarking configuration for patient prepayments.

            When provided on unattributed allocations, holds the payment for future auto-allocation to matching encounters.'
      required:
      - amount_cents
      - target
      description: 'Allocations are portions of payments that are applied to specific resources, known as targets. Each allocation has

        and amount, defined in cents, and a target.'
      title: AllocationCreate
    type_commons_SortDirection:
      type: string
      enum:
      - asc
      - desc
      title: SortDirection
    type_financials_Allocation:
      type: object
      properties:
        allocation_id:
          $ref: '#/components/schemas/type_commons_AllocationId'
        amount_cents:
          type: integer
        target:
          $ref: '#/components/schemas/type_financials_AllocationTarget'
        earmark:
          $ref: '#/components/schemas/type_financials_BalanceEarmark'
          description: The active earmark created by this allocation, if any. Only present when this allocation created an earmark for future auto-allocation and the earmark has not been deleted.
        allocated_on:
          type: string
          format: date-time
      required:
      - amount_cents
      - target
      title: Allocation
    type_payers_v3_PayerId:
      type: string
      title: PayerId
    type_payers_v3_Payer:
      type: object
      properties:
        payer_uuid:
          $ref: '#/components/schemas/type_payers_v3_PayerUuid'
          description: Auto-generated ID set on creation.
        payer_id:
          type: string
          description: The primary national payer ID of the payer.
        payer_name:
          type: string
          description: The primary display name of the payer.
        availity_payer_name:
          type: string
          description: The name of the payer as it appears in Availity.
        availity_claims_payer_id:
          type: string
          description: The ID of the payer as it appears in Availity.
        availity_eligibility_id:
          type: string
          description: The eligibility ID of the payer as it appears in Availity.
        availity_remittance_payer_id:
          type: string
          description: The remittance ID of the payer as it appears in Availity.
        street_address:
          $ref: '#/components/schemas/type_commons_StreetAddressLongZip'
      required:
      - payer_uuid
      - payer_id
      - payer_name
      title: Payer
    type_commons_State:
      type: string
      enum:
      - AA
      - AE
      - AP
      - AL
      - AK
      - AS
      - AZ
      - AR
      - CA
      - CO
      - CT
      - DC
      - DE
      - FL
      - FM
      - GA
      - GU
      - HI
      - ID
      - IL
      - IN
      - IA
      - KS
      - KY
      - LA
      - ME
      - MD
      - MA
      - MH
      - MI
      - MN
      - MP
      - MS
      - MO
      - MT
      - NE
      - NV
      - NH
      - NJ
      - NM
      - NY
      - NC
      - ND
      - OH
      - OK
      - OR
      - PA
      - PR
      - PW
      - RI
      - SC
      - SD
      - TN
      - TX
      - UT
      - VI
      - VT
      - VA
      - WA
      - WV
      - WI
      - WY
      title: State
    type_commons_AppointmentId:
      type: string
      title: AppointmentId
    type_commons_AllocationId:
      type: string
      format: uuid
      title: AllocationId
    type_commons_ServiceLineId:
      type: string
      format: uuid
      title: ServiceLineId
    type_commons_UnauthorizedErrorMessage:
      type: object
      properties:
        message:
          type: string
      title: UnauthorizedErrorMessage
    type_commons_StreetAddressLongZip:
      type: object
      properties:
        address1:
          type: string
        address2:
          type: string
        city:
          type: string
        state:
          $ref: '#/components/schemas/type_commons_State'
        zip_code:
          type: string
          description: 5-digit zip code
        zip_plus_four_code:
          type: string
          description: 4-digit zip add-on code https://en.wikipedia.org/wiki/ZIP_Code#ZIP+4
      required:
      - address1
      - city
      - state
      - zip_code
      - zip_plus_four_code
      title: StreetAddressLongZip
    type_insurance-refunds_v1_InsuranceRefundId:
      type: string
      format: uuid
      title: InsuranceRefundId
    type_commons_Date:
      type: string
      description: ISO 8601 date; formatted YYYY-MM-DD (i.e. 2012-02-01)
      title: Date
    type_payers_v3_PayerUuid:
      type: string
      format: uuid
      title: PayerUuid
    type_financials_AllocationTargetCreate:
      oneOf:
      - type: object
        properties:
          type:
            type: string
            enum:
            - service_line_by_id
            description: 'Discriminator value: service_line_by_id'
          value:
            $ref: '#/components/schemas/type_commons_ServiceLineId'
        required:
        - type
        - value
      - type: object
        properties:
          type:
            type: string
            enum:
            - claim_by_id
            description: 'Discriminator value: claim_by_id'
          value:
            $ref: '#/components/schemas/type_commons_ClaimId'
        required:
        - type
        - value
      - type: object
        properties:
          type:
            type: string
            enum:
            - claim_by_encounter_external_id
            description: 'Discriminator value: claim_by_encounter_external_id'
          value:
            $ref: '#/components/schemas/type_commons_EncounterExternalId'
        required:
        - type
        - value
      - type: object
        properties:
          type:
            type: string
            enum:
            - billing_provider_by_id
            description: 'Discriminator value: billing_provider_by_id'
          value:
            $ref: '#/components/schemas/type_commons_ProviderId'
        required:
        - type
        - value
      - type: object
        properties:
          type:
            type: string
            enum:
            - appointment_by_id_and_patient_external_id
            description: 'Discriminator value: appointment_by_id_and_patient_external_id'
          appointment_id:
            $ref: '#/components/schemas/type_commons_AppointmentId'
          patient_external_id:
            $ref: '#/components/schemas/type_commons_PatientExternalId'
        required:
        - type
        - appointment_id
        - patient_external_id
      - type: object
        properties:
          type:
            type: string
            enum:
            - unattributed
            description: 'Discriminator value: unattributed'
        required:
        - type
      discriminator:
        propertyName: type
      description: 'Allocation targets describe whether the portion of a payment is being applied toward a specific service line,

        claim, billing provider, or is unallocated.'
      title: AllocationTargetCreate
    type_commons_ProviderId:
      type: string
      format: uuid
      title: ProviderId
    type_payers_v3_PayerIdentifier:
      oneOf:
      - type: object
        properties:
          type:
            type: string
            enum:
            - payer_info
            description: 'Discriminator value: payer_info'
          payer_id:
            $ref: '#/components/schemas/type_payers_v3_PayerId'
          payer_name:
            $ref: '#/components/schemas/type_payers_v3_PayerName'
        required:
        - type
        - payer_id
        - payer_name
      - type: object
        properties:
          type:
            type: string
            enum:
            - payer_uuid
            description: 'Discriminator value: payer_uuid'
          value:
            $ref: '#/components/schemas/type_payers_v3_PayerUuid'
        required:
        - type
        - value
      discriminator:
        propertyName: type
      title: PayerIdentifier
  securitySchemes:
    OAuthScheme:
      type: http
      scheme: bearer
      description: OAuth 2.0 authentication