Candid Health subpackage_encounters.subpackage_encounters/v4 API

openapi: 3.1.0
info:
  title: API Reference subpackage_auth.subpackage_auth/default subpackage_encounters.subpackage_encounters/v4 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: subpackage_encounters.subpackage_encounters/v4
paths:
  /api/encounters/v4:
    get:
      operationId: get-all
      summary: Get all encounters
      tags:
      - subpackage_encounters.subpackage_encounters/v4
      parameters:
      - name: limit
        in: query
        description: Maximum number of entities per page, defaults to 100.
        required: false
        schema:
          type: integer
      - name: claim_status
        in: query
        description: Indicates the current status of an insurance claim within the billing process.
        required: false
        schema:
          $ref: '#/components/schemas/type_claims:ClaimStatus'
      - name: sort
        in: query
        description: Defaults to created_at:desc.
        required: false
        schema:
          $ref: '#/components/schemas/type_encounters/v4:EncounterSortOptions'
      - name: page_token
        in: query
        required: false
        schema:
          $ref: '#/components/schemas/type_commons:PageToken'
      - name: date_of_service_min
        in: query
        description: 'Date formatted as YYYY-MM-DD; eg: 2019-08-25.'
        required: false
        schema:
          type: string
          format: date
      - name: date_of_service_max
        in: query
        description: 'Date formatted as YYYY-MM-DD; eg: 2019-08-25.'
        required: false
        schema:
          type: string
          format: date
      - name: primary_payer_names
        in: query
        description: Comma delimited string.
        required: false
        schema:
          type: string
      - name: search_term
        in: query
        description: 'Filter by any of the following fields: encounter_id, claim_id, patient external_id,

          patient date of birth, patient first name, patient last name,

          or encounter external id.'
        required: false
        schema:
          type: string
      - name: external_id
        in: query
        description: Filter to an exact match on encounter external_id, if one exists.
        required: false
        schema:
          $ref: '#/components/schemas/type_commons:EncounterExternalId'
      - name: diagnoses_updated_since
        in: query
        description: 'ISO 8601 timestamp; ideally in UTC (although not required): 2019-08-24T14:15:22Z.'
        required: false
        schema:
          type: string
          format: date-time
      - name: tag_ids
        in: query
        description: Filter by name of tags on encounters.
        required: false
        schema:
          $ref: '#/components/schemas/type_tags:TagId'
      - name: work_queue_id
        in: query
        required: false
        schema:
          $ref: '#/components/schemas/type_commons:WorkQueueId'
      - name: billable_status
        in: query
        description: Defines if the Encounter is to be billed by Candid to the responsible_party. Examples for when this should be set to NOT_BILLABLE include if the Encounter has not occurred yet or if there is no intention of ever billing the responsible_party.
        required: false
        schema:
          $ref: '#/components/schemas/type_encounters/v4:BillableStatusType'
      - name: responsible_party
        in: query
        description: Defines the party to be billed with the initial balance owed on the claim. Use SELF_PAY if you intend to bill self pay/cash pay.
        required: false
        schema:
          $ref: '#/components/schemas/type_encounters/v4:ResponsiblePartyType'
      - name: owner_of_next_action
        in: query
        description: The party who is responsible for taking the next action on an Encounter, as defined by ownership of open Tasks.
        required: false
        schema:
          $ref: '#/components/schemas/type_encounters/v4:EncounterOwnerOfNextActionType'
      - name: patient_external_id
        in: query
        description: The patient ID from the external EMR platform for the patient
        required: false
        schema:
          type: string
      - name: include_merged_patient_data
        in: query
        description: If true and patient_external_id is set, then also include the encounters of all alternative patients.
        required: false
        schema:
          type: boolean
      - 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_encounters/v4:EncounterPage'
        '422':
          description: Error response with status 422
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - HttpRequestValidationsError
                  content:
                    type: array
                    items:
                      $ref: '#/components/schemas/type_commons:RequestValidationError'
                required:
                - errorName
                - content
        '500':
          description: Error response with status 500
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - InternalError
                  content:
                    $ref: '#/components/schemas/type_commons:InternalErrorMessage'
                required:
                - errorName
                - content
    post:
      operationId: create
      summary: Create professional encounter
      tags:
      - subpackage_encounters.subpackage_encounters/v4
      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_encounters/v4:Encounter'
        '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: Raised for universal claims that fail to provider either an attending_provider or rendering_provider value
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - EncounterRenderingOrAttendingProviderRequired
                    description: Raised for universal claims that fail to provider either an attending_provider or rendering_provider value
                  content:
                    $ref: '#/components/schemas/type_encounters/v4:EncounterRenderingOrAttendingProviderRequiredError'
                    description: Raised for universal claims that fail to provider either an attending_provider or rendering_provider value
                required:
                - errorName
                - content
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/type_encounters/v4:EncounterCreate'
  /api/encounters/v4/{encounter_id}:
    get:
      operationId: get
      summary: Get encounter
      tags:
      - subpackage_encounters.subpackage_encounters/v4
      parameters:
      - name: encounter_id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_commons:EncounterId'
      - 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_encounters/v4:Encounter'
    patch:
      operationId: update
      summary: Update professional encounter
      tags:
      - subpackage_encounters.subpackage_encounters/v4
      parameters:
      - name: encounter_id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_commons:EncounterId'
      - 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_encounters/v4:Encounter'
        '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:
                    - PayerPlanGroupPayerDoesNotMatchInsuranceCardHttpError
                  content:
                    $ref: '#/components/schemas/type_encounters/v4:PayerPlanGroupPayerDoesNotMatchInsuranceCardError'
                required:
                - errorName
                - content
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/type_encounters/v4:EncounterUpdate'
  /api/encounters/v4/universal:
    post:
      operationId: create-universal
      summary: Create institutional or professional encounter
      description: 'Notice: The UB-04 Data File, 2025, is copyrighted by American Hospital Association (AHA), Chicago, Illinois.

        No portion of the THE UB-04 Data File, may be reproduced, stored in a retrieval system, or transmitted,

        in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior

        express, written consent of AHA.'
      tags:
      - subpackage_encounters.subpackage_encounters/v4
      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_encounters/v4:Encounter'
        '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: Raised for universal claims that fail to provider either an attending_provider or rendering_provider value
          content:
            application/json:
              schema:
                type: object
                properties:
                  errorName:
                    type: string
                    enum:
                    - EncounterRenderingOrAttendingProviderRequired
                    description: Raised for universal claims that fail to provider either an attending_provider or rendering_provider value
                  content:
                    $ref: '#/components/schemas/type_encounters/v4:EncounterRenderingOrAttendingProviderRequiredError'
                    description: Raised for universal claims that fail to provider either an attending_provider or rendering_provider value
                required:
                - errorName
                - content
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/type_encounters-universal:UniversalEncounterCreate'
  /api/encounters/v4/create-from-pre-encounter/universal:
    post:
      operationId: create-from-pre-encounter-patient-universal
      summary: Create institutional or professional encounter from pre-encounter patient and appointment
      description: "Create an encounter from a pre-encounter patient and appointment. This endpoint is intended to be used by consumers who are managing\npatients and appointments in the pre-encounter service and is currently under development. Consumers who are not taking advantage\nof the pre-encounter service should use the standard create endpoint.\n\nThe endpoint will create an encounter from the provided fields, pulling information from the provided patient and appointment objects\nwhere applicable. In particular, the following fields are populated from the patient and appointment objects:\n  - Patient\n  - Referring Provider\n  - Subscriber Primary\n  - Subscriber Secondary\n  - Referral Number\n  - Responsible Party\n  - Guarantor\n\nUtilizing this endpoint opts you into automatic updating of the encounter when the patient or appointment is updated, assuming the\nencounter has not already been submitted or adjudicated.\n\nNotice: The UB-04 Data File, 2025, is copyrighted by American Hospital Association (AHA), Chicago, Illinois.\nNo portion of the THE UB-04 Data File, may be reproduced, stored in a retrieval system, or transmitted,\nin any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior\nexpress, written consent of AHA."
      tags:
      - subpackage_encounters.subpackage_encounters/v4
      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_encounters/v4:Encounter'
        '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:
                    - PayerPlanGroupPayerDoesNotMatchInsuranceCardHttpError
                  content:
                    $ref: '#/components/schemas/type_encounters/v4:PayerPlanGroupPayerDoesNotMatchInsuranceCardError'
                required:
                - errorName
                - content
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/type_encounters-universal:UniversalEncounterCreateFromPreEncounter'
  /api/encounters/v4/create-from-pre-encounter:
    post:
      operationId: create-from-pre-encounter-patient
      summary: Create professional encounter from pre-encounter patient and appointment
      description: "Create an encounter from a pre-encounter patient and appointment. This endpoint is intended to be used by consumers who are managing\npatients and appointments in the pre-encounter service and is currently under development. Consumers who are not taking advantage\nof the pre-encounter service should use the standard create endpoint.\n\nThe endpoint will create an encounter from the provided fields, pulling information from the provided patient and appointment objects\nwhere applicable. In particular, the following fields are populated from the patient and appointment objects:\n  - Patient\n  - Referring Provider\n  - Subscriber Primary\n  - Subscriber Secondary\n  - Referral Number\n  - Responsible Party\n  - Guarantor\n\nUtilizing this endpoint opts you into automatic updating of the encounter when the patient or appointment is updated, assuming the\nencounter has not already been submitted or adjudicated."
      tags:
      - subpackage_encounters.subpackage_encounters/v4
      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_encounters/v4:Encounter'
        '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:
                    - PayerPlanGroupPayerDoesNotMatchInsuranceCardHttpError
                  content:
                    $ref: '#/components/schemas/type_encounters/v4:PayerPlanGroupPayerDoesNotMatchInsuranceCardError'
                required:
                - errorName
                - content
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/type_encounters/v4:EncounterCreateFromPreEncounter'
  /api/encounters/v4/{encounter_id}/universal:
    patch:
      operationId: update-universal
      summary: Update institutional or professional encounter
      description: 'Notice: The UB-04 Data File, 2025, is copyrighted by American Hospital Association (AHA), Chicago, Illinois.

        No portion of the THE UB-04 Data File, may be reproduced, stored in a retrieval system, or transmitted,

        in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior

        express, written consent of AHA.'
      tags:
      - subpackage_encounters.subpackage_encounters/v4
      parameters:
      - name: encounter_id
        in: path
        required: true
        schema:
          $ref: '#/components/schemas/type_commons:EncounterId'
      - 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_encounters/v4:Encounter'
        '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:
                    - PayerPlanGroupPayerDoesNotMatchInsuranceCardHttpError
                  content:
                    $ref: '#/components/schemas/type_encounters/v4:PayerPlanGroupPayerDoesNotMatchInsuranceCardError'
                required:
                - errorName
                - content
      requestBody:
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/type_encounters-universal:UniversalEncounterUpdate'
components:
  schemas:
    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:EntityNotFoundErrorMessage:
      type: object
      properties:
        id:
          type: string
      required:
      - id
      title: EntityNotFoundErrorMessage
    type_commons:StreetAddressShortZip:
      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
      title: StreetAddressShortZip
    type_commons:DelayReasonCode:
      type: string
      enum:
      - '1'
      - '2'
      - '3'
      - '4'
      - '5'
      - '6'
      - '7'
      - '8'
      - '9'
      - '10'
      - '11'
      - '15'
      - '16'
      - '17'
      description: Code indicating the reason why a request was delayed
      title: DelayReasonCode
    type_commons:EncounterExternalId:
      type: string
      title: EncounterExternalId
    type_commons:UnauthorizedErrorMessage:
      type: object
      properties:
        message:
          type: string
      title: UnauthorizedErrorMessage
    type_commons:FacilityTypeCode:
      type: string
      enum:
      - '01'
      - '02'
      - '03'
      - '04'
      - '05'
      - '06'
      - '07'
      - 08
      - 09
      - '10'
      - '11'
      - '12'
      - '13'
      - '14'
      - '15'
      - '16'
      - '17'
      - '18'
      - '19'
      - '20'
      - '21'
      - '22'
      - '23'
      - '24'
      - '25'
      - '26'
      - '31'
      - '32'
      - '33'
      - '34'
      - '41'
      - '42'
      - '49'
      - '50'
      - '51'
      - '52'
      - '53'
      - '54'
      - '55'
      - '56'
      - '57'
      - '58'
      - '60'
      - '61'
      - '62'
      - '65'
      - '71'
      - '72'
      - '81'
      - '99'
      description: 'Box 24B on the CMS-1500 claim form. Line-level place of service is not currently supported.

        02 for telemedicine, 11 for in-person. Full list here:

        https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set'
      title: FacilityTypeCode
    type_individual:SubscriberCreate:
      type: object
      properties:
        first_name:
          type: string
        last_name:
          type: string
        gender:
          $ref: '#/components/schemas/type_individual:Gender'
        patient_relationship_to_subscriber_code:
          $ref: '#/components/schemas/type_commons:PatientRelationshipToInsuredCodeAll'
        date_of_birth:
          type: string
          format: date
        address:
          $ref: '#/components/schemas/type_commons:StreetAddressShortZip'
        insurance_card:
          $ref: '#/components/schemas/type_insurance-cards/v2:InsuranceCardCreate'
          description: Please reference our [Payer Information](https://docs.joincandidhealth.com/introduction/payer-information) documentation for more details on how to populate the `insurance_card` fields.
      required:
      - first_name
      - last_name
      - gender
      - patient_relationship_to_subscriber_code
      - insurance_card
      title: SubscriberCreate
    type_encounters-universal:UniversalEncounterUpdate:
      type: object
      properties:
        benefits_assigned_to_provider:
          type: boolean
          description: Whether this patient has authorized insurance payments to be made to you, not them. If false, patient may receive reimbursement. Box 13 on the CMS-1500 claim form or Form Locator 53 on a UB-04 claim form.
        prior_authorization_number:
          $ref: '#/components/schemas/type_encounters/v4:PriorAuthorizationNumber'
          description: Box 23 on the CMS-1500 claim form or Form Locator 63 on a UB-04 claim form.
        external_id:
          $ref: '#/components/schemas/type_commons:EncounterExternalId'
          description: 'A client-specified unique ID to associate with this encounter;

            for example, your internal encounter ID or a Dr. Chrono encounter ID.

            This field should not contain PHI.'
        date_of_service:
          type: string
          format: date
          description: 'Date formatted as YYYY-MM-DD; eg: 2019-08-24.

            This date must be the local date in the timezone where the service occurred.

            Box 24a on the CMS-1500 claim form or Form Locator 45 on the UB-04 claim form.

            If service occurred over a range of dates, this should be the start date.

            If service lines have distinct date_of_service values, updating the encounter''s date_of_service will fail. If all service line date_of_service values are the same, updating the encounter''s date_of_service will update all service line date_of_service values.'
        tag_ids:
          type: array
          items:
            $ref: '#/components/schemas/type_tags:TagId'
          description: Names of tags that should be on the encounter.  Note all tags on encounter will be overridden with this list.
        billable_status:
          $ref: '#/components/schemas/type_encounters/v4:BillableStatusType'
          description: Defines if the Encounter is to be billed by Candid to the responsible_party. Examples for when this should be set to NOT_BILLABLE include if the Encounter has not occurred yet or if there is no intention of ever billing the responsible_party.
        responsible_party:
          $ref: '#/components/schemas/type_encounters/v4:ResponsiblePartyType'
          description: Defines the party to be billed with the initial balance owed on the claim. Use SELF_PAY if you intend to bill self pay/cash pay.
        provider_accepts_assignment:
          type: boolean
          description: Whether you have accepted the patient's authorization for insurance payments to be made to you, not them. Box 27 on the CMS-1500 claim form. There is no exact equivalent of this field on a UB-04 claim, 

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