Claim.MD Reference API

openapi: 3.0.1
info:
  title: Claim.MD Claim Status Reference API
  description: REST API for the Claim.MD medical-claims clearinghouse. The API supports electronic claim submission (837P/837I and other formats), claim status and response retrieval, electronic remittance advice (835 ERA), real-time eligibility (270/271), the payer directory, provider enrollment, appeals, and webhook notifications. All requests are authenticated with an AccountKey and responses can be returned as XML (default) or JSON via the Accept header.
  termsOfService: https://www.claim.md/terms
  contact:
    name: Claim.MD Support
    url: https://www.claim.md/contact
  version: '1.0'
servers:
- url: https://svc.claim.md
  description: Claim.MD production API service
security:
- AccountKey: []
tags:
- name: Reference
  description: Payer directory, enrollment, appeals, and webhooks.
paths:
  /services/payerlist/:
    post:
      operationId: listPayers
      tags:
      - Reference
      summary: Retrieve the payer directory
      description: Look up payers and their supported service capabilities.
      requestBody:
        required: true
        content:
          application/x-www-form-urlencoded:
            schema:
              type: object
              required:
              - AccountKey
              properties:
                AccountKey:
                  type: string
                payerid:
                  type: string
                  description: Optional specific payer ID.
                payer_name:
                  type: string
                  description: Optional payer-name wildcard search.
      responses:
        '200':
          description: Payer directory.
  /services/enroll/:
    post:
      operationId: requestEnrollment
      tags:
      - Reference
      summary: Request provider enrollment
      description: Initiate a provider enrollment request (ERA, paper, UB, eligibility, or attachments) and receive an enrollment link.
      requestBody:
        required: true
        content:
          application/x-www-form-urlencoded:
            schema:
              type: object
              required:
              - AccountKey
              - payerid
              - enroll_type
              - prov_taxid
              properties:
                AccountKey:
                  type: string
                payerid:
                  type: string
                enroll_type:
                  type: string
                  description: Enrollment type (era, 500, ub, elig, attach).
                prov_taxid:
                  type: string
                prov_npi:
                  type: string
                prov_name_l:
                  type: string
                prov_name_f:
                  type: string
      responses:
        '200':
          description: Enrollment link URL.
  /services/appeal/:
    post:
      operationId: requestAppeal
      tags:
      - Reference
      summary: Request a claim appeal
      description: Initiate a claim appeal and receive an appeal form link.
      requestBody:
        required: true
        content:
          application/x-www-form-urlencoded:
            schema:
              type: object
              required:
              - AccountKey
              properties:
                AccountKey:
                  type: string
                claimid:
                  type: string
                  description: Claim ID (or use remote_claimid).
                remote_claimid:
                  type: string
                  description: Vendor-side claim identifier.
      responses:
        '200':
          description: Appeal form link URL.
components:
  securitySchemes:
    AccountKey:
      type: apiKey
      in: query
      name: AccountKey
      description: Account authentication key from Settings > Account Settings in the Claim.MD portal. Submitted with each request (as a form field or query parameter).