Moxe Health Claims API

openapi: 3.2.0
info:
  title: Moxe Health Claims API
  version: 0.1.0
  description: 'Operations tagged Claims across 2 of this provider''s published API definitions: moxe-health-claim-management-initiate-openapi.json, moxe-health-claim-management-status-openapi.json. Each path carries the servers of the definition it was published in.'
servers:
- url: https://${environment}-api.moxehealth.com/chart-retrieval
tags:
- name: Claims
paths:
  /v1/claim-management-request:
    post:
      tags:
      - Claims
      summary: Initiate Claim Request
      description: Initiate a new request for claim management
      operationId: initiateClaimManagementRequest
      requestBody:
        description: Information about the patient whose data is being requested
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/claimManagementRequestRequest'
        required: true
      x-amazon-apigateway-integration:
        type: http_proxy
        uri: https://${environment}-chaselistmanager.moxehealth.com/chart-retrieval/v1/claim-management-request
        httpMethod: POST
        connectionType: VPC_LINK
        connectionId: ${vpc_link}
      responses:
        '202':
          description: Claim Management request was accepted but processing has not necessarily begun
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/patientChartRequestResponse'
        '400':
          description: Invalid input
        '401':
          description: The user or app initiating the request was not authenticated. Reauthenticate and try again.
        '403':
          description: The user or app does not have the appropriate permissions to make this request
        '429':
          description: Too many requests. API rate limit reached.
        '500':
          description: The request was valid, but an unexpected error occured on the server
      security:
      - moxe_auth:
        - write:claim-management-request
      - ${environment}-chart-retrieval-api-authorizer: []
      - x-api-key: []
    servers:
    - url: https://${environment}-api.moxehealth.com/chart-retrieval
  /v1/claim-management-request/{moxeRequestId}/status:
    get:
      tags:
      - Claims
      summary: Get Claim Status
      description: Get the status of the specified claim management request
      operationId: getClaimManagementRequestStatus
      parameters:
      - in: path
        name: moxeRequestId
        schema:
          type: string
        required: true
        description: The moxeRequestId provided by us when the claim-management-request in question was created
      x-amazon-apigateway-integration:
        type: http_proxy
        uri: https://${environment}-chaselistmanager.moxehealth.com/chart-retrieval/v1/claim-management-request/{moxeRequestId}/status
        httpMethod: GET
        connectionType: VPC_LINK
        connectionId: ${vpc_link}
        requestParameters:
          integration.request.path.moxeRequestId: method.request.path.moxeRequestId
      responses:
        '200':
          description: Successfully determined the status of the given request
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/claimManagementRequestStatus'
        '401':
          description: The user or app initiating the request was not authenticated. Reauthenticate and try again.
        '404':
          description: A claim management request with the given moxeRequestId could not be found. This means that either you are not authorized to access the request or it does not exist.
        '429':
          description: Too many requests. API rate limit reached.
        '500':
          description: The request was valid, but an unexpected error occured on the server
      security:
      - moxe_auth:
        - read:claim-management-request
      - ${environment}-chart-retrieval-api-authorizer: []
      - x-api-key: []
    servers:
    - url: https://${environment}-api.moxehealth.com/chart-retrieval
components:
  schemas:
    link:
      type: object
      properties:
        href:
          type: string
          description: A URL endpoint used to fetch the status of the request
        method:
          type: string
          description: The HTTP verb used with the href to return the status of the request
    claimManagementRequestRequest:
      required:
      - RequestId
      - SubscriberId
      - PatientId
      - PatientIdType
      - DateOfBirth
      - FirstName
      - LastName
      - AdministrativeGender
      - VisitId
      - PurposeOfUse
      - RequestSourceId
      - StartDate
      - EndDate
      - ClaimId
      - DenialRemarkCode
      - ProviderOrganizationId
      type: object
      properties:
        RequestId:
          type: string
          description: Customer generated RequestId. This does not have to be unique between requests.
        MemberId:
          type: string
          description: Member’s Unique Identifier
        SubscriberId:
          type: string
          description: Member’s coverage provided through this individual
        PatientId:
          type: string
          description: Patient’s unique identifier
        PatientIdType:
          type: string
          description: Patient’s unique identifier type
        DateOfBirth:
          type: string
          description: Member’s date of birth (YYYY-MM-DD)
        FirstName:
          type: string
          description: Member’s first name
        LastName:
          type: string
          description: Member’s last name
        MiddleName:
          type: string
          description: Member’s middle name
        AdministrativeGender:
          type: string
          description: Member’s gender. Allowed values — male, female, other, unknown.
        VisitId:
          type: string
          description: Encounter identifier
        Address1:
          type: string
          description: Member’s primary address line 1
        Address2:
          type: string
          description: Member’s primary address line 2
        City:
          type: string
          description: Member’s primary city
        State:
          type: string
          description: Member’s primary state (2 letter abbreviation)
        Zip:
          type: string
          description: Member’s primary 5-digit zip code
        PurposeOfUse:
          type: string
          description: The reason for the request. Work with your Moxe representative to discuss allowed values.
        RequestSourceId:
          type: string
          description: The group authorized to issue the request. Work with your Moxe representative to discuss allowed values.
        StartDate:
          type: string
          description: The start date of service for data to include in the request (YYYY-MM-DD)
        EndDate:
          type: string
          description: The end date of service for data to include in the request (YYYY-MM-DD)
        ProviderOrganizationId:
          type: string
          description: An identifier agreed used to specify the organization from which Moxe will pull data. Work with your Moxe representative to discuss allowed values.
        ClaimId:
          type: string
          description: Claim invoice identifier
        PatientAccountNumber:
          type: string
          description: Patient account identifier in provider system
        DenialRemarkCode:
          type: string
          description: Claim adjustment code
        ProviderNpi:
          type: string
          description: The Type 1 NPI associated with the request
        GroupNpi:
          type: string
          description: The Type 2 NPI associated with the request location
        TaxId:
          type: string
          description: The TaxID associated with the request location
        ProcedureCode:
          type: object
          properties:
            Type:
              type: string
            Category:
              type: string
            Section:
              type: string
            Codes:
              type: array
    patientChartRequestResponse:
      type: object
      properties:
        data:
          type: object
          properties:
            moxeRequestId:
              type: string
              description: The unique identifier of this request within Moxe's system
            links:
              type: array
              description: A list of links that can be used to access resources related to the created patient chart request
              items:
                $ref: '#/components/schemas/link'
        createdDate:
          type: string
          format: date-time
          description: The timestamp of when this request was created
        createdBy:
          type: string
          description: The unique identifier of the client that initiated this request
    claimManagementRequestStatus:
      type: object
      properties:
        data:
          type: object
          properties:
            requestId:
              type: string
              description: The request ID initially provided when the request was initiated
            moxeRequestId:
              type: string
              description: The unique identifier of this request within Moxe's system
            requestStatusCode:
              type: string
              description: A code representing the current status of the request
            requestStatusDescription:
              type: string
              description: A human-readable description of the status of the request, which correspends to the requestStatusCode
            requestStatusDateTime:
              type: string
              format: date-time
              description: The timestamp of when the request entered into the reported status
  securitySchemes:
    moxe_auth:
      type: oauth2
      flows:
        clientCredentials:
          tokenUrl: https://${environment}-api.moxehealth.com/oauth/token
          scopes:
            write:patient-chart-request: create patient chart transactions
            read:patient-chart-request: get information on existing transactions
x-refined-from:
- moxe-health-claim-management-initiate-openapi.json
- moxe-health-claim-management-status-openapi.json
x-readme:
  explorer-enabled: false
  proxy-enabled: true
x-amazon-apigateway-importexport-version: '1.0'
x-si-base: ./api/chartretrievalapi.yaml
x-github-repo: MoxeHealth/ChaseListManager
x-github-sha: 6705c89c377f138b5d91395fcaba1440c7aed96a