OpenAPI Specification
openapi: 3.0.0
info:
title: NexHealth Adjustment Types Claims API
description: v3.0.0 and v20240412 are two names for the same API version; the Nex-Api-Version header accepts either value. Welcome to the developer hub and documentation for NexHealth API. This section of guide describes the operations, response parameters, request parameters, and parameter constraints related to User API. The term Operations refer to functions or methods. The operations are included in requests and send to the web server. Each operation performs a different action or a query on database.
termsOfService: https://www.nexhealth.com/terms-of-service
contact:
name: NexHealth
email: info@nexhealth.com
license:
name: NexHealth License 1.0
url: https://www.nexhealth.com/privacy
version: v20240412
servers:
- url: https://nexhealth.info
security:
- Authorization: []
tags:
- name: Claims
description: Claims resources
paths:
/claims:
get:
summary: View claims
description: This endpoint returns a list of insurance claims for a location. You can filter by patient_id, guarantor_id, provider_id, updated_since or date_of_service, and must provide at least one of these filters. location_id is always required, but does not satisfy the at-least-one-filter requirement on its own. Soft-deleted claims are excluded unless include_deleted is true.
parameters:
- in: header
name: Nex-Api-Version
description: The NexHealth API version
required: true
schema:
type: string
default: v3.0.0
- in: query
name: subdomain
description: Used to scope the request to the specified institution
required: true
schema:
type: string
- in: query
name: location_id
description: Used to scope the request to the specified location
required: true
schema:
type: integer
format: int32
- in: query
name: sort
description: "Optional comma-separated string of fields to sort on.\nInclude a leading dash for descending order.\n\nAvailable fields:\n * updated_at\n * -updated_at\n"
required: false
schema:
type: string
- in: query
name: patient_id
description: The ID of the patient associated with the claim
required: false
example: 162
schema:
type: integer
format: int32
- in: query
name: guarantor_id
description: The ID of the guarantor associated with the claim
required: false
example: 1001
schema:
type: integer
format: int32
- in: query
name: provider_id
description: The ID of the provider associated with the claim
required: false
example: 84
schema:
type: integer
format: int32
- in: query
name: updated_since
description: Claims updated at or after the specified time (UTC). The comparison is inclusive, so a record whose updated_at exactly equals the given value is returned
required: false
example: '2024-04-12T10:30:00Z'
schema:
type: string
format: date-time
- in: query
name: date_of_service
description: Claims whose date of service exactly matches the specified date
required: false
example: '2024-04-12'
schema:
type: string
format: date
- in: query
name: include_deleted
description: Include soft-deleted claims in the results
required: false
schema:
type: boolean
default: false
- in: query
name: start_cursor
description: First item of the current page. Starts empty
required: false
schema:
type: string
- in: query
name: end_cursor
description: Last item of the current page. Starts empty
required: false
schema:
type: string
- in: query
name: per_page
description: Number of results to return per page. Maximum allowed amount is 1000.
required: false
schema:
type: integer
format: int32
default: 5
responses:
'200':
description: Successful
content:
application/json:
schema:
$ref: '#/components/schemas/API_V20240412_Entities_Ledger_Insurance_ClaimBasicWithDelete_Collection_Response_WithCursor'
'400':
description: Bad Request
content:
application/json:
schema:
$ref: '#/components/schemas/API_Errors_BadRequest'
'401':
description: Unauthorized
content:
application/json:
schema:
$ref: '#/components/schemas/API_Errors_Unauthorized'
'403':
description: Forbidden
content:
application/json:
schema:
$ref: '#/components/schemas/API_Errors_Forbidden'
'500':
description: Internal Server Error
content:
application/json:
schema:
$ref: '#/components/schemas/API_Errors_InternalServerError'
tags:
- Claims
operationId: getClaims
/claims/{id}:
get:
summary: View claim
description: 'This endpoint returns a single insurance claim by its NexHealth id. Use the include parameter to embed related resources: patient, provider, guarantor, charges and/or charge_payouts. Note: when no claim with the given id exists, or it belongs to a location your token cannot access, this endpoint currently responds with HTTP 500 rather than a 404.'
parameters:
- in: header
name: Nex-Api-Version
description: The NexHealth API version
required: true
schema:
type: string
default: v3.0.0
- in: path
name: id
required: true
schema:
type: integer
format: int64
- in: query
name: subdomain
description: Used to scope the request to the specified institution
required: true
schema:
type: string
- in: query
name: include[]
description: Resources to be included in the response
required: false
explode: true
schema:
type: array
items:
type: string
enum:
- patient
- provider
- guarantor
- charges
- charge_payouts
responses:
'200':
description: Successful
content:
application/json:
schema:
$ref: '#/components/schemas/API_V20240412_Entities_Ledger_Insurance_Claim_Response'
'400':
description: Bad Request
content:
application/json:
schema:
$ref: '#/components/schemas/API_Errors_BadRequest'
'401':
description: Unauthorized
content:
application/json:
schema:
$ref: '#/components/schemas/API_Errors_Unauthorized'
'403':
description: Forbidden
content:
application/json:
schema:
$ref: '#/components/schemas/API_Errors_Forbidden'
'404':
description: Not Found
content:
application/json:
schema:
$ref: '#/components/schemas/API_Errors_NotFound'
'500':
description: Internal Server Error
content:
application/json:
schema:
$ref: '#/components/schemas/API_Errors_InternalServerError'
tags:
- Claims
operationId: getClaimsId
components:
schemas:
API_V20240412_Entities_Ledger_ChargeBasic:
type: object
properties:
id:
type: integer
format: int64
example: 113
description: Resource id
foreign_id:
type: string
example: 1234-5678
description: Unique identifier of this resource from the integrated system
location_id:
type: integer
format: int32
example: 10
description: The ID of the location that this item is for
nullable: true
patient_id:
type: integer
format: int32
example: 3
description: The ID of the patient that this item is for
nullable: true
guarantor_id:
type: integer
format: int32
example: 5
description: The ID of the guarantor that this item is for
nullable: true
provider_id:
type: integer
format: int32
example: 15
description: The ID of the provider that this item is for
nullable: true
procedure_id:
type: integer
format: int64
example: 34
description: The ID of the procedure associated with this charge
nullable: true
procedure_code:
type: string
example: D0120
description: The procedure code associated with this charge
nullable: true
updated_at:
type: string
format: date-time
example: '2024-09-05T20:31:17.007Z'
description: Last updated time for item in UTC
description:
type: string
example: This is a description
description: A description of the charge
nullable: true
fee:
$ref: '#/components/schemas/API_V2_Entities_Price'
charged_at:
type: string
format: date
example: '2024-10-05'
description: The UTC date charge was made
nullable: true
API_V20240412_Entities_Ledger_ChargePayout:
type: object
properties:
amount_billed_to_insurance:
$ref: '#/components/schemas/API_V2_Entities_Price'
estimated_insurance_payment:
$ref: '#/components/schemas/API_V2_Entities_Price'
insurance_payment:
$ref: '#/components/schemas/API_V2_Entities_Price'
write_off:
$ref: '#/components/schemas/API_V2_Entities_Price'
allowed_amount:
$ref: '#/components/schemas/API_V2_Entities_Price'
fee_schedule_procedure_code:
$ref: '#/components/schemas/API_V20240412_Entities_FeeScheduleProcedureCode'
charge_id:
type: integer
format: int64
example: 1234
description: The ID of the charge associated with this payout
API_Errors_InternalServerError:
type: object
properties:
code:
type: boolean
description: Indicates the success or failure of the request.
description:
type: string
description: Additional context about the request to help with debugging.
data:
type: object
error:
type: array
items:
type: string
description: Any errors that occured during the execution of the request.
description: API_Errors_InternalServerError model
API_Errors_Forbidden:
type: object
properties:
code:
type: boolean
description: Indicates the success or failure of the request.
description:
type: string
description: Additional context about the request to help with debugging.
data:
type: object
error:
type: array
items:
type: string
description: Any errors that occured during the execution of the request.
description: API_Errors_Forbidden model
API_Errors_Unauthorized:
type: object
properties:
code:
type: boolean
description: Indicates the success or failure of the request.
description:
type: string
description: Additional context about the request to help with debugging.
data:
type: object
error:
type: array
items:
type: string
description: Any errors that occured during the execution of the request.
description: API_Errors_Unauthorized model
API_V20240412_Entities_Ledger_Insurance_ClaimBasicWithDelete:
type: object
properties:
id:
type: integer
format: int64
example: 10
description: Claim id
location_id:
type: integer
format: int32
example: 1
description: Location id. Null when the claim is not attached to a location
nullable: true
patient_id:
type: integer
format: int32
example: 1002
description: Patient id. Null when the claim is not attached to a patient
nullable: true
provider_id:
type: integer
format: int32
example: 101
description: Provider id. Null when the claim is not attached to a provider
nullable: true
guarantor_id:
type: integer
format: int32
example: 1001
description: User id of the patient's responsible party. Null when the claim is not attached to a guarantor
nullable: true
status:
type: string
enum:
- draft
- sent
- received
- canceled
example: sent
description: Claim status
nullable: true
received_at:
type: string
format: date-time
example: '2024-06-10T15:16:57.000Z'
description: Date and time in UTC when the claim was received from insurance
nullable: true
sent_at:
type: string
format: date-time
example: '2024-06-03T11:23:12.000Z'
description: Date and time in UTC when the claim was sent to insurance
nullable: true
note:
type: string
example: Claim was sent to the insurance company
description: Claim notes
nullable: true
primary_insurance_plan_id:
type: integer
format: int64
example: 10021
description: Id of the primary insurance plan this claim was or will be sent to
nullable: true
secondary_insurance_plan_id:
type: integer
format: int64
example: 10022
description: Id of the secondary insurance plan this claim was or will be sent to
nullable: true
date_of_service:
type: string
format: date
example: '2024-06-03'
description: The date in UTC when the procedures included in the claim occurred
nullable: true
totals:
$ref: '#/components/schemas/API_V20240412_Entities_Ledger_ChargeClaimTotals'
updated_at:
type: string
format: date-time
example: '2020-06-05T20:16:57.007Z'
description: Claim update date in UTC
deleted_at:
type: string
format: date-time
example: '2022-01-01T00:00:00Z'
description: The UTC date and time the claim was deleted. Null when the claim is not deleted. Deleted claims are only listed when include_deleted is true
nullable: true
API_V20240412_Entities_Ledger_ChargeClaimTotals:
type: object
properties:
amount_billed_to_insurance:
$ref: '#/components/schemas/API_V2_Entities_Price'
estimated_insurance_payment:
$ref: '#/components/schemas/API_V2_Entities_Price'
insurance_payment:
$ref: '#/components/schemas/API_V2_Entities_Price'
write_off:
$ref: '#/components/schemas/API_V2_Entities_Price'
API_V2_Entities_User:
type: object
properties:
id:
type: integer
format: int32
example: 415
description: User id
email:
type: string
example: Amy.Ramos@nexhealth.com
description: User email
nullable: true
first_name:
type: string
example: John
description: First name
middle_name:
type: string
example: Anthony
description: Middle name
nullable: true
last_name:
type: string
example: Smith
description: Last name
name:
type: string
example: John Smith
description: Full name
created_at:
type: string
format: date-time
example: '2020-06-05T20:16:57.007Z'
description: User creation date in UTC
updated_at:
type: string
format: date-time
example: '2020-06-05T20:16:57.007Z'
description: User last updation date in UTC
institution_id:
type: integer
format: int32
example: 105
description: The institution this user belongs to
foreign_id:
type: string
example: '100437'
description: Foreign Id is a unique identifier from the integrated system
nullable: true
foreign_id_type:
type: string
example: --DataSource-
description: Foreign Id type is a unique string identifier for the integrated system
bio:
type: object
example:
city: New York
state: NY
gender: Female
zip_code: '20814'
new_patient: false
non_patient: true
phone_number: '5163042196'
date_of_birth: '1964-05-03'
address_line_1: ''
address_line_2: ''
street_address: ''
cell_phone_number: ''
home_phone_number: ''
work_phone_number: ''
description: Patient biographical data, fields shown in our example response represent all possible data we retrieve but depending on system and what is actually saved in the health records system you cannot assume any field will consistently be returned
inactive:
type: boolean
example: false
description: Is the user inactivated?
last_sync_time:
type: string
format: date-time
example: '2024-04-12T10:30:00Z'
description: The most recent time the resource's data changed meaningfully at the source
nullable: true
API_Errors_BadRequest:
type: object
properties:
code:
type: boolean
description: Indicates the success or failure of the request.
description:
type: string
description: Additional context about the request to help with debugging.
data:
type: object
error:
type: array
items:
type: string
description: Any errors that occured during the execution of the request.
description: API_Errors_BadRequest model
API_V20240412_Entities_Ledger_Insurance_Claim:
type: object
properties:
id:
type: integer
format: int64
example: 10
description: Claim id
location_id:
type: integer
format: int32
example: 1
description: Location id. Null when the claim is not attached to a location
nullable: true
patient_id:
type: integer
format: int32
example: 1002
description: Patient id. Null when the claim is not attached to a patient
nullable: true
provider_id:
type: integer
format: int32
example: 101
description: Provider id. Null when the claim is not attached to a provider
nullable: true
guarantor_id:
type: integer
format: int32
example: 1001
description: User id of the patient's responsible party. Null when the claim is not attached to a guarantor
nullable: true
status:
type: string
enum:
- draft
- sent
- received
- canceled
example: sent
description: Claim status
nullable: true
received_at:
type: string
format: date-time
example: '2024-06-10T15:16:57.000Z'
description: Date and time in UTC when the claim was received from insurance
nullable: true
sent_at:
type: string
format: date-time
example: '2024-06-03T11:23:12.000Z'
description: Date and time in UTC when the claim was sent to insurance
nullable: true
note:
type: string
example: Claim was sent to the insurance company
description: Claim notes
nullable: true
primary_insurance_plan_id:
type: integer
format: int64
example: 10021
description: Id of the primary insurance plan this claim was or will be sent to
nullable: true
secondary_insurance_plan_id:
type: integer
format: int64
example: 10022
description: Id of the secondary insurance plan this claim was or will be sent to
nullable: true
date_of_service:
type: string
format: date
example: '2024-06-03'
description: The date in UTC when the procedures included in the claim occurred
nullable: true
totals:
$ref: '#/components/schemas/API_V20240412_Entities_Ledger_ChargeClaimTotals'
updated_at:
type: string
format: date-time
example: '2020-06-05T20:16:57.007Z'
description: Claim update date in UTC
deleted_at:
type: string
format: date-time
example: '2022-01-01T00:00:00Z'
description: The UTC date and time the claim was deleted. Null when the claim is not deleted. Deleted claims are only listed when include_deleted is true
nullable: true
patient:
$ref: '#/components/schemas/API_V20240412_Entities_PatientBasic'
provider:
$ref: '#/components/schemas/API_V2_Entities_Provider'
guarantor:
$ref: '#/components/schemas/API_V2_Entities_User'
charge_payouts:
type: array
items:
$ref: '#/components/schemas/API_V20240412_Entities_Ledger_ChargePayout'
description: Billing details for each charge associated with this claim
charges:
type: array
items:
$ref: '#/components/schemas/API_V20240412_Entities_Ledger_ChargeBasic'
description: Charges associated with this claim
API_V20240412_Entities_Ledger_Insurance_Claim_Response:
type: object
properties:
code:
type: boolean
example: false
description: Indicates the success or failure of the request
description:
type: string
example: Description
description: Additional context on the request to help with debugging.
error:
type: array
items:
type: string
example:
- Error message
description: Any errors that occur during the execution of the request.
data:
$ref: '#/components/schemas/API_V20240412_Entities_Ledger_Insurance_Claim'
count:
type: integer
format: int32
example: 2
description: Number of total objects, in case of collection.
description: API_V20240412_Entities_Ledger_Insurance_Claim_Response model
API_V20240412_Entities_FeeScheduleProcedureCode:
type: object
properties:
procedure_code_id:
type: string
example: ab123456-11aa-99ff-a111-d1ee12345678
description: The uuid of the procedure code associated with the fee schedule
nullable: true
fee:
$ref: '#/components/schemas/API_V2_Entities_Price'
code:
type: string
example: D0120
description: The code of the procedure associated with the fee schedule
nullable: true
id:
type: integer
format: int64
example: 113
description: Fee Schedule Procedure Resource id
location_id:
type: integer
format: int32
example: 10
description: The location id of the fee schedule
nullable: true
fee_schedule_id:
type: integer
format: int64
example: 1234
description: The id of the fee schedule associated with the fee schedule procedure
nullable: true
updated_at:
type: string
format: date-time
example: '2020-06-05T20:16:57.007Z'
description: Fee Schedule Procedure update date in UTC
API_V2_Entities_Provider:
type: object
properties:
id:
type: integer
format: int32
example: 415
description: User id
email:
type: string
example: Amy.Ramos@nexhealth.com
description: User email
nullable: true
first_name:
type: string
example: John
description: First name
middle_name:
type: string
example: Anthony
description: Middle name
nullable: true
last_name:
type: string
example: Smith
description: Last name
name:
type: string
example: John Smith
description: Full name
created_at:
type: string
format: date-time
example: '2020-06-05T20:16:57.007Z'
description: User creation date in UTC
updated_at:
type: string
format: date-time
example: '2020-06-05T20:16:57.007Z'
description: User last updation date in UTC
institution_id:
type: integer
format: int32
example: 105
description: The institution this user belongs to
foreign_id:
type: string
example: '100437'
description: Foreign Id is a unique identifier from the integrated system
nullable: true
foreign_id_type:
type: string
example: --DataSource-
description: Foreign Id type is a unique string identifier for the integrated system
bio:
type: object
example:
city: New York
state: NY
gender: Female
zip_code: '20814'
new_patient: false
non_patient: true
phone_number: '5163042196'
date_of_birth: '1964-05-03'
address_line_1: ''
address_line_2: ''
street_address: ''
cell_phone_number: ''
home_phone_number: ''
work_phone_number: ''
description: Patient biographical data, fields shown in our example response represent all possible data we retrieve but depending on system and what is actually saved in the health records system you cannot assume any field will consistently be returned
inactive:
type: boolean
example: false
description: Is the user inactivated?
last_sync_time:
type: string
format: date-time
example: '2024-04-12T10:30:00Z'
description: The most recent time the resource's data changed meaningfully at the source
nullable: true
display_name:
type: string
example: John Smith
description: Display name
npi:
type: string
example: '1912507500'
description: National Provider Identifier as registered in NPPES. May be null if the practice did not enter it into the integrated system.
tin:
type: string
example: 078051120
description: Taxpayer Identification Number (SSN or ITIN). May be null if the practice did not enter it into the integrated system.
state_license:
type: string
example: R219935
description: State license number. May be null if the practice did not enter it into the integrated system.
specialty_code:
type: string
example: 363L00000X
description: Specialty code corresponding to the provider's state license and NPI. May be null if the practice did not enter it into the integrated system.
API_V2_Entities_Price:
type: object
properties:
amount:
type: string
example: '62.00'
description: The currency value, in whole units (e.g. dollars)
currency:
type: string
example: USD
description: The ISO currency code
API_V20240412_Entities_PatientBasic:
type: object
properties:
id:
type: integer
format: int32
example: 415
description: User id
email:
type: string
example: Amy.Ramos@nexhealth.com
description: User email
nullable: true
first_name:
type: string
example: John
description: First name
middle_name:
type: string
example: Anthony
description: Middle name
nullable: true
last_name:
type: string
example: Smith
description: Last name
name:
type: string
example: John Smith
description: Full name
created_at:
type: string
format: date-time
example: '2020-06-05T20:16:57.007Z'
description: User creation date in UTC
updated_at:
type: string
format: date-time
example: '2020-06-05T20:16:57.007Z'
description: User last updation date in UTC
institution_id:
type: integer
format: int32
example: 105
description: The institution this user belongs to
foreign_id:
type: string
example: '100437'
description: Foreign Id is a unique identifier from the integrated system
nullable: true
foreign_id_type:
type: string
example: --DataSource-
description: Foreign Id type is a unique string identifier for the integrated system
bio:
type: object
example:
city: New York
state: NY
gender: Female
zip_code: '20814'
new_patient: false
non_patient: true
phone_number: '5163042196'
date_of_birth: '1964-05-03'
address_line_1: ''
address_line_2: ''
street_address: ''
cell_phone_number: ''
home_phone_number: ''
work_phone_number: ''
description: Patient biographical data, fields shown in our example response represent all possible data we retrieve but depending on system and what is actually saved in the health records system you cannot assume any field will consistently be returned
inactive:
type: boolean
example: false
description: Is the user inactivated?
last_sync_time:
type: string
format: date-time
example: '2024-04-12T10:30:00Z'
description: The most recent time the resource's data changed meaningfully at the source
nullable: true
guarantor_id:
type: integer
format: int32
example: 472
description: User id of this patient's responsible party
nullable: true
billing_type:
type: string
example: Standard Billing - finance charges
description: Used by practices in some integrated systems to categorize and filter patients when creating reports, requesting payments, and performing other related office tasks. Some integrated systems call this an account type rather than a billing type
nullable: true
chart_id:
type: string
example: '017407'
description: User-facing ID for referencing patient data, used in some integrated systems
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