Optum

Optum Report API

The Report API from Optum — 3 operation(s) for report.

GitHub OpenAPI
Business capability
Healthcare Revenue Cycle Management BC-2870

Operations 4

GET /{filename} Get Single Report #
DELETE /{filename} Delete Single Report #
GET /{filename}/277 Convert Report 277 #
GET /{filename}/835 Convert Report 835 #

Documentation

📖
APIReference
https://developer.optum.com/eligibilityandclaims/reference/api-overview
📖
GettingStarted
https://developer.optum.com/eligibilityandclaims/docs/get-started-with-optum-api
📖
Authentication
https://developer.optum.com/eligibilityandclaims/docs/optum-security-and-authorization
📖
APIReference
https://developer.optum.com/optumreal-dental/reference/overview-real-dental
📖
GettingStarted
https://developer.optum.com/optumreal-dental/reference/get-started
📖
APIReference
https://developer.optum.com/pharmacysolutions/reference
📖
APIReference
https://developer.optum.com/paymentandreimbursement/reference
📖
APIReference
https://developer.optum.com/platformandinteroperability/reference
📖
APIReference
https://developer.optum.com/analyticsandinsights/reference
📖
APIReference
https://developer.optum.com/apitools/reference/security-and-authorization-v2-overview
📖
Documentation
https://developer.optum.com/apitools/docs/getting-started

Specifications

⚙
OpenAPI
https://raw.githubusercontent.com/api-evangelist/optum/refs/heads/main/openapi/optum-report-api-openapi.yml

Other Resources

🔗
ChangeLog
https://developer.optum.com/eligibilityandclaims/docs/eligibility-release-notes

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OpenAPI Specification

optum-report-api-openapi.yml Raw ↑ 
openapi: 3.2.0
info:
  title: Medical Network Claims Responses And Reports v2 Report API
  description: Claims Responses And Reports
  version: v2
servers:
- url: https://sandbox-apigw.optum.com/medicalnetwork/reports/v2
  description: Optum
tags:
- name: Report
paths:
  /{filename}:
    get:
      tags:
      - Report
      summary: Get Single Report
      operationId: get_single_report_v2_reports__filename__get
      parameters:
      - name: Authorization
        in: header
        description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
        required: true
        schema:
          type: string
      - required: true
        schema:
          title: Filename
        name: filename
        in: path
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ReportContent'
        '422':
          description: Validation Error
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
    delete:
      tags:
      - Report
      summary: Delete Single Report
      operationId: delete_single_report_v2_reports__filename__delete
      parameters:
      - name: Authorization
        in: header
        description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
        required: true
        schema:
          type: string
      - required: true
        schema:
          title: Filename
        name: filename
        in: path
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ReportDeleted'
        '422':
          description: Validation Error
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
  /{filename}/277:
    get:
      tags:
      - Report
      summary: Convert Report 277
      operationId: convert_report_277_v2_reports__filename__277_get
      parameters:
      - name: Authorization
        in: header
        description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
        required: true
        schema:
          type: string
      - required: true
        schema:
          title: Filename
        name: filename
        in: path
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ClaimStatusTransactionResponse'
        '422':
          description: Validation Error
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
  /{filename}/835:
    get:
      tags:
      - Report
      summary: Convert Report 835
      operationId: convert_report_835_v2_reports__filename__835_get
      parameters:
      - name: Authorization
        in: header
        description: 'Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b>'
        required: true
        schema:
          type: string
      - required: true
        schema:
          title: Filename
        name: filename
        in: path
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ClaimPaymentAdviceTransactionResponse'
        '422':
          description: Validation Error
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/HTTPValidationError'
components:
  schemas:
    ClaimStatusTransactionResponse:
      title: ClaimStatusTransactionResponse
      required:
      - meta
      type: object
      properties:
        transactions:
          type: array
          items:
            $ref: '#/components/schemas/ClaimStatusResponse'
          description: transactions
          default: []
        meta:
          $ref: '#/components/schemas/Meta'
    ContactMethod:
      title: ContactMethod
      type: object
      properties:
        email:
          type: string
          description: PER04-06 where PER03-05 = EM
        fax:
          type: string
          description: PER04-06 where PER03-05 = FX
        phone:
          type: string
          description: PER04-06 where PER03-05 = TE
        phoneExtension:
          type: string
          description: PER06-08 where PER05-07 = EX
    InpatientAdjudication:
      title: InpatientAdjudication
      type: object
      properties:
        coveredDaysOrVisitsCount:
          type: string
          description: LOOP 2100; MIA01
        ppsOperatingOutlierAmount:
          type: string
          description: LOOP 2100; MIA02
        lifetimePsychiatricDaysCount:
          type: string
          description: LOOP 2100; MIA03
        claimDRGAmount:
          type: string
          description: LOOP 2100; MIA04
        claimPaymentRemarkCode1:
          type: string
          description: LOOP 2100; MIA05
        claimDisproportionateShareAmount:
          type: string
          description: LOOP 2100; MIA06
        claimMSPPassThroughAmount:
          type: string
          description: LOOP 2100; MIA07
        claimPPSCapitalAmount:
          type: string
          description: LOOP 2100; MIA08
        ppsCapitalFSPDRGAmount:
          type: string
          description: LOOP 2100; MIA09
        ppsCapitalHSPDRGAmount:
          type: string
          description: LOOP 2100; MIA10
        ppsCapitalDSHDRGAmount:
          type: string
          description: LOOP 2100; MIA11
        oldCapitalAmount:
          type: string
          description: LOOP 2100; MIA12
        ppsCapitalIMEAmount:
          type: string
          description: LOOP 2100; MIA13
        ppsOperatingHospitalSpecificDRGAmount:
          type: string
          description: LOOP 2100; MIA14
        costReportDayCount:
          type: string
          description: LOOP 2100; MIA15
        ppsOperatingFederalSpecificDRGAmount:
          type: string
          description: LOOP 2100; MIA16
        claimPPSCapitalOutlierAmount:
          type: string
          description: LOOP 2100; MIA17
        claimIndirectTeachingAmount:
          type: string
          description: LOOP 2100; MIA18
        nonPayableProfessionalComponentAmount:
          type: string
          description: LOOP 2100; MIA19
        claimPaymentRemarkCode2:
          type: string
          description: LOOP 2100; MIA20
        claimPaymentRemarkCode3:
          type: string
          description: LOOP 2100; MIA21
        claimPaymentRemarkCode4:
          type: string
          description: LOOP 2100; MIA22
        claimPaymentRemarkCode5:
          type: string
          description: LOOP 2100; MIA23
        ppsCapitalExceptionAmount:
          type: string
          description: LOOP 2100; MIA24
    ClaimStatusResponse:
      title: ClaimStatusResponse
      type: object
      properties:
        controlNumber:
          type: string
          description: ST02
        referenceIdentification:
          type: string
          description: BHT03
        transactionSetCreationDate:
          type: string
          description: BHT04
        transactionSetCreationTime:
          type: string
          description: BHT05
        payers:
          type: array
          items:
            $ref: '#/components/schemas/cdpedi__x12__v5010__newmodels__claim_status_cdpedi__Payer'
          description: Loop 2100A
          default: []
    ContactMethods:
      title: ContactMethods
      type: object
      properties:
        electronicDataInterChangeAccessNumber:
          type: string
          description: PER04-06-08 where PER03-05-7=ED
        email:
          type: string
          description: PER04-06-08 where PER03-05-7=EM
        fax:
          type: string
          description: PER04-06-08 where PER03-05-7=FX
        phone:
          type: string
          description: PER04-06-08 where PER03-05-7=TE
        phoneExtension:
          type: string
          description: PER04-06-08 where PER03-05-7=EX
    ClaimStatus:
      title: ClaimStatus
      type: object
      properties:
        referencedTransactionTraceNumber:
          type: string
          description: Loop 2200[D|E] TRN02
        informationClaimStatuses:
          type: array
          items:
            $ref: '#/components/schemas/InformationClaimStatus'
          description: Loop 2200[D|E]
          default: []
        tradingPartnerClaimNumber:
          type: string
          description: Loop 2200[D|E] REF02 where REF01=1K
        billTypeIdentifier:
          type: string
          description: Loop 2200[D|E] REF02 where REF01=BLT
        patientAccountNumber:
          type: string
          description: Loop 2200[D|E] REF02 where REF01=EJ
        pharmacyPrescriptionNumber:
          type: string
          description: Loop 2200[D|E] REF02 where REF01=XZ
        voucherIdentifier:
          type: string
          description: Loop 2200[D|E] REF02 where REF01=VV
        clearinghouseTraceNumber:
          type: string
          description: Loop 2200[D|E] REF02 where REF01=D9
        claimServiceBeginDate:
          type: string
          description: Loop 2200[D|E] DTP03 where DTP02=RD8
        claimServiceEndDate:
          type: string
          description: Loop 2200[D|E] DTP03 where DTP02=RD8
        claimServiceDate:
          type: string
          description: Loop 2200[D|E] DTP03 where DTP02=D8
    RenderingProviderIdentification:
      title: RenderingProviderIdentification
      type: object
      properties:
        stateLicenseNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = 0B
        blueCrossProviderNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = 1A
        blueShieldProviderNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = 1B
        medicareProviderNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = 1C
        medicaidProviderNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = 1D
        providerUPINNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = 1G
        champusIdentificationNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = 1H
        facilityIdNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = 1J
        nationalCouncilForPrescriptionDrugProgramPharmacyNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = D3
        providerCommercialNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = G2
        locationNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = LU
    Meta:
      title: Meta
      type: object
      properties:
        applicationMode:
          type: string
        senderId:
          type: string
        traceId:
          type: string
    cdpedi__x12__v5010__newmodels__claim_status_cdpedi__Payer:
      title: Payer
      type: object
      properties:
        organizationName:
          type: string
          description: NM103
        payerIdentification:
          type: string
          description: NM109 where NM108=PI
        centersForMedicareAndMedicaidServicePlanId:
          type: string
          description: NM109 where NM108=XV
        payerContactInformation:
          allOf:
          - $ref: '#/components/schemas/Contact'
          description: PER
          default: {}
        claimStatusTransactions:
          type: array
          items:
            $ref: '#/components/schemas/ClaimStatusTransactions'
          description: Loop 2000C
          default: []
      description: Model for the Payer Identification for LOOP 2100A
    ServiceProvider:
      title: ServiceProvider
      type: object
      properties:
        organizationName:
          type: string
          description: NM103 where NM102=2
        lastName:
          type: string
          description: NM103 where NM102=1
        firstName:
          type: string
          description: NM104
        middleName:
          type: string
          description: NM105
        suffix:
          type: string
          description: NM107
        tin:
          type: string
          description: NM109 where NM108=FI
        spn:
          type: string
          description: NM109 where NM108=SV
        npi:
          type: string
          description: NM109 where NM108=XX
    OtherClaimRelatedIdentification:
      title: OtherClaimRelatedIdentification
      type: object
      properties:
        groupOrPolicyNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = 1L
        memberIdentificationNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = 1W
        employeeIdentificationNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = 28
        groupNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = 6P
        rePricedClaimReferenceNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = 9A
        adjustedRePricedClaimReferenceNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = 9C
        authorizationNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = BB
        classOfContractCode:
          type: string
          description: LOOP 2100; REF02 where REF01 = CE
        medicalRecordIdentificationNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = EA
        originalReferenceNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = F8
        priorAuthorizationNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = G1
        predeterminationOfBenefitsIdentificationNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = G3
        insurancePolicyNumber:
          type: string
          description: LOOP 2100; REF02 where REF01 = IG
        ssn:
          type: string
          description: LOOP 2100; REF02 where REF01 = SY
    cdpedi__x12__v5010__newmodels__claim_status_cdpedi__Subscriber:
      title: Subscriber
      type: object
      properties:
        organizationName:
          type: string
          description: NM103 where NM102=2
        lastName:
          type: string
          description: NM103 where NM102=1
        firstName:
          type: string
          description: NM104
        middleName:
          type: string
          description: NM105
        suffix:
          type: string
          description: NM107
        memberId:
          type: string
          description: NM109 where NM108=MI
        employerIdentificationNumber:
          type: string
          description: NM109 where NM108=24
        standardUniqueHealthIdentifierForEachIndividualInTheUnitedStates:
          type: string
          description: NM109 where NM108=II
    Address:
      title: Address
      type: object
      properties:
        address1:
          type: string
          description: N301
        address2:
          type: string
          description: N302
        city:
          type: string
          description: N401
        state:
          type: string
          description: N402
        postalCode:
          type: string
          description: N403
        countryCode:
          type: string
          description: N404
        countrySubCode:
          type: string
          description: N407
      description: Model for Address segment N3 and N4
    ClaimPaymentAdviceResponse:
      title: ClaimPaymentAdviceResponse
      type: object
      properties:
        controlNumber:
          type: string
          description: ST02
        paymentAndRemitReassociationDetails:
          allOf:
          - $ref: '#/components/schemas/PaymentAndRemitReassociationDetails'
          description: TRN
        foreignCurrency:
          type: string
          description: CUR02 where CUR01=PR
        productionDate:
          type: string
          description: DTM02 where DTM01=405
        receiverIdentifier:
          type: string
          description: REF02 where REF01=EV
        versionIdentification:
          type: string
          description: REF02 where REF01=F2
        financialInformation:
          allOf:
          - $ref: '#/components/schemas/FinancialInformation'
          description: BPR
        payer:
          $ref: '#/components/schemas/cdpedi__x12__v5010__newmodels__claim_payment_advice__Payer'
        payee:
          $ref: '#/components/schemas/Payee'
        detailInfo:
          type: array
          items:
            $ref: '#/components/schemas/DetailInfo'
          default: []
        providerAdjustments:
          type: array
          items:
            $ref: '#/components/schemas/ProviderAdjustments'
          description: PLB; segment REPEAT >1
          default: []
    CorrectedPatientOrInsuredName:
      title: CorrectedPatientOrInsuredName
      type: object
      properties:
        organizationName:
          type: string
          description: LOOP 2100; NM103 where NM102=2
        lastName:
          type: string
          description: LOOP 2100; NM103 where NM102=1
        firstName:
          type: string
          description: LOOP 2100; NM104
        middleName:
          type: string
          description: LOOP 2100; NM105
        suffix:
          type: string
          description: LOOP 2100; NM107
        insuredsChangedUniqueIdentificationNumber:
          type: string
          description: LOOP 2100; NM109 where NM108=C
    ProviderClaimStatus:
      title: ProviderClaimStatus
      type: object
      properties:
        statusInformationEffectiveDate:
          type: string
          description: Loop 2200C STC02
        providerStatuses:
          type: array
          items:
            $ref: '#/components/schemas/ProviderStatus'
          description: Loop 2200C STC01 ,STC10, STC11
          default: []
    ValidationError:
      title: ValidationError
      required:
      - loc
      - msg
      - type
      type: object
      properties:
        loc:
          title: Location
          type: array
          items:
            type: string
        msg:
          title: Message
          type: string
        type:
          title: Error Type
          type: string
    ContactInformation:
      title: ContactInformation
      type: object
      properties:
        contactName:
          type: string
          description: PER02
        contactMethods:
          type: array
          items:
            $ref: '#/components/schemas/ContactMethod'
          description: each contact will have a single property set, except for phone with extention
      description: PER - PAYER BUSINESS CONTACT INFORMATION when PER01=CX
    cdpedi__x12__v5010__newmodels__claim_payment_advice__Payer:
      title: Payer
      type: object
      properties:
        name:
          type: string
          description: N102
        centersForMedicareAndMedicaidServicesPlanId:
          type: string
          description: LOOP 1000A N104 and LOOP 1000A N103=XV
        payerIdentificationNumber:
          type: string
          description: REF02 where REF01=2U
        submitterIdentificationNumber:
          type: string
          description: REF02 where REF01=EO
        healthIndustryNumber:
          type: string
          description: REF02 where REF01=HI
        nationalAssociationOfInsuranceCommissioners:
          type: string
          description: REF02 where REF01=NF
        payerWebSiteUrl:
          type: string
          description: PER04 where PER01=IC and PER03=UR
        address:
          allOf:
          - $ref: '#/components/schemas/Address'
          description: LOOP 1000A PAYER Address N3 and N4
          default: {}
        businessContactInformation:
          allOf:
          - $ref: '#/components/schemas/ContactInformation'
          description: LOOP 1000A; PER where PER01=CX
        technicalContactInformation:
          type: array
          items:
            $ref: '#/components/schemas/TechnicalContactInformation'
          description: LOOP 1000A; PER where PER01=BL
          default: []
      description: Model for the Payer Identification for LOOP 1000A
    ClaimAdjustments:
      title: ClaimAdjustments
      type: object
      properties:
        claimAdjustmentGroupCode:
          type: string
          description: CAS01
        claimAdjustmentGroupCodeValue:
          type: string
          description: CAS01 Code Value
        adjustmentReasonCode1:
          type: string
          description: CAS02
        adjustmentAmount1:
          type: string
          description: CAS03
        adjustmentQuantity1:
          type: string
          description: CAS04
        adjustmentReasonCode2:
          type: string
          description: CAS05
        adjustmentAmount2:
          type: string
          description: CAS06
        adjustmentQuantity2:
          type: string
          description: CAS07
        adjustmentReasonCode3:
          type: string
          description: CAS08
        adjustmentAmount3:
          type: string
          description: CAS09
        adjustmentQuantity3:
          type: string
          description: CAS10
        adjustmentReasonCode4:
          type: string
          description: CAS11
        adjustmentAmount4:
          type: string
          description: CAS12
        adjustmentQuantity4:
          type: string
          description: CAS13
        adjustmentReasonCode5:
          type: string
          description: CAS14
        adjustmentAmount5:
          type: string
          description: CAS15
        adjustmentQuantity5:
          type: string
          description: CAS16
        adjustmentReasonCode6:
          type: string
          description: CAS17
        adjustmentAmount6:
          type: string
          description: CAS18
        adjustmentQuantity6:
          type: string
          description: CAS19
    RemittanceDeliveryMethod:
      title: RemittanceDeliveryMethod
      type: object
      properties:
        name:
          type: string
          description: RDM02
        email:
          type: string
          description: RDM03 where RDM01=EM
        ftp:
          type: string
          description: RDM03 where RDM01=FT
        onLine:
          type: string
          description: RDM03 where RDM01=OL
    cdpedi__x12__v5010__newmodels__claim_status_cdpedi__ServiceLines:
      title: ServiceLines
      type: object
      properties:
        service:
          allOf:
          - $ref: '#/components/schemas/Service'
          description: service for Loop 2220[D|E]
          default: {}
        serviceClaimStatuses:
          type: array
          items:
            $ref: '#/components/schemas/ServiceClaimStatus'
          description: Loop 2220[D|E]
          default: []
        lineItemControlNumber:
          type: string
          description: Loop 2220[D|E] REF02
        serviceLineDate:
          type: string
          description: Loop 2220[D|E] DTP03 where DTP02=D8
        beginServiceLineDate:
          type: string
          description: Loop 2220[D|E] DTP03 where DTP02=RD8
        endServiceLineDate:
          type: string
          description: Loop 2220[D|E] DTP03 where DTP02=RD8
    RenderingProvider:
      title: RenderingProvider
      type: object
      properties:
        organizationName:
          type: string
          description: LOOP 2100; NM103 NM102=2
        lastName:
          type: string
          description: LOOP 2100; NM103 NM102=1
        firstName:
          type: string
          description: LOOP 2100; NM104
        middleName:
          type: string
          description: LOOP 2100; NM105
        suffix:
          type: string
          description: LOOP 2100; NM107
        blueCrossProviderNumber:
          type: string
          description: LOOP 2100; NM109 where NM108=BD
        blueShieldProviderNumber:
          type: string
          description: LOOP 2100; NM109 where NM108=BS
        taxId:
          type: string
          description: LOOP 2100; NM109 where NM108=FI
        medicaidProviderNumber:
          type: string
          description: LOOP 2100; NM109 where NM108=MC
        providerCommercialNumber:
          type: string
          description: LOOP 2100; NM109 where NM108=PC
        stateLicenseNumber:
          type: string
          description: LOOP 2100; NM109 where NM108=SL
        uniquePhysicianIdentificationNumber:
          type: string
          description: LOOP 2100; NM109 where NM108=UP
        npi:
          type: string
          description: LOOP 2100; NM109 where NM108=XX
    PaymentAndRemitReassociationDetails:
      title: PaymentAndRemitReassociationDetails
      type: object
      properties:
        traceTypeCode:
          type: string
          description: TRN01
        checkOrEFTTraceNumber:
          type: string
          description: TRN02
        originatingCompanyIdentifier:
          type: string
          description: TRN03
        originatingCompanySupplementalCode:
          type: string
          description: TRN04
      description: Model for Payment And Remit Reassociation Details in claim payment advice transactions TRN
    IdentificationEntity:
      title: IdentificationEntity
      type: object
      properties:
        organizationName:
          type: string
          description: LOOP 2100; NM103 where NM102=2
        blueCrossBlueShieldAssociationPlanCode:
          type: string
          description: LOOP 2100; NM109 WHERE NM108=AD
        taxId:
          type: string
          description: LOOP 2100; NM109 WHERE NM108=FI
        nationalAssociationOfInsuranceCommissionersIdentification:
          type: string
          description: LOOP 2100; NM109 WHERE NM108=NI
        payorId:
          type: string
          description: LOOP 2100; NM109 WHERE NM108=PI
        pharmacyProcessorNumber:
          type: string
          description: LOOP 2100; NM109 WHERE NM108=PP
        centersForMedicareAndMedicaidServicesPlanId:
          type: string
          description: LOOP 2100; NM109 WHERE NM108=XV
    cdpedi__x12__v5010__newmodels__claim_payment_advice__ServiceLines:
      title: ServiceLines
      type: object
      properties:
        serviceDate:
          type: string
          description: LOOP 2110; DTM02 where DTM01=472
        serviceStartDate:
          type: string
          description: LOOP 2110; DTM02 where DTM01=150
        serviceEndDate:
          type: string
          description: LOOP 2110; DTM02 where DTM01=151
        lineItemControlNumber:
          type: string
          description: LOOP 2110; REF02 where REF01=6R
        servicePaymentInformation:
          allOf:
          - $ref: '#/components/schemas/ServicePaymentInformation'
          description: LOOP 2110; SVC - SERVICE PAYMENT INFORMATION
        serviceAdjustments:
          type: array
          items:
            $ref: '#/components/schemas/ClaimAdjustments'
          description: LOOP 2110; CAS - SERVICE ADJUSTMENT, Segment repeat = 99
          default: []
        serviceIdentification:
          allOf:
          - $ref: '#/components/schemas/ServiceIdentification'
          description: LOOP 2110; REF - SERVICE IDENTIFICATION
        renderingProviderInformation:
          allOf:
          - $ref: '#/components/schemas/RenderingProviderInformation'
          description: LOOP 2110; REF - RENDERING PROVIDER INFORMATION
        serviceSupplementalAmounts:
          allOf:
          - $ref: '#/components/schemas/ServiceSupplementalAmounts'
          description: LOOP 2110; AMT - SERVICE SUPPLEMENTAL AMOUNT
        serviceSupplementalQuantities:
          allOf:
          - $ref: '#/components/schemas/ServiceSupplementalQuantities'
          description: LOOP 2110; QTY - SERVICE SUPPLEMENTAL QUANTITY
        healthCareCheckRemarkCodes:
          type: array
          items:
            $ref: '#/components/schemas/HealthCareCheckRemarkCodes'
          description: LOOP 2110; LQ - HEALTH CARE REMARK CODES, Segment repeat = 99
          default: []
        healthCarePolicyIdentification:
          type: array
          items:
            $ref: '#/components/schemas/HealthCarePolicyIdentification'
          description: LOOP 2120; REF where REF01 = 0K; segment repeat 5
          default: []
      description: LOOP ID = 2110 ; Loop Repeat = 999
    TechnicalContactMethod:
      title: TechnicalContactMethod
      type: object
      properties:
        url:
          type: string
          description: PER04-06-08 where PER03-05-07 = UR
        email:
          type: string
          description: PER04-06-08 where PER03-05 = EM
        fax:
          type: string
          description: PER06-08 where PER05-07 = FX
        phone:
          type: string
          description: PER04-06 where PER03-05 = TE
        phoneExtension:
          type: string
          description: PER06-08 where PER05-07 = EX
    OutpatientAdjudication:
      title: OutpatientAdjudication
      type: object
      properties:
        reimbursementRate:
          type: string
          description: LOOP 2100; MOA01
        claimHCPCSPayableAmount:
          type: string
          description: LOOP 2100; MOA02
        claimPaymentRemarkCode1:
          type: string
          description: LOOP 2100; MOA03
        claimPaymentRemarkCode2:
          type: string
          description: LOOP 2100; MOA04
        claimPaymentRemarkCode3:
          type: string
          description: LOOP 2100; MOA05
        claimPaymentRemarkCode4:
          type: string
          description: LOOP 2100; MOA06
        claimPaymentRemarkCode5:
          type: string
          description: LOOP 2100; MOA07
        claimESRDPaymentAmount:
          type: string
          description: LOOP 2100; MOA08
        nonPayableProfessionalComponentAmount:
          type: string
          description: LOOP 2100; MOA09
    Payee:
      title: Payee
      type: object
      properties:
        name:
          type: string
          description: N102
        taxId:
          type: string
          description: N104 where N103 where N103=FI
        centersForMedicareAndMedicaidServicesPlanId:
          type: string
          description: N104 where N103 where N103=XV
        npi:
          type: string
          description: N104 where N103 where N103=XX
        address:
          allOf:
          - $ref: '#/components/schemas/Address'
          description: LOOP 1000B PAYEE Address N3 and N4
          default: {}
        stateLicenseNumber:
          type: string
          description: LOOP 1000B REF02 where REF01=0B
        nationalCouncilForPrescriptionDrugProgramsPharmacyNumber:
          type: string
          description: LOOP 1000B REF02 where REF01=D3
        payeeIdentification:
          type: string
          description: LOOP 1000B REF02 where REF01=PQ
        federalTaxPayersIdentificationNumber:
          type: string
          description: LOOP 1000B REF02 where REF01=TJ
        remittanceDeliveryMethod:
          allOf:
          - $ref: '#/components/schemas/RemittanceDeliveryMethod'
          description: RDM - REMITTANCE DELIVERY METHOD
      description: Model for the Payee Identification for LOOP 1000B
    PatientName:
      title: PatientName
      type: object
      properties:
        lastName:
          type: string
          description: LOOP 2100; NM103
        firstName:
          type: string
          description: LOOP 2100; NM104
        middleName:
          type: string
          description: LOOP 2100; NM105
        suffix:
          type: string
          description: LOOP 2100; NM107
        ssn:
          type: string
          description: LOOP 2100 NM109 where NM108=34
        healthInsuranceClaimNumber:
          type: string
          description: LOOP 2100 NM109 where NM108=HN
        standardUniqueHealthIdentifierForEachIndividualInTheUnitedStates:
          type: string
          description: LOOP 2100 NM109 where NM108=II
        memberId:
          type: string
          description: LOOP 2100 NM109 where NM108=MI
        medicaidRecipientIdentificationNumber:
          type: string
          description: LO

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