sharp_revenue_testing_guide
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| sharp_revenue_testing_guide [2025/01/03 18:31] – brad.sharp | sharp_revenue_testing_guide [2025/06/05 20:09] (current) – [Eligibility/Insurance Discovery Products] brad.sharp | ||
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| ====== Sharp Revenue Tools API Guide ====== | ====== Sharp Revenue Tools API Guide ====== | ||
| - | ===== Product ID’s ===== | + | ===== Product List ===== |
| + | ==== Eligibility - Product ID: 1 ==== | ||
| + | This is used when you have all the information about the patient' | ||
| + | ==== Demographics - Product ID: 2==== | ||
| + | This runs the top level of the patients credit report and is utilized in Insurance Discovery. It will return | ||
| + | information such as address, gender, SSN. Use Product ID of 2 | ||
| + | ==== Sharp Coverage Discovery - Product ID: 3==== | ||
| + | When you don't know what insurance the patient has, you can run this. Using as much information you can provide this will fish for insurance. Use Product ID of 3 | ||
| + | ==== MbiFinder - Product ID: 5==== | ||
| + | This is used when you have the old Medicare member number and you need the new member number. Use Product ID of 5 | ||
| - | * **Eligibility** = 1 | ||
| - | * **Demographics** = 2 | ||
| - | * **InsuranceDiscovery** = 3 | ||
| - | * **MbiFinder** = 5 | ||
| ===== Selected API List ===== | ===== Selected API List ===== | ||
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| To run Revenue Tools with the mentioned products, use this API: | To run Revenue Tools with the mentioned products, use this API: | ||
| - | **POST**: | + | **POST**: / |
| ==== Request ==== | ==== Request ==== | ||
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| - | "procedures": | + | "payerNumber": |
| - | | + | "payerName": "BCBS of Indiana (Anthem)", |
| - | | + | "subscriberNumber": "M45695321" |
| - | "type": "string" | + | }] |
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| * UniqueTransactionNumber - This should be unique to your system. The system will create one if left blank. | * UniqueTransactionNumber - This should be unique to your system. The system will create one if left blank. | ||
| * ProductsToRun - An array of all the products you'd like to run for this patient. | * ProductsToRun - An array of all the products you'd like to run for this patient. | ||
| + | * IsRevenueToolsPayerID - this is set to true if using payer ID's from the Revenue Tools portion of the processing system. If you're using the Payer ID that is typically on a claim, the system has to lookup the mapping for that payer. In that case you'd use False in this location. If an EMR is setup to send claims to ClaimRev, that EMR will have claim payer ID's setup with the insurance information for that patient. That is when this value should be false. | ||
| Note: The PreAuthorization product is still in development, | Note: The PreAuthorization product is still in development, | ||
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| + | * uniqueTransactionNumber is the number that comes back on the results of / | ||
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| + | ==== Response ==== | ||
| + | Same as RunSharpRevenue. | ||
| + | |||
| + | |||
| + | ===== Check Sharp Revenue Get Previous Results By Object ID ===== | ||
| + | The RunSharpRevenue api returns a property called claimRevResultsId, | ||
| + | |||
| + | GET: / | ||
| + | **Note: this is a GET call, there is no body and should be set to none in postman.** | ||
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| + | |||
| ==== Response ==== | ==== Response ==== | ||
| Same as RunSharpRevenue. | Same as RunSharpRevenue. | ||
| ===== How To Get Test Information Back ===== | ===== How To Get Test Information Back ===== | ||
| + | Note that the test API's are just to get started, switching to production with real data is important and will help complete your integration. | ||
| ==== Demographics/ | ==== Demographics/ | ||
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| ==== Eligibility/ | ==== Eligibility/ | ||
| The behavior of the service is largely dependent on the name of the subscriber / guarantor: | The behavior of the service is largely dependent on the name of the subscriber / guarantor: | ||
| + | * **Note Use Payer** Payer Number: 00015 and PayerName: | ||
| * **Subscriber first name starts with “H”** – return Active coverage if subscriber id is present, otherwise return an AAA 72 validation (indicating a missing subscriber id). | * **Subscriber first name starts with “H”** – return Active coverage if subscriber id is present, otherwise return an AAA 72 validation (indicating a missing subscriber id). | ||
| * **Subscriber first name starts with “I”** – return Not Found response with an AAA 42 validation (indicating service temporarily unable to respond); a different AAA validation code can be sent if the first name contains a hyphen followed by the code (for example, a first name of “I-41” will cause a AAA 41 to be returned). | * **Subscriber first name starts with “I”** – return Not Found response with an AAA 42 validation (indicating service temporarily unable to respond); a different AAA validation code can be sent if the first name contains a hyphen followed by the code (for example, a first name of “I-41” will cause a AAA 41 to be returned). | ||
sharp_revenue_testing_guide.1735929074.txt.gz · Last modified: 2025/01/03 18:31 by brad.sharp