Claim Status Request Guide

The claim status request requires the following JSON structure:

{
  "accountNumber": "string",
  "practiceName": "string",
  "requestingSoftware": "string",
  "createDate": "2025-04-08T14:22:05.749Z",
  "originatingSystemId": "string",
  "npi": {
    "practiceName": "string",
    "npi": "string"
  },
  "submitterNpi": {
    "practiceName": "string",
    "npi": "string"
  },
  "claim": {
    "originatingSystemPatientKey": "string",
    "originatingSystemClaimKey": "string",
    "visitNumber": "string",
    "firstname": "string",
    "lastname": "string",
    "middlename": "string",
    "suffix": "string",
    "gender": "string",
    "dob": "2025-04-08T14:22:05.749Z",
    "serviceBeginDate": "2025-04-08T14:22:05.749Z",
    "serviceEndDate": "2025-04-08T14:22:05.749Z",
    "trackingNumber": "string",
    "submittedCharges": 0,
    "payer": {
      "isRevenueToolsPayerId": true,
      "payerNumber": "string",
      "payerName": "string",
      "subscriberNumber": "string",
      "removeGuarantor": true,
      "serviceTypeCodeAllowedList": "string"
    },
    "guarantor": {
      "firstname": "string",
      "lastname": "string",
      "middlename": "string",
      "suffix": "string",
      "gender": "string",
      "dob": "2025-04-08T14:22:05.749Z"
    },
    "identifiers": [
      {
        "qualifier": "PayersClaimNumber",
        "identifier": "string"
      }
    ],
    "services": [
      {
        "lineItemControlNumber": "string",
        "procedureCodeQualifier": "string",
        "procedureCode": "string",
        "procedureModifier1": "string",
        "procedureModifier2": "string",
        "procedureModifier3": "string",
        "procedureModifier4": "string",
        "amount": 0,
        "identifyingNumber": "string",
        "quantity": "string",
        "serviceBeginDate": "2025-04-08T14:22:05.749Z",
        "serviceEndDate": "2025-04-08T14:22:05.749Z"
      }
    ]
  }
}

Within the `“claim”` object, you can supply multiple identifiers in the `“identifiers”` array. Each identifier has a qualifier and an identifier value. Qualifier options include:

• PayersClaimNumber = 1
  • Represents the payer control number assigned by the payer
  • Converts to “1K” in the EDI

• TraceNumber = 7
  • Represents the control number assigned by the clearinghouse
  • Converts to “D9” in the EDI

• PatientAcctNumber = 5
  • Represents the claim control number assigned by the provider (found in CLM-01 on the 837)
  • Converts to “EJ” in the EDI

Other available qualifiers:

• BillingType = 2
  • Converts to “BLT” in the EDI
  • May be used if your payer requires a specific billing type indicator (e.g., professional, institutional, or dental).

• LocationNumber = 3
  • Converts to “LU” in the EDI
  • Useful if you have multiple service or billing locations that need to be specified.

• RxNumber = 6
  • Converts to “XZ” in the EDI
  • Often used for pharmacy-related claims or when referencing a specific prescription number.

• BillingType
  1. Some payers differentiate claims by billing scenario (e.g., professional vs. institutional). Using this qualifier can help direct a claim to the correct processing logic.

• LocationNumber
  1. If multiple offices or facilities operate under the same organization, this qualifier ensures the payer or clearinghouse knows exactly which location provided the service.

• RxNumber
  1. Especially important in pharmacy contexts, this qualifier helps match prescription details to the claim and can be critical for accurate status returns.

When submitting a claim status request, fill out as much of the JSON as possible, including at least one identifier. Different payers may search claims differently—some can “try harder” to find a claim, while others require precise matching. In some cases, a payer may return an incorrect claim if identifiers are too general or missing entirely.

Because each payer’s system behaves differently, we have no control over how they match or return claim information. Please use caution and provide detailed, accurate identifiers whenever possible.