---
title: "POST /api/claim/professional/v1"
method: POST
path: "/api/claim/professional/v1"
---

# POST /api/claim/professional/v1

`POST /api/claim/professional/v1`

## Request

- Base URL: `https://forecaster.cairhealth.com`
- URL: `https://forecaster.cairhealth.com/api/claim/professional/v1`
- Auth: HTTP bearer

Creates a professional claim from a CMS 1500 file. This schema is an augmentation of the Healthie CMS 1500 schema to support the full CMS-1500 claim format.

## Query parameters

- `attachmentId` string
- `primaryPcn` string

## Request body

- object
  - `accept_assignment` boolean, required: Whether the provider agrees to accept assignment
  - `id` string, required: Unique identifier for the CMS 1500 form
  - `date_of_service` string, required: Date when the service was provided
  - `total_charge` string, required: Total charge amount for the claim
  - `patient` object, required: Information about the patient
    - `id` string: Patient identifier
    - `first_name` string: Patient's first name
    - `last_name` string: Patient's last name
    - `name` string: Patient's full name
    - `gender` string: Patient's gender
    - `dob` string: Patient's date of birth
    - `email` string: Patient email address
    - `phone_number` string: Patient phone number
    - `location` object: Patient's address information
      - `city` string: City
      - `country` string: Country
      - `line1` string: Address line 1
      - `line2` string: Address line 2
      - `name` string: Location name
      - `state` string: State
      - `to_oneline` string: Single line address representation
      - `zip` string: ZIP/Postal code
      - `place_of_service` object: Place of service details
        - `code` string: Code of the place of service
        - `name` string: Name of the place of service
        - `code_name` string: Code name of the place of service
    - `policies` object[]: Patient's insurance policies
      - `id` string: Policy identifier
      - `num` string: Policy number
      - `group_num` string: Insurance group number
      - `name` string: Policy name
      - `holder_first` string: Policy holder's first name
      - `holder_last` string: Policy holder's last name
      - `holder_relationship` string: Relationship between patient and policy holder
      - `claim_filing_indicator` string: Claim filing indicator code. Use WC for Workers' Compensation claims. When WC is selected, employer information should be provided.
      - `insurance_type_code` '12' | '13' | '14' | '15' | '16' | '41' | '42' | '43' | '47': Insurance type code for Medicare secondary claims. Required when claim_filing_indicator is MA or MB and the policy is secondary.
      - `priority_type` string: Priority type of the insurance policy
      - `prior_authorization` string: Prior authorization reference number for the policy.
      - `insurance_plan` object: Insurance plan details
        - `payer_name` string, required: Name of the insurance payer
        - `payer_id` string, required: Identifier for the insurance payer
        - `name_and_id` string: Combined name and ID of the insurance plan
      - `employer` object: Employer information for Workers' Compensation claims. Required when claim_filing_indicator is WC.
        - `name` string, required: Employer name
        - `tax_id` string: Employer Tax ID / Employer Identification Number (EIN)
        - `location` object: Employer address
          - `city` string: City
          - `country` string: Country
          - `line1` string: Address line 1
          - `line2` string: Address line 2
          - `state` string: State code
          - `zip` string: ZIP code
  - `billing_provider` object, required: Information about the billing provider. Resolved to an Organization or, for individual (Type 1 NPI) providers, a Practitioner with a matching NPI and EIN.
    - `name` string, required: Provider name
    - `npi` string, required: National Provider Identifier
    - `tax_id` string, required: Provider tax ID (EIN). Used with the NPI to resolve the billing provider
    - `taxonomy_code` string: Provider taxonomy code
    - `location` object, required: Provider's address information
      - `city` string: City
      - `country` string: Country
      - `line1` string: Address line 1
      - `line2` string: Address line 2
      - `name` string: Location name
      - `state` string: State
      - `to_oneline` string: Single line address representation
      - `zip` string: ZIP/Postal code
      - `place_of_service` object: Place of service details
        - `code` string: Code of the place of service
        - `name` string: Name of the place of service
        - `code_name` string: Code name of the place of service
  - `rendering_provider` object, required: Information about the rendering provider
    - `id` string: Provider identifier
    - `first_name` string: Provider's first name
    - `last_name` string: Provider's last name
    - `name` string: Provider's full name
    - `npi` string, required: Provider's NPI
    - `taxonomy_code` string: Provider's taxonomy code
    - `gender` string: Provider's gender
    - `dob` string: Provider's date of birth
    - `location` object: Provider's address information
      - `city` string: City
      - `country` string: Country
      - `line1` string: Address line 1
      - `line2` string: Address line 2
      - `name` string: Location name
      - `state` string: State
      - `to_oneline` string: Single line address representation
      - `zip` string: ZIP/Postal code
      - `place_of_service` object: Place of service details
        - `code` string: Code of the place of service
        - `name` string: Name of the place of service
        - `code_name` string: Code name of the place of service
  - `referring_provider` object: Information about the referring provider.
    - `id` string: Provider identifier
    - `first_name` string: Provider's first name
    - `last_name` string: Provider's last name
    - `name` string: Provider's full name
    - `npi` string, required: Provider's NPI
    - `gender` string: Provider's gender
    - `dob` string: Provider's date of birth
  - `ordering_provider` object: Information about the ordering provider.
    - `id` string: Provider identifier
    - `first_name` string: Provider's first name
    - `last_name` string: Provider's last name
    - `name` string: Provider's full name
    - `npi` string, required: Provider's NPI
    - `taxonomy_code` string: Provider's taxonomy code
    - `gender` string: Provider's gender
    - `dob` string: Provider's date of birth
    - `location` object: Provider's address information
      - `city` string: City
      - `country` string: Country
      - `line1` string: Address line 1
      - `line2` string: Address line 2
      - `name` string: Location name
      - `state` string: State
      - `to_oneline` string: Single line address representation
      - `zip` string: ZIP/Postal code
      - `place_of_service` object: Place of service details
        - `code` string: Code of the place of service
        - `name` string: Name of the place of service
        - `code_name` string: Code name of the place of service
  - `service_location` object: Location of the service
    - `id` string: Location identifier. If provided, will be used to match the location.
    - `city` string: City
    - `country` string: Country
    - `line1` string: Address line 1. If id is not provided, this field will be used to match the location in conjunction with the name.
    - `line2` string: Address line 2
    - `name` string: Location name. If id is not provided, this field will be used to match the location in conjunction with the address.
    - `state` string: State
    - `to_oneline` string: Single line address representation
    - `zip` string: ZIP/Postal code
    - `place_of_service` object: Place of service details
      - `code` string: Code of the place of service
      - `name` string: Name of the place of service
      - `code_name` string: Code name of the place of service
  - `cpt_codes_cms1500s` object[], required: CPT codes associated with the claim
    - `fee` string: Billed amount for this service
    - `units` string: Number of units for this service
    - `mod1` string: Modifier 1
    - `mod2` string: Modifier 2
    - `mod3` string: Modifier 3
    - `mod4` string: Modifier 4
    - `ndc_information` object: Optional NDC drug identification for the service line. When present, all fields are required.
      - `ndc_code` string, required: National Drug Code for the service line
      - `ndc_quantity` string, required: Drug quantity for the NDC on this service line
      - `ndc_quantity_unit` 'F2' | 'GR' | 'ME' | 'ML' | 'UN', required: Unit of measure.
    - `cpt_code` object, required
      - `code` string, required: CPT code value
  - `icd_codes_cms1500s` object[], required: ICD diagnosis codes associated with the claim
    - `icd_code` object, required
      - `code` string, required: ICD code value
  - `claim_condition_codes` object[]: Claim condition codes
    - `code` string, required: Condition code value
  - `claim_additional_information` object[]: Additional information codes for the claim
    - `code` string, required: Additional information code
    - `text` string: Additional information text
  - `injury_cause_reasons` object: Information about injury cause and reasons. If all are false, omit this field.
    - `employment_related` boolean, required: Whether the injury is employment related
    - `auto_accident` boolean, required: Whether the injury is from an auto accident
    - `other` boolean, required: Whether the injury is from another cause
    - `state` string: State where the accident occurred
    - `accident_date` string, date: Date of the accident or injury in YYYY-MM-DD format (X12 DTP*439). Defaults to date_of_service when omitted.
  - `patient_paid_amount` number: Amount paid by the patient
  - `clia_number` string: Clinical Laboratory Improvement Amendment (CLIA) number for CLIA-certified facilities performing CLIA-covered laboratory services.

## Response `200`

Claim created successfully

- OperationOutcome: A FHIR standard response format for operations
  - `resourceType` 'OperationOutcome', required: Type of resource
  - `id` string: Logical id of this artifact
  - `issue` object[], required: A list of issues with the operation
    - `severity` 'fatal' | 'error' | 'warning' | 'information', required: Severity of the issue
    - `code` 'invalid' | 'structure' | 'required' | 'value' | 'invariant' | 'security' | 'login' | 'unknown' | 'expired' | 'forbidden' | 'suppressed' | 'processing' | 'not-supported' | 'duplicate' | 'multiple-matches' | 'not-found' | 'deleted' | 'too-long' | 'code-invalid' | 'extension' | 'too-costly' | 'business-rule' | 'conflict' | 'transient' | 'lock-error' | 'no-store' | 'exception' | 'timeout' | 'incomplete' | 'throttled' | 'informational', required: Error or warning code
    - `diagnostics` string: Additional diagnostic information about the issue
    - `details` object
      - `text` string: Text description of the issue
      - `coding` object[]: Coding of the issue
    - `location` string[]: Locations in the resource where the issue occurred
    - `expression` string[]: FHIRPath of element(s) causing the issue

## Other responses

- `400`: Invalid request body or validation error
- `401`: Unauthorized access or invalid organization ID
- `409`: Claim with patient control number already exists

## Changes

- **2026-11-03** `b32380ccde9a`: 5 info
  - added the new optional request property `injury_cause_reasons/accident_date`
  - added the new optional request property `patient/email`
  - added the new optional request property `patient/phone_number`
  - added the new optional request property `patient/policies/items/employer`
  - …1 more

[Operation history](https://skmtc.dev/cairhealth/apis/cair-health-apis/changes/api/claim/professional/v1/post.md)

---

[API](https://skmtc.dev/cairhealth/apis/cair-health-apis.md) - [All operations](https://skmtc.dev/cairhealth/apis/cair-health-apis/llms.txt) - [OpenAPI document](https://skmtc.dev/cairhealth/apis/cair-health-apis/revisions/b32380ccde9a?raw)