EncountersV4

Update professional encounter

patch/api/encounters/v4/{encounter_id}

Request

  • Base URL: https://api.taigabilling.com
  • URL: https://api.taigabilling.com/api/encounters/v4/{encounter_id}
  • Auth: HTTP bearer

Path parameters

encounter_idstring uuid required

Request body

benefits_assigned_to_providerboolean nullable

Whether this patient has authorized insurance payments to be made to you, not them. If false, patient may receive reimbursement. Box 13 on the CMS-1500 claim form or Form Locator 53 on a UB-04 claim form.

prior_authorization_numberstring
external_idstring
date_of_servicestring date nullable

Date formatted as YYYY-MM-DD; eg: 2019-08-24. This date must be the local date in the timezone where the service occurred. Box 24a on the CMS-1500 claim form or Form Locator 45 on the UB-04 claim form. If service occurred over a range of dates, this should be the start date. If service lines have distinct date_of_service values, updating the encounter's date_of_service will fail. If all service line date_of_service values are the same, updating the encounter's date_of_service will update all service line date_of_service values.

tag_idsTagId[] nullable

Names of tags that should be on the encounter. Note all tags on encounter will be overridden with this list.

billable_status'BILLABLE' | 'NOT_BILLABLE'
responsible_party'INSURANCE_PAY' | 'SELF_PAY' | 'UNKNOWN'
provider_accepts_assignmentboolean nullable

Whether you have accepted the patient's authorization for insurance payments to be made to you, not them. Box 27 on the CMS-1500 claim form. There is no exact equivalent of this field on a UB-04 claim, however contributes to the concept of Form Locator 53.

synchronicity'Synchronous' | 'Asynchronous'
place_of_service_code'01' | '02' | '03' | '04' | '05' | '06' | '07' | '08' | '09' | '10' | '11' | '12' | '13' | '14' | '15' | '16' | '17' | '18' | '19' | '20' | '21' | '22' | '23' | '24' | '25' | '26' | '31' | '32' | '33' | '34' | '41' | '42' | '49' | '50' | '51' | '52' | '53' | '54' | '55' | '56' | '57' | '58' | '60' | '61' | '62' | '65' | '71' | '72' | '81' | '99'

Box 24B on the CMS-1500 claim form. Line-level place of service is not currently supported. 02 for telemedicine, 11 for in-person. Full list here: https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set

appointment_typestring nullable

Human-readable description of the appointment type (ex: "Acupuncture - Headaches").

end_date_of_servicestring date nullable

Date formatted as YYYY-MM-DD; eg: 2019-08-25. This date must be the local date in the timezone where the service occurred. If omitted, the Encounter is assumed to be for a single day. Must not be temporally before the date_of_service field. If service lines have distinct end_date_of_service values, updating the encounter's end_date_of_service will fail. If all service line end_date_of_service values are the same, updating the encounter's end_date_of_service will update all service line date_of_service values.

additional_informationstring nullable

Defines additional information on the claim needed by the payer. Box 19 on the CMS-1500 claim form or Form Locator 80 on a UB-04 claim form.

outside_labboolean nullable

Indicates whether lab services were performed outside the billing entity. Box 20 (Yes/No) on the CMS-1500 claim form.

outside_lab_charges_amount_centsinteger nullable

The charges associated with outside lab services, in cents. Box 20 (Charges) on the CMS-1500 claim form. Applicable when outside_lab is true.

purchased_service_provider_npistring
service_authorization_exception_code'1' | '2' | '3' | '4' | '5' | '6' | '7'

Required when mandated by government law or regulation to obtain authorization for specific service(s) but, for the reasons listed in one of the enum values, the service was performed without obtaining the authorization.

admission_datestring date nullable

837p Loop2300 DTP*435, CMS-1500 Box 18 or UB-04 Form Locator 12. Required on all ambulance claims when the patient was known to be admitted to the hospital. OR Required on all claims involving inpatient medical visits.

discharge_datestring date nullable

837p Loop2300 DTP*096, CMS-1500 Box 18 Required for inpatient claims when the patient was discharged from the facility and the discharge date is known. Not used on an institutional claim.

onset_of_current_illness_or_symptom_datestring date nullable

837p Loop2300 DTP*431, CMS-1500 Box 14 Required for the initial medical service or visit performed in response to a medical emergency when the date is available and is different than the date of service. OR This date is the onset of acute symptoms for the current illness or condition. For UB-04 claims, this is populated separately via occurrence codes.

last_menstrual_period_datestring date nullable

837p Loop2300 DTP*484, CMS-1500 Box 14 Required when, in the judgment of the provider, the services on this claim are related to the patient's pregnancy.de This field is populated separately via occurrence codes for UB-04 claim forms.

delay_reason_code'1' | '2' | '3' | '4' | '5' | '6' | '7' | '8' | '9' | '10' | '11' | '15' | '16' | '17'

Code indicating the reason why a request was delayed

patient_authorized_releaseboolean nullable

Whether this patient has authorized the release of medical information for billing purpose. Box 12 on the CMS-1500 claim form or Form Locator 52 on a UB-04 claim form.

referral_numberstring nullable

Refers to REF*9F on the 837p. Value cannot be greater than 50 characters.

secondary_payer_carrier_codestring nullable

When Medicaid is billed as the secondary payer the Carrier Code is used to identify the primary payer. This is required for certain states.

Response

external_idstring required
date_of_servicestring date nullable

Date formatted as YYYY-MM-DD; eg: 2019-08-24. This date must be the local date in the timezone where the service occurred. Box 24a on the CMS-1500 claim form or Form Locator 45 on the UB-04 claim form. If service occurred over a range of dates, this should be the start date. date_of_service must be defined on either the encounter or the service lines but not both. If there are greater than zero service lines, it is recommended to specify date_of_service on the service_line instead of on the encounter to prepare for future API versions.

end_date_of_servicestring date nullable

Date formatted as YYYY-MM-DD; eg: 2019-08-25. This date must be the local date in the timezone where the service occurred. If omitted, the Encounter is assumed to be for a single day. Must not be temporally before the date_of_service field. If there are greater than zero service lines, it is recommended to specify end_date_of_service on the service_line instead of on the encounter to prepare for future API versions.

patient_authorized_releaseboolean required

Whether this patient has authorized the release of medical information for billing purpose. Box 12 on the CMS-1500 claim form or Form Locator 52 on a UB-04 claim form.

benefits_assigned_to_providerboolean required

Whether this patient has authorized insurance payments to be made to you, not them. If false, patient may receive reimbursement. Box 13 on the CMS-1500 claim form or Form Locator 53 on a UB-04 claim form.

provider_accepts_assignmentboolean required

Whether you have accepted the patient's authorization for insurance payments to be made to you, not them. Box 27 on the CMS-1500 claim form. There is no exact equivalent of this field on a UB-04 claim, however contributes to the concept of Form Locator 53.

appointment_typestring nullable

Human-readable description of the appointment type (ex: "Acupuncture - Headaches").

synchronicity'Synchronous' | 'Asynchronous'
billable_status'BILLABLE' | 'NOT_BILLABLE' required
additional_informationstring nullable

Defines additional information on the claim needed by the payer. Box 19 on the CMS-1500 claim form or Form Locator 80 on a UB-04 claim form.

outside_labboolean nullable

Indicates whether lab services were performed outside the billing entity. Box 20 (Yes/No) on the CMS-1500 claim form.

outside_lab_charges_amount_centsinteger nullable

The charges associated with outside lab services, in cents. Box 20 (Charges) on the CMS-1500 claim form. Applicable when outside_lab is true.

purchased_service_provider_npistring
service_authorization_exception_code'1' | '2' | '3' | '4' | '5' | '6' | '7'

Required when mandated by government law or regulation to obtain authorization for specific service(s) but, for the reasons listed in one of the enum values, the service was performed without obtaining the authorization.

admission_datestring date nullable

837p Loop2300 DTP*435, CMS-1500 Box 18 or UB-04 Form Locator 12. Required on all ambulance claims when the patient was known to be admitted to the hospital. OR Required on all claims involving inpatient medical visits.

discharge_datestring date nullable

837p Loop2300 DTP*096, CMS-1500 Box 18 Required for inpatient claims when the patient was discharged from the facility and the discharge date is known. Not used on an institutional claim.

onset_of_current_illness_or_symptom_datestring date nullable

837p Loop2300 DTP*431, CMS-1500 Box 14 Required for the initial medical service or visit performed in response to a medical emergency when the date is available and is different than the date of service. OR This date is the onset of acute symptoms for the current illness or condition. For UB-04 claims, this is populated separately via occurrence codes.

last_menstrual_period_datestring date nullable

837p Loop2300 DTP*484, CMS-1500 Box 14 Required when, in the judgment of the provider, the services on this claim are related to the patient's pregnancy. This field is populated separately via occurrence codes for UB-04 claim forms.

delay_reason_code'1' | '2' | '3' | '4' | '5' | '6' | '7' | '8' | '9' | '10' | '11' | '15' | '16' | '17'

Code indicating the reason why a request was delayed

Example response

{
  "existing_medications": [
    {
      "name": "Lisinopril"
    }
  ],
  "interventions": [
    {
      "name": "Physical Therapy Session",
      "medication": {
        "name": "Lisinopril"
      },
      "labs": [
        {
          "name": "Genetic Health Labs"
        }
      ]
    }
  ]
}

Changes

No recorded changes to this operation across all 1 revision of this API.