EncountersV4

Create institutional or professional encounter from pre-encounter patient and appointment

Create an encounter from a pre-encounter patient and appointment. This endpoint is intended to be used by consumers who are managing patients and appointments in the pre-encounter service and is currently under development. Consumers who are not taking advantage of the pre-encounter service should use the standard create endpoint.

The endpoint will create an encounter from the provided fields, pulling information from the provided patient and appointment objects where applicable. In particular, the following fields are populated from the patient and appointment objects:

  • Patient
  • Referring Provider
  • Subscriber Primary
  • Subscriber Secondary
  • Referral Number
  • Responsible Party
  • Guarantor

Utilizing this endpoint opts you into automatic updating of the encounter when the patient or appointment is updated, assuming the encounter has not already been submitted or adjudicated.

Notice: The UB-04 Data File, 2025, is copyrighted by American Hospital Association (AHA), Chicago, Illinois. No portion of the THE UB-04 Data File, may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior express, written consent of AHA.

post/api/encounters/v4/create-from-pre-encounter/universal

Request

  • Base URL: https://api.taigabilling.com
  • URL: https://api.taigabilling.com/api/encounters/v4/create-from-pre-encounter/universal
  • Auth: HTTP bearer

Request body

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 request

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

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.