claims

Price or reconcile a whole claim

Many claim lines at one or more candidate billing entities → the rate each entity would be paid per line (APC case rates, packaging, office vs facility), totals, and — with claim_allowed_total — a reconciliation verdict.

Workflows

Workflow estimate-visit-cost, step 4/4 price-visit: Estimate what a visit will cost a person before care, under their plan, at a specific place.

  • Purpose: Prices all expected lines at the candidate billing entities for the given place of service.
  • Call after: find_codes

Workflow check-a-bill, step 3/3 reconcile: Check whether a received bill or EOB matches the plan's published negotiated prices.

  • Purpose: Reconciles the claim at the billing entity and related entities; hospital bills are place_of_service hospital_outpatient.
  • Call after: find_providers
post/v1/claims/price

Request

  • Base URL: https://api.ticexplorer.com
  • URL: https://api.ticexplorer.com/v1/claims/price
  • Auth: HTTP bearer

Request body

zipstring required
place_of_service'office' | 'hospital_outpatient' | 'facility' | 'unknown'

office = clinic / urgent care / doctor's office ("physician services"); hospital_outpatient = hospital outpatient department, hospital imaging or lab ("hospital services").

claim_allowed_totalnumber nullable

Actual allowed amount from the bill/EOB, to reconcile.

milesnumber
wait_secondsinteger

Example request

{
  "zip": "98052"
}

Response

Successful Response

billing_entitiesobject[] required
per_entity_totalsobject[] required
expected_total_rangenumber[] required
next_stepsstring[]

Changes

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