APIs for VBASoftware
- Create or Update Batch ClaimBatchDetail
Create ClaimBatchDetail
List ClaimBatchDetail
Get ClaimBatchDetail
Update ClaimBatchDetail
Delete ClaimBatchDetail
List matching benefit detail
Create or Update Batch Cl...
VBASoftware (v1)
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VBAPI VBASoftware
https://vbapi.vbasoftware.com/vbasoftware/
- VBAPI VBASoftwarehttps://vbapi.vbasoftware.com/vbasoftware/claim-batches/{batchNumber}/claims/{batchClaim}/details/{claimSeq}/{adjustmentSeq}
- curl
- JavaScript
- Node.js
- Python
- Java
- C#
- PHP
- Go
- Ruby
- R
- Payload
curl -i -X DELETE \
'https://vbapi.vbasoftware.com/vbasoftware/claim-batches/{batchNumber}/claims/{batchClaim}/details/{claimSeq}/{adjustmentSeq}' \
-H 'Authorization: Bearer <YOUR_JWT_HERE>' \
-H 'vbasoftware-database: string' \
-H 'x-api-key: YOUR_API_KEY_HERE'Body
- application/json
- text/json
- application/*+json
References the ClaimBatch.Batch_Number value on the parent record. Note: This field is marked as NOT NULL in the database and therefore required by the API.
References the ClaimBatch.Batch_Claim value on the parent record. Note: This field is marked as NOT NULL in the database and therefore required by the API.
In combination with Adjustment_Seq, creates a unique sequence for each service line on this claim.
In combination with Claim_Seq, creates a unique sequence for each service line on this claim. Used to note adjustments, cascading, etc. when utlized. Note: This field is marked as NOT NULL in the database and therefore required by the API.
The APC code applied to this service if identified for calculation during adjudication.
For reference purposes, this hold the individual service line funding payor/account. If multiple payor/accounts are found on different service lines for the same claim, adjudication spits out an error.
References the Adjustment_Seq value on the original claim that this claim is adjusting.
References the Claim_Seq value on the original claim that this claim is adjusting.
The Auth Number for services that require authorization. References Auth.Auth_Number.
If an Auth Penalty is applied during adjudication, that is housed here.
This is the benefit code assigned to this service line based on the Plan assigned on the Claim header. References BenefitCodes.Benefit_Code.
The billed charges assigned by the provider for this service. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
For dental claims, notes if this surface had services rendered. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Holds the Other Insurance calculated amount that would affect the payable amount for this service (calculated from COB_Hold, COB_Mem_Resp, COB_Savings, and COB_Savings_Used). Note: This field is marked as NOT NULL in the database and therefore required by the API.
Used in COB calculations (Dupe or Non-Dupe) to determine the COB_Amt to be applied.
Used in COB calculations (Dupe or Non-Dupe) to determine the COB_Amt to be applied.
Used in COB calculations (Dupe or Non-Dupe) to determine the COB_Amt to be applied.
Used in COB calculations (Dupe or Non-Dupe) to determine the COB_Amt to be applied.
Used for Flex Claims to indicate the calendar year this claim applies.
Notes if this service line is captiated. If the Claim.Capitation_Claim value is flagged, it overrides this value and notes the entire claim and all service lines as capitated. Note: This field is marked as NOT NULL in the database and therefore required by the API.
The co-insurance amount applied by adjudication based on benefit definition. Note: This field is marked as NOT NULL in the database and therefore required by the API.
The co-pay amount applied by adjudication based on benefit definition. Note: This field is marked as NOT NULL in the database and therefore required by the API.
For currency calculations, this holds the destination currency.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
If the service is eligiblity for deductible credits, they would be stored here.
The deductible amount applied by adjudication based on benefit definition. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Indicates which Plan Year the service line correlates to from GroupPlanYear.Plan_Year
The diagnosis pointer for this service line indicating which Diagnostic Codes from the Claim are applicable to this service.
The difference between Billed and Allowed is stored as the Discount Amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
For dental claims, notes if this surface had services rendered. Note: This field is marked as NOT NULL in the database and therefore required by the API.
For RX claims or medical claims that hold a drug code. References DrugCode.Drug_Code.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
During adjudication, this holds the results of claim rules associated with this error code. For a list of valid Error Codes, check the ErrorCategoryType table.
During adjudication, this holds the results of claim rules associated with this error code. For a list of valid Error Codes, check the ErrorCategoryType table.
During adjudication, this holds the results of claim rules associated with this error code. For a list of valid Error Codes, check the ErrorCategoryType table.
During adjudication, this holds the results of claim rules associated with this error code. For a list of valid Error Codes, check the ErrorCategoryType table.
During adjudication, this holds the results of claim rules associated with this error code. For a list of valid Error Codes, check the ErrorCategoryType table.
During adjudication, this holds the results of claim rules associated with this error code. For a list of valid Error Codes, check the ErrorCategoryType table.
During adjudication, this holds the results of claim rules associated with this error code. For a list of valid Error Codes, check the ErrorCategoryType table.
During adjudication, this holds the results of claim rules associated with this error code. For a list of valid Error Codes, check the ErrorCategoryType table.
During adjudication, this holds the results of claim rules associated with this error code. For a list of valid Error Codes, check the ErrorCategoryType table.
During adjudication, this holds the results of claim rules associated with this error code. For a list of valid Error Codes, check the ErrorCategoryType table.
During adjudication, this holds the results of claim rules associated with this error code. For a list of valid Error Codes, check the ErrorCategoryType table.
A place for both user assigned reason codes applicable to this claim or for adjudication to automatically assign ex code. References ExplanationCodes.Ex_Code.
A place for both user assigned reason codes applicable to this claim or for adjudication to automatically assign ex code. References ExplanationCodes.Ex_Code.
A place for both user assigned reason codes applicable to this claim or for adjudication to automatically assign ex code. References ExplanationCodes.Ex_Code.
The FICA tax amount for disability claims. Note: This field is marked as NOT NULL in the database and therefore required by the API.
For dental claims, notes if this surface had services rendered. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Based on taxable amount and various configurations, this holds the Federal "To Tax" amount for disability claim.
The calculated Federal tax amount based on the "To Tax" amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
A flat federal tax amount applied in addition to the calculated tax amount.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
For dental claims, notes if this surface had services rendered. Note: This field is marked as NOT NULL in the database and therefore required by the API.
If interest is calculated on a claim, it is stored here and applied to payable amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
For dental claims, notes if this surface had services rendered. Note: This field is marked as NOT NULL in the database and therefore required by the API.
The Life Benefit to be applied for Life claims processing.
The Life Benefit calculated volume based on benefit definition.
Number added manually to claims and from 837 files and sent outbound on 835 files.
For dental claims, notes if this surface had services rendered. Note: This field is marked as NOT NULL in the database and therefore required by the API.
If a locality tax is applicable it would be housed here. Note: The database will apply a default value of 0 for this field if a value is not provided.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
Based on taxable amount and various configurations, this holds the Medicare "To Tax" amount for disability claim.
For dental claims, notes if this surface had services rendered. Note: This field is marked as NOT NULL in the database and therefore required by the API.
This is for anesthesia, each Unit of anesthesia is equal to a specific amount of Minutes.
The number of the units from this detail line that comes from the Modifier. This determines pricing for the line.
For not covered services, or partially not covered services, this reflects that deduction. Note: This field is marked as NOT NULL in the database and therefore required by the API.
For dental claims, notes if this surface had services rendered. Note: This field is marked as NOT NULL in the database and therefore required by the API.
For dental claims this holds the oral cavity designation sent on the 837D.
For dental claims this holds the oral cavity designation sent on the 837D.
For dental claims this holds the oral cavity designation sent on the 837D.
For dental claims this holds the oral cavity designation sent on the 837D.
For dental claims this holds the oral cavity designation sent on the 837D.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
This flag indicates if the benefit code has been overridden. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Notes that the associated amount field was manually overrided by an application user or automated process that would skip adjudication calculations for this amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Information field used in custom processing and reporting.
The final paid amount for this service line based on allowed amount (Plan_Price) minus all applicable deductions. Note: This field is marked as NOT NULL in the database and therefore required by the API.
The partial loss amount for disability claims. Note: This field is marked as NOT NULL in the database and therefore required by the API.
For reference purposes, this hold the individual service line funding payor/account. If multiple payor/accounts are found on different service lines for the same claim, adjudication spits out an error.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
The place of service for the services being rendered on this service line.
The allowed amount for this service based on fee schedule, pricing, repricing, etc. Note: This field is marked as NOT NULL in the database and therefore required by the API.
The premium deduction amount for disability claims. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
For reprice claims (typically submitted via 837), this notes the reprice method used to reprice this service line.
For life claims, this holds the principal amount for reporting. Note: This field is marked as NOT NULL in the database and therefore required by the API.
The number of th eunits from this detail line that comes from the Prtocedure Code. This determines pricing for the line.
QPA (Qualified Payment Amount) values received in upcoming EDI transactions for the NSA (No Surprise Act) mandate.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
Holds the submitted reprice savings amount for services that include this amount in the pricing calculation.
For dental claims, notes if this surface had services rendered. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Based on taxable amount and various configurations, this holds the Social Security "To Tax" amount for disability claim.
The calculated Social Security tax amount based on the "To Tax" amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Based on taxable amount and various configurations, this holds the State "To Tax" amount for disability claim.
The calculated State tax amount based on the "To Tax" amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
A flat state tax amount applied in addition to the calculated tax amount.
When state taxes are calculated, this indicates the state the tax amount was calculated against.
Holds the individaul status of this service line based on Ex Codes. A - Payable, D - Denied, E - Pended.
This holds the starting taxable amount based on pre-tax and pre-gross deductions applied to this service.
For dental claims, this identifies the tooth, quadrant or arch being worked for this service.
No longer in use. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
Pharmacy claim information submitted via file submission and used in reporting and interfaces.
For plans that allow withhold, this amount is used to track that amount. Note: This field is marked as NOT NULL in the database and therefore required by the API.
- VBAPI VBASoftwarehttps://vbapi.vbasoftware.com/vbasoftware/claim-batches/{batchNumber}/claims/{batchClaim}/details-batch
- curl
- JavaScript
- Node.js
- Python
- Java
- C#
- PHP
- Go
- Ruby
- R
- Payload
curl -i -X PUT \
'https://vbapi.vbasoftware.com/vbasoftware/claim-batches/{batchNumber}/claims/{batchClaim}/details-batch' \
-H 'Authorization: Bearer <YOUR_JWT_HERE>' \
-H 'Content-Type: application/json' \
-H 'vbasoftware-database: string' \
-H 'x-api-key: YOUR_API_KEY_HERE' \
-d '[
{
"batch_Number": 0,
"batch_Claim": 0,
"claim_Seq": "st",
"adjustment_Seq": "str",
"ansI_Code": "string",
"apC_Code": "string",
"account_Key": 0,
"adjusted_From_Adjustment_Line": "str",
"adjusted_From_Line": "st",
"auth_Number": "string",
"auth_Penalty": 0.1,
"auth_Required": "s",
"benefit_Code": "string",
"benefit_Rate_Applied": 0.1,
"billed_Price": 0.1,
"brand_Indicator": "s",
"buccal": true,
"cliA_Number": "string",
"coB_Amt": 0.1,
"coB_Hold": 0.1,
"coB_Mem_Resp": 0.1,
"coB_Savings": 0.1,
"coB_Savings_Used": 0.1,
"calendar_Year": "stri",
"capitation_Claim": true,
"check_ID": 0,
"co_Ins_Amt": 0.1,
"co_Pay_Amt": 0.1,
"currency_ID": "string",
"days_Supply": 0,
"ded_Credit_Amt": 0.1,
"deductible_Amt": 0.1,
"detail_Plan_Year": "string",
"diagnosis_Code": "string",
"discount_Amt": 0.1,
"dispense_As_Written": 0,
"distal": true,
"drug_Code": "string",
"drug_Quantity": 0.1,
"entry_Date": "2019-08-24T14:15:22Z",
"entry_User": "string",
"error_Auth": "s",
"error_Benefit": "s",
"error_Count": "s",
"error_Covered": "s",
"error_Dates": "s",
"error_Diagnosis": "s",
"error_ExCode": "s",
"error_Modifier": "s",
"error_Place": "s",
"error_Price": "s",
"error_Procedure": "s",
"ex_Code": "string",
"ex_Code2": "string",
"ex_Code3": "string",
"fica": 0.1,
"facial": true,
"federal_Amount_To_Tax": 0.1,
"federal_Tax": 0.1,
"federal_Tax_Flat": 0.1,
"fill_Date": "2019-08-24T14:15:22Z",
"flex_Description": "string",
"formulary_Indicator": "s",
"incisal": true,
"interest": 0.1,
"labial": true,
"life_Benefit": "string",
"life_Benefit_Volume": 0.1,
"line_Control_Number": "string",
"lingual": true,
"local_Tax": 0.1,
"mail_Order_Indicator": "s",
"medicare_Amount_To_Tax": 0.1,
"medicare_Tax": 0.1,
"mesial": true,
"minutes_Per_Unit": 0.1,
"modifier": "string",
"modifier_2": "string",
"modifier_3": "string",
"modifier_4": "string",
"modifier_Units": 0.1,
"not_Covered_Amt": 0.1,
"occlusal": true,
"oral_Cavity_Designation_Code_1": "str",
"oral_Cavity_Designation_Code_2": "str",
"oral_Cavity_Designation_Code_3": "str",
"oral_Cavity_Designation_Code_4": "str",
"oral_Cavity_Designation_Code_5": "str",
"other_Deduction_Amount": 0.1,
"override_Benefit_Code": true,
"override_COB_Amt": true,
"override_Co_Ins_Amt": true,
"override_Co_Pay_Amt": true,
"override_Ded_Credit_Amt": true,
"override_Deductible_Amt": true,
"override_Federal_Tax": true,
"override_Local_Tax": true,
"override_Medicare_Tax": true,
"override_Not_Covered_Amt": true,
"override_Plan_Price": true,
"override_Social_Security": true,
"override_State_Tax": true,
"override_With_Hold_Amt": true,
"ppO_Price_Plan_Price_Diff": 0.1,
"paid_Amt": 0.1,
"partial_Loss": 0.1,
"payor_ID": "string",
"pharmacy_Name": "string",
"place_Of_Service": "strin",
"plan_Price": 0.1,
"premium_Deduction": 0.1,
"prescriber_ID": "string",
"prescription_Date": "2019-08-24T14:15:22Z",
"prescription_Number": "string",
"pricing_Method": "string",
"pricing_Rate": 0.1,
"principal": 0.1,
"procedure_Code": "string",
"procedure_Code2": "string",
"procedure_Code_Units": 0.1,
"qualifying_Payment_Amount": 0.1,
"reason_Code": 0,
"refill_Indicator": 0,
"repriced_Savings_Amount": 0.1,
"root": true,
"service_Date": "2019-08-24T14:15:22Z",
"service_Thru": "2019-08-24T14:15:22Z",
"socSec_Amount_To_Tax": 0.1,
"social_Security": 0.1,
"state_Amount_To_Tax": 0.1,
"state_Tax": 0.1,
"state_Tax_Flat": 0.1,
"state_Tax_State": "st",
"status_Code": "s",
"svc_Count": 0.1,
"taxable_Amount": 0.1,
"tooth_Number": 0,
"ucR_Price": 0.1,
"unit_Dose": 0,
"unit_Of_Measure": "st",
"update_Date": "2019-08-24T14:15:22Z",
"update_User": "string",
"with_Hold_Amt": 0.1,
"rx_CoPay_Assist_Amt": 0.1,
"rx_Penalty_Amt": 0.1
}
]'Response
No response example- VBAPI VBASoftwarehttps://vbapi.vbasoftware.com/vbasoftware/claim-batches/{batchNumber}/claims/{batchClaim}/details/{claimSeq}/adjudicate-benefit-match
- curl
- JavaScript
- Node.js
- Python
- Java
- C#
- PHP
- Go
- Ruby
- R
- Payload
curl -i -X GET \
'https://vbapi.vbasoftware.com/vbasoftware/claim-batches/{batchNumber}/claims/{batchClaim}/details/{claimSeq}/adjudicate-benefit-match?planId=string&providerId=string&providerType=string' \
-H 'Authorization: Bearer <YOUR_JWT_HERE>' \
-H 'vbasoftware-database: string' \
-H 'x-api-key: YOUR_API_KEY_HERE'Response
No response example