Adv. Claim

Full Delete ClaimBatch Advanced API

Deletes an ClaimBatch record along with all associated processing needed as a result of that delete.

SecurityapiKeyAuth and bearerAuth
Request
path Parameters
batchNumber
required
integer <int32>

Batch Number

batchClaim
required
integer <int32>

Batch Claim

query Parameters
claimStatusCategoryCode
string

Claim Status Category Code

claimStatusCode
string

Claim Status Code

header Parameters
vbasoftware-database
required
string

Target database

Responses
204

Success

401

Unauthorized

delete/claim-batches/{batchNumber}/claims/{batchClaim}/full-delete
Request samples 
List matching benefit detail Advanced API 
List of potential benefit matches along with a match count for a specific claim service line.


SecurityapiKeyAuth and bearerAuth 
Request 
path Parameters
batchNumber
required
integer <int32> 
Batch Number


 
batchClaim
required
integer <int32> 
Batch Claim


 
claimSeq
required
string
Claim Seq


 
query Parameters
planId
string
Plan ID


 
providerId
string
Provider ID


 
providerType
string
Provider Type


 
header Parameters
vbasoftware-database
required
string
Target database


 
Responses 
200
Success


401
Unauthorized


get/claim-batches/{batchNumber}/claims/{batchClaim}/details/{claimSeq}/adjudicate-benefit-match
Request samples 
Response samples 
No sample
Create a Life Claim Advanced API 
Setup a Life Claim based on defined configuration and optionally setup the Life Claim payments.


SecurityapiKeyAuth and bearerAuth 
Request 
header Parameters
vbasoftware-database
required
string
Target database


 
Request Body schema: 
required
subscriber_ID
string or null
 
member_Seq
string or null
 
plan_ID
string or null
 
volume
number or null <double> 
 
claimNumber
string or null
 
deathDate
string or null <date-time> 
 
lastDayWorked
string or null <date-time> 
 
causeOfDeath
integer or null <int32> 
 
illness
integer or null <int32> 
 
illnessDuration
integer or null <int32> 
 
illnessDurationType
string or null
 
attendingProviderID
string or null
 
attendingFirstName
string or null
 
attendingLastName
string or null
 
attendingOrgName
string or null
 
attendingAddress
string or null
 
attendingAddress2
string or null
 
attendingCity
string or null
 
attendingState
string or null
 
attendingZipCode
string or null
 
attendingEntityID
string or null
 
diagType
string or null
 
diag1
string or null
 
diag2
string or null
 
diag3
string or null
 
diag4
string or null
 
payTo
string or null
 
mailTo
string or null
 
exCode1
string or null
 
exCode2
string or null
 
place
string or null
 
receivedDate
string or null <date-time> 
 
procedureCode
string or null
 
createPayment
boolean
 
Array of objects or null (IDCodeValue) 
 
Array of objects or null (MemberBeneficiary) 
 
Array of objects or null (ClaimBatchLifeBenefit) 
 
Array of objects or null (Note_NoteAttachment) 
 
Responses 
200
Success


401
Unauthorized


post/create-life-claim
Request samples 
{
  • "subscriber_ID": "string",
  • "member_Seq": "string",
  • "plan_ID": "string",
  • "volume": 0.1,
  • "claimNumber": "string",
  • "deathDate": "2019-08-24T14:15:22Z",
  • "lastDayWorked": "2019-08-24T14:15:22Z",
  • "causeOfDeath": 0,
  • "illness": 0,
  • "illnessDuration": 0,
  • "illnessDurationType": "string",
  • "attendingProviderID": "string",
  • "attendingFirstName": "string",
  • "attendingLastName": "string",
  • "attendingOrgName": "string",
  • "attendingAddress": "string",
  • "attendingAddress2": "string",
  • "attendingCity": "string",
  • "attendingState": "string",
  • "attendingZipCode": "string",
  • "attendingEntityID": "string",
  • "diagType": "string",
  • "diag1": "string",
  • "diag2": "string",
  • "diag3": "string",
  • "diag4": "string",
  • "payTo": "string",
  • "mailTo": "string",
  • "exCode1": "string",
  • "exCode2": "string",
  • "place": "string",
  • "receivedDate": "2019-08-24T14:15:22Z",
  • "procedureCode": "string",
  • "createPayment": true,
  • "customFields": [
    ],
  • "beneficiaries": [
    ],
  • "lifeBenefits": [
    ],
  • "documents": [
    ]
}
Response samples 
{
  • "data": 0,
  • "error": {
    },
  • "debug": {
    }
}
Release Suspended Claims Advanced API 
Release a selection of suspended claims so they can be Funded.


SecurityapiKeyAuth and bearerAuth 
Request 
header Parameters
vbasoftware-database
required
string
Target database


 
Request Body schema: 
required
 Array 
claim_Number
integer <int32> 
 
claimPaidAmount
number or null <double> 
 
claim_Funded_Status
string or null
 
serviceLines
integer or null <int32> 
 
claim_Status
string or null
 
payor_ID
string or null
 
account_Key
integer or null <int32> 
 
group_ID
string or null
 
division_ID
string or null
 
batch_Number
integer or null <int32> 
 
batch_Claim
integer or null <int32> 
 
provider_ID
string or null
 
subscriber_ID
string or null
 
member_Seq
string or null
 
payee_ID
string or null
 
provider_First_Name
string or null
 
provider_Last_Name
string or null
 
provider_Org_Name
string or null
 
payee_Name
string or null
 
member_First_Name
string or null
 
member_Last_Name
string or null
 
service_Date
string or null <date-time> 
 
service_Thru
string or null <date-time> 
 
selected
integer <int32> 
 
reinsClaim
integer <int32> 
 
claimAudit_Key
integer or null <int32> 
 
check_Batch
integer or null <int32> 
 
paid
integer <int32> 
 
fee_Sched
string or null
 
suspense_Type
string or null
 
zelis_Suspense
boolean or null
 
process_Date
string or null <date-time> 
 
process_User
string or null
 
suspenseClaim_Key
integer or null <int32> 
 
Responses 
202
Accepted for processing


401
Unauthorized


post/suspense-claim-release
Request samples 
[
  • {
    }
]
Return Suspended Claims Advanced API 
Return a selection of suspended claims to Batch so they can be reprocessed.  Assign an optional Ex Code to the claim returned.


SecurityapiKeyAuth and bearerAuth 
Request 
path Parameters
exCode
required
string
Ex Code


 
header Parameters
vbasoftware-database
required
string
Target database


 
Request Body schema: 
required
 Array 
claim_Number
integer <int32> 
 
claimPaidAmount
number or null <double> 
 
claim_Funded_Status
string or null
 
serviceLines
integer or null <int32> 
 
claim_Status
string or null
 
payor_ID
string or null
 
account_Key
integer or null <int32> 
 
group_ID
string or null
 
division_ID
string or null
 
batch_Number
integer or null <int32> 
 
batch_Claim
integer or null <int32> 
 
provider_ID
string or null
 
subscriber_ID
string or null
 
member_Seq
string or null
 
payee_ID
string or null
 
provider_First_Name
string or null
 
provider_Last_Name
string or null
 
provider_Org_Name
string or null
 
payee_Name
string or null
 
member_First_Name
string or null
 
member_Last_Name
string or null
 
service_Date
string or null <date-time> 
 
service_Thru
string or null <date-time> 
 
selected
integer <int32> 
 
reinsClaim
integer <int32> 
 
claimAudit_Key
integer or null <int32> 
 
check_Batch
integer or null <int32> 
 
paid
integer <int32> 
 
fee_Sched
string or null
 
suspense_Type
string or null
 
zelis_Suspense
boolean or null
 
process_Date
string or null <date-time> 
 
process_User
string or null
 
suspenseClaim_Key
integer or null <int32> 
 
Responses 
202
Accepted for processing


401
Unauthorized


post/suspense-claim-return/{exCode}
Request samples 
[
  • {
    }
]
Adjust Claim(s) Advanced API 
Adjust a selected list of claims by Claim Number.


SecurityapiKeyAuth and bearerAuth 
Request 
header Parameters
vbasoftware-database
required
string
Target database


 
Request Body schema: 
required
claimNumbers
Array of integers or null <int32> 
 
newBatch
boolean
 
newBatchDescription
string or null
 
seqList
string or null
 
reenterClaim
boolean
 
subscriberID
string or null
 
memberSeq
string or null
 
providerID
string or null
 
payTo
string or null
 
applyBackoutExCode
boolean
 
backoutExCode
string or null
 
autoProcessBackout
boolean
 
applyReentryExCode
boolean
 
reentryExCode
string or null
 
use_Original_Received_Date
boolean
 
object (NoteData) 
 
Responses 
202
Accepted for processing


401
Unauthorized


post/claim-adjustment
Request samples 
{
  • "claimNumbers": [
    ],
  • "newBatch": true,
  • "newBatchDescription": "string",
  • "seqList": "string",
  • "reenterClaim": true,
  • "subscriberID": "string",
  • "memberSeq": "string",
  • "providerID": "string",
  • "payTo": "string",
  • "applyBackoutExCode": true,
  • "backoutExCode": "string",
  • "autoProcessBackout": true,
  • "applyReentryExCode": true,
  • "reentryExCode": "string",
  • "use_Original_Received_Date": true,
  • "addNote": {
    }
}
Return Claim(s) to Batch Advanced API 
Return a selected list of claims to batch.


SecurityapiKeyAuth and bearerAuth 
Request 
header Parameters
vbasoftware-database
required
string
Target database


 
Request Body schema: 
required
 Array 
integer <int32> 
 
Responses 
202
Accepted for processing


401
Unauthorized


post/claim-return-to-batch
Request samples 
[
  • 0
]
Copy Claim(s) to Batch Advanced API 
Copy a selected list of claims to batch.


SecurityapiKeyAuth and bearerAuth 
Request 
header Parameters
vbasoftware-database
required
string
Target database


 
Request Body schema: 
required
 Array 
integer <int32> 
 
Responses 
202
Accepted for processing


401
Unauthorized


post/claim-copy-to-batch
Request samples 
[
  • 0
]
Split Claims by Payor/Account Advanced API 
When the chosen claim has a multi-Payor/Account error, this process will automatically split the claim and create a bridgre reference in ClaimBatchReference.


SecurityapiKeyAuth and bearerAuth 
Request 
query Parameters
batchNumber
required
integer <int32> 
Batch Number


 
batchClaim
required
integer <int32> 
Batch Claim


 
header Parameters
vbasoftware-database
required
string
Target database


 
Responses 
202
Accepted for processing


401
Unauthorized


post/claim-copy-multi-payor-account
Request samples 
Split Claims by Plan Year Advanced API 
When the chosen claim has a multi-Plan Year error, this process will automatically split the claim and create a bridgre reference in ClaimBatchReference.


SecurityapiKeyAuth and bearerAuth 
Request 
query Parameters
batchNumber
required
integer <int32> 
Batch Number


 
batchClaim
required
integer <int32> 
Batch Claim


 
header Parameters
vbasoftware-database
required
string
Target database


 
Responses 
202
Accepted for processing


401
Unauthorized


post/claim-copy-multi-plan-year
Request samples 
Suspend Claims on Audit Advanced API 
This process will take a Claim Audit key and then suspend any claims associated with that Claim Audit (assuming that claim is not Funded).


SecurityapiKeyAuth and bearerAuth 
Request 
query Parameters
claimAuditKey
required
integer <int32> 
Claim Audit Key


 
header Parameters
vbasoftware-database
required
string
Target database


 
Responses 
202
Accepted for processing


401
Unauthorized


post/claim-suspend-from-audit
Request samples 
Copy Selected Service Lines Advanced API 
Copy a list of ClaimBatchDetails x amount of times and add y amount of days to each copy.


SecurityapiKeyAuth and bearerAuth 
Request 
query Parameters
numberOfCopies
required
integer <int32> 
Number of Copies


 
daysOnCopy
required
integer <int32> 
Days on Copy


 
header Parameters
vbasoftware-database
required
string
Target database


 
Request Body schema: 
required
 Array 
batch_Number
required
integer <int32> 
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.


 
batch_Claim
required
integer <int32> 
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.


 
claim_Seq
required
string  [ 1 .. 2 ] characters 
In combination with Adjustment_Seq, creates a unique sequence for each service line on this claim.


 
adjustment_Seq
required
string  [ 1 .. 3 ] characters 
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.


 
ansI_Code
string or null  <= 8 characters 
No longer in use.


 
apC_Code
string or null  <= 8 characters 
The APC code applied to this service if identified for calculation during adjudication.


 
account_Key
integer or null <int32> 
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.


 
adjusted_From_Adjustment_Line
string or null  <= 3 characters 
References the Adjustment_Seq value on the original claim that this claim is adjusting.


 
adjusted_From_Line
string or null  <= 2 characters 
References the Claim_Seq value on the original claim that this claim is adjusting.


 
auth_Number
string or null  <= 20 characters 
The Auth Number for services that require authorization. References Auth.Auth_Number.


 
auth_Penalty
number or null <double> 
If an Auth Penalty is applied during adjudication, that is housed here.


 
auth_Required
string or null  <= 1 characters 
Notes that this service lines required authorization.


 
benefit_Code
string or null  <= 10 characters 
This is the benefit code assigned to this service line based on the Plan assigned on the Claim header. References BenefitCodes.Benefit_Code.


 
benefit_Rate_Applied
number or null <double> 
Benefit Rate being applied to this detail line.


 
billed_Price
required
number <double> 
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.


 
brand_Indicator
string or null  <= 1 characters 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
buccal
required
boolean
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.


 
cliA_Number
string or null  <= 32 characters 
No longer in use.


 
coB_Amt
required
number <double> 
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.


 
coB_Hold
number or null <double> 
Used in COB calculations (Dupe or Non-Dupe) to determine the COB_Amt to be applied.


 
coB_Mem_Resp
number or null <double> 
Used in COB calculations (Dupe or Non-Dupe) to determine the COB_Amt to be applied.


 
coB_Savings
number or null <double> 
Used in COB calculations (Dupe or Non-Dupe) to determine the COB_Amt to be applied.


 
coB_Savings_Used
number or null <double> 
Used in COB calculations (Dupe or Non-Dupe) to determine the COB_Amt to be applied.


 
calendar_Year
string or null  <= 4 characters 
Used for Flex Claims to indicate the calendar year this claim applies.


 
capitation_Claim
required
boolean
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.


 
check_ID
integer or null <int32> 
No longer in use.


 
co_Ins_Amt
required
number <double> 
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.


 
co_Pay_Amt
required
number <double> 
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.


 
currency_ID
string or null  <= 16 characters 
For currency calculations, this holds the destination currency.


 
days_Supply
integer or null <int32> 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
ded_Credit_Amt
number or null <double> 
If the service is eligiblity for deductible credits, they would be stored here.


 
deductible_Amt
required
number <double> 
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.


 
detail_Plan_Year
string or null  <= 8 characters 
Indicates which Plan Year the service line correlates to from GroupPlanYear.Plan_Year


 
diagnosis_Code
string or null  <= 8 characters 
The diagnosis pointer for this service line indicating which Diagnostic Codes from the Claim are applicable to this service.


 
discount_Amt
required
number <double> 
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.


 
dispense_As_Written
integer or null <int32> 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
distal
required
boolean
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.


 
drug_Code
string or null  <= 20 characters 
For RX claims or medical claims that hold a drug code. References DrugCode.Drug_Code.


 
drug_Quantity
number or null <double> 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
entry_Date
string <date-time> 
Date when the record was first added to the system.


 
entry_User
string or null  <= 20 characters 
User that first added the record to the system.


 
error_Auth
string or null  <= 1 characters 
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.


 
error_Benefit
string or null  <= 1 characters 
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.


 
error_Count
string or null  <= 1 characters 
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.


 
error_Covered
string or null  <= 1 characters 
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.


 
error_Dates
string or null  <= 1 characters 
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.


 
error_Diagnosis
string or null  <= 1 characters 
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.


 
error_ExCode
string or null  <= 1 characters 
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.


 
error_Modifier
string or null  <= 1 characters 
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.


 
error_Place
string or null  <= 1 characters 
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.


 
error_Price
string or null  <= 1 characters 
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.


 
error_Procedure
string or null  <= 1 characters 
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.


 
ex_Code
string or null  <= 6 characters 
A place for both user assigned reason codes applicable to this claim or for adjudication to automatically assign ex code. References ExplanationCodes.Ex_Code.


 
ex_Code2
string or null  <= 6 characters 
A place for both user assigned reason codes applicable to this claim or for adjudication to automatically assign ex code. References ExplanationCodes.Ex_Code.


 
ex_Code3
string or null  <= 6 characters 
A place for both user assigned reason codes applicable to this claim or for adjudication to automatically assign ex code. References ExplanationCodes.Ex_Code.


 
fica
required
number <double> 
The FICA tax amount for disability claims. Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
facial
required
boolean
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.


 
federal_Amount_To_Tax
number or null <double> 
Based on taxable amount and various configurations, this holds the Federal "To Tax" amount for disability claim.


 
federal_Tax
required
number <double> 
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.


 
federal_Tax_Flat
number or null <double> 
A flat federal tax amount applied in addition to the calculated tax amount.


 
fill_Date
string or null <date-time> 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
flex_Description
string or null  <= 128 characters 
Manually entered description of this flex claim.


 
formulary_Indicator
string or null  <= 1 characters 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
incisal
required
boolean
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.


 
interest
required
number <double> 
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.


 
labial
required
boolean
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.


 
life_Benefit
string or null  <= 10 characters 
The Life Benefit to be applied for Life claims processing.


 
life_Benefit_Volume
number or null <double> 
The Life Benefit calculated volume based on benefit definition.


 
line_Control_Number
string or null  <= 64 characters 
Number added manually to claims and from 837 files and sent outbound on 835 files.


 
lingual
required
boolean
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.


 
local_Tax
number or null <double> 
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.


 
mail_Order_Indicator
string or null  <= 1 characters 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
medicare_Amount_To_Tax
number or null <double> 
Based on taxable amount and various configurations, this holds the Medicare "To Tax" amount for disability claim.


 
medicare_Tax
number or null <double> 
The calculated Medicare tax amount based on the "To Tax" amount.


 
mesial
required
boolean
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.


 
minutes_Per_Unit
number or null <double> 
This is for anesthesia, each Unit of anesthesia is equal to a specific amount of Minutes.


 
modifier
string or null  <= 8 characters 
The modifier applied to this service.


 
modifier_2
string or null  <= 8 characters 
The modifier applied to this service.


 
modifier_3
string or null  <= 8 characters 
The modifier applied to this service.


 
modifier_4
string or null  <= 8 characters 
The modifier applied to this service.


 
modifier_Units
number or null <double> 
The number of the units from this detail line that comes from the Modifier. This determines pricing for the line.


 
not_Covered_Amt
required
number <double> 
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.


 
occlusal
required
boolean
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.


 
oral_Cavity_Designation_Code_1
string or null  <= 3 characters 
For dental claims this holds the oral cavity designation sent on the 837D.


 
oral_Cavity_Designation_Code_2
string or null  <= 3 characters 
For dental claims this holds the oral cavity designation sent on the 837D.


 
oral_Cavity_Designation_Code_3
string or null  <= 3 characters 
For dental claims this holds the oral cavity designation sent on the 837D.


 
oral_Cavity_Designation_Code_4
string or null  <= 3 characters 
For dental claims this holds the oral cavity designation sent on the 837D.


 
oral_Cavity_Designation_Code_5
string or null  <= 3 characters 
For dental claims this holds the oral cavity designation sent on the 837D.


 
other_Deduction_Amount
number or null <double> 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
override_Benefit_Code
required
boolean
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.


 
override_COB_Amt
required
boolean
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.


 
override_Co_Ins_Amt
required
boolean
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.


 
override_Co_Pay_Amt
required
boolean
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.


 
override_Ded_Credit_Amt
required
boolean
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.


 
override_Deductible_Amt
required
boolean
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.


 
override_Federal_Tax
required
boolean
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.


 
override_Local_Tax
required
boolean
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.


 
override_Medicare_Tax
required
boolean
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.


 
override_Not_Covered_Amt
required
boolean
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.


 
override_Plan_Price
required
boolean
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.


 
override_Social_Security
required
boolean
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.


 
override_State_Tax
required
boolean
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.


 
override_With_Hold_Amt
required
boolean
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.


 
ppO_Price_Plan_Price_Diff
number or null <double> 
Information field used in custom processing and reporting.


 
paid_Amt
required
number <double> 
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.


 
partial_Loss
required
number <double> 
The partial loss amount for disability claims. Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
payor_ID
string or null  <= 20 characters 
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_Name
string or null  <= 128 characters 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
place_Of_Service
string or null  <= 5 characters 
The place of service for the services being rendered on this service line.


 
plan_Price
required
number <double> 
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.


 
premium_Deduction
required
number <double> 
The premium deduction amount for disability claims. Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
prescriber_ID
string or null  <= 32 characters 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
prescription_Date
string or null <date-time> 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
prescription_Number
string or null  <= 50 characters 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
pricing_Method
string or null  <= 8 characters 
For reprice claims (typically submitted via 837), this notes the reprice method used to reprice this service line.


 
pricing_Rate
number or null <double> 
The rate associated with the reprice method (Pricing_Method).


 
principal
required
number <double> 
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.


 
procedure_Code
string or null  <= 8 characters 
The service being rendered on this claim.


 
procedure_Code2
string or null  <= 8 characters 
The secondary service being rendered on this claim.


 
procedure_Code_Units
number or null <double> 
The number of th eunits from this detail line that comes from the Prtocedure Code. This determines pricing for the line.


 
qualifying_Payment_Amount
number or null <double> 
QPA (Qualified Payment Amount) values received in upcoming EDI transactions for the NSA (No Surprise Act) mandate.


 
reason_Code
integer or null <int32> 
No longer in use.


 
refill_Indicator
integer or null <int32> 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
repriced_Savings_Amount
number or null <double> 
Holds the submitted reprice savings amount for services that include this amount in the pricing calculation.


 
root
required
boolean
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.


 
service_Date
string or null <date-time> 
The start date of the services being rendered.


 
service_Thru
string or null <date-time> 
The end date of the services being rendered.


 
socSec_Amount_To_Tax
number or null <double> 
Based on taxable amount and various configurations, this holds the Social Security "To Tax" amount for disability claim.


 
social_Security
required
number <double> 
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.


 
state_Amount_To_Tax
number or null <double> 
Based on taxable amount and various configurations, this holds the State "To Tax" amount for disability claim.


 
state_Tax
required
number <double> 
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.


 
state_Tax_Flat
number or null <double> 
A flat state tax amount applied in addition to the calculated tax amount.


 
state_Tax_State
string or null  <= 2 characters 
When state taxes are calculated, this indicates the state the tax amount was calculated against.


 
status_Code
string or null  <= 1 characters 
Holds the individaul status of this service line based on Ex Codes. A - Payable, D - Denied, E - Pended.


 
svc_Count
number or null <double> 
The units applied to this service.


 
taxable_Amount
number or null <double> 
This holds the starting taxable amount based on pre-tax and pre-gross deductions applied to this service.


 
tooth_Number
integer or null <int32> 
For dental claims, this identifies the tooth, quadrant or arch being worked for this service.


 
ucR_Price
required
number <double> 
No longer in use. Note: This field is marked as NOT NULL in the database and therefore required by the API.


 
unit_Dose
integer or null <int32> 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
unit_Of_Measure
string or null  <= 2 characters 
Pharmacy claim information submitted via file submission and used in reporting and interfaces.


 
update_Date
string <date-time> 
Date when the record was last updated in the system.


 
update_User
string or null  <= 20 characters 
User that last updated the record in the system.


 
with_Hold_Amt
required
number <double> 
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.


 
Responses 
202
Accepted for processing


401
Unauthorized


post/claim-copy-service-lines
Request samples 
[
  • {
    }
]
Create Disability Payments Advanced API 
Create a Batch of Claims that represent Disability Payments for a STD or LTD disability claim.


SecurityapiKeyAuth and bearerAuth 
Request 
header Parameters
vbasoftware-database
required
string
Target database


 
Request Body schema: 
required
description
string or null
Used to give a description for this episode of care.


 
sickTime
boolean
This flag identifies that there is sick time during this disability.


 
sickTimeFrom
string or null <date-time> 
This is the begin date of the sick time payment.


 
sickTimeThru
string or null <date-time> 
This is the end date of the sick time payment.


 
sickTimeExCode
string or null
This is the explanation code that will be applied to the sick time payments during this disability.


 
vacation
boolean
This flag identifies that there is vacation during this disability.


 
vacationFrom
string or null <date-time> 
This is the begin date of the vacation payment.


 
vacationThru
string or null <date-time> 
This is the end date of the vacation payment.


 
vacationExCode
string or null
This is the explanation code that will be applied to the vacation payments during this disability.


 
salaryContinuation
boolean
This flag identifies that salary continuation is part of the payment during this disability.


 
salaryContinuationFrom
string or null <date-time> 
This is the begin date of the salary continuation payment.


 
salaryContinuationThru
string or null <date-time> 
This is the end date of the salary continuation payment.


 
salaryContinuationExCode
string or null
This is the explanation code that will be applied to the salary continuation payments during this disability.


 
partialDisability
boolean
This will identify if this is a partial disability payment.  Partial Disability payments have additional tax and payment rules applied during adjudication.


 
partialDisabilityHours
boolean
This flag will identify if there is partial disability hours involved during the claim.


 
imageNumber
string or null
 
imageNumber2
string or null
 
imageNumber3
string or null
 
imageNumber4
string or null
 
receivedDate
string or null <date-time> 
 
lastDayWorked
string or null <date-time> 
 
diagnosis1
string or null
This identifies the primary diagnosis for this disability.


 
diagnosis2
string or null
This identifies additional diagnosis for this disability.


 
dateOfSurgery
string or null <date-time> 
This identifies the date of surgery for disability due to surgery.


 
waitingPeriod
integer or null <int32> 
This is the number of waiting period days that will be assigned to the waiting period payment on this disability.


 
rollupWaitingPeriod
boolean
This flag if set will create the Waiting Period in one claim.


 
admitDate
string or null <date-time> 
This identifies the date the member was admitted to the Hospital if hospitalized as part of this disability.


 
applyExtension
boolean
This will let the Disability Payment Creator know that the created payments need to have a reminder Ex Code applied to the final two payments.


 
applyExtensionExCode
string or null
This is the Ex Code that is applied to the final two payments created by the Disability Payment Creator if the Apply Extension option is selected.


 
closureEffectiveDate
string or null <date-time> 
This is an information only field that allows the tracking of the Closure Effective Date.


 
dateFirstAttended
string or null <date-time> 
This identifies the date the member first visited the Physician. This field, in combination with Disabled by Physician Date and Last Day Worked, create the Disability Date for the Member.


 
disabledByPhysician
string or null <date-time> 
This identifies the date the member was disabled by the Physician. This field, in combination with First Attended Physician Date and Last Day Worked, create the Disability Date for the Member.


 
dob
string or null <date-time> 
This is the Members Birth Date.


 
duringEmployment
boolean
Flag to identify if this disability happened while member was at work.


 
surgery
integer or null <int32> 
Used to identify if surgery is involved in this disability.


 
typeOfSurgery
string or null
This is the procedure code of the surgery being performed for this disability.


 
disabilityType
string or null
This identifies the type of disability (Injury or Illness).


 
typeOfDelivery
string or null
This will identify the type of delivery that is performed as a result of pregnancy.


 
numberOfPayments
integer or null <int32> 
This will identify the number of payments that will be involved during this claim.


 
waiveWaitingPeriod
boolean
This will identify whether the Waive Waiting Period option was selected.


 
stateTax
number or null <double> 
This will identify the state withhold amount for each payment. If tax calculation module is enabled, this option will be ignored.


 
federalWithheld
number or null <double> 
This will hold the amount for the Federal tax withheld from each payment.


 
fica
number or null <double> 
This will hold the FICA tax deduction for each payment.


 
subscriberID
string or null
This is the member’s unique system ID.


 
memberSeq
string or null
This is the member's sequence number.


 
firstName
string or null
This is the Members First Name.


 
lastName
string or null
This is the Members Last Name.


 
groupID
string or null
This is the Members Last Name.


 
planID
string or null
This will identify the plan under which this disability falls.


 
planType
string or null
This is the Plan Type associated with the Plan ID.


 
planTypeLTD
boolean
This is the Plan Type identifier for Long Term Disability.


 
exceedReturnToWork
boolean
This will be the Exceed Return To Work flag associated with the case.


 
exceedMax
boolean
This will indicate if max exceeded in disability payment creation.


 
followupDate
string or null <date-time> 
This will be the date the case is being followed up on.


 
followupExCode
string or null
This will identify the follow-up ExCode to be used.


 
includeReturnToWork
boolean
This will identify if the claim should include return to work.


 
scd
boolean
This is an SCD Payment identifier.


 
paymentInterval
integer or null <int32> 
This identifies the payment interval for the disability claim (e.g., 5-day, 7-day, Monthly).


 
surgeryExCode
string or null
This is the explanation code attached to the surgery payments during this disability claim.


 
jobType
string or null
This will indicate the type of job associated with the disability (e.g., Sedentary, Light, Medium, Heavy).


 
waitingPeriodExCode
string or null
This is the explanation code applied to the waiting period payment for this disability.


 
includeWaitingPeriod
boolean
This will identify if the claim includes waiting period coverage.


 
maxDisability
integer or null <int32> 
This will identify the maximum amount of disability payments for this claim.


 
includeInMax
boolean
This flag indicates if the waiting period is included in the maximum disability calculation.


 
firstDayHospital
boolean
This flag identifies if the first day in the hospital is included in the disability coverage.


 
liabilityInjury
boolean
This flag identifies if the injury was due to liability.


 
pay_To
string or null
 
mail_To
string or null
 
exCode
string or null
 
hospitalized
boolean
 
pregnancy
boolean
This flag identifies if the disability is related to pregnancy.


 
dischargeDate
string or null <date-time> 
This identifies the date of discharge from the hospital.


 
expectedTypicalDuration
integer or null <int32> 
This identifies the expected typical duration of the disability.


 
dateOfDelivery
string or null <date-time> 
This identifies the date of the delivery for pregnancy-related disability.


 
returnToWork
string or null <date-time> 
This identifies the date the employee returned to work after the disability.


 
ltdEffectiveDate
string or null <date-time> 
This identifies the date the long-term disability becomes effective.


 
ltdPacketDate
string or null <date-time> 
This identifies the date the long-term disability packet was sent.


 
depSSDIEndDate
string or null <date-time> 
This identifies the end date for dependent SSDI coverage.


 
lastPhysicianWarrantDate
string or null <date-time> 
This identifies the last warrant date for the physician for this claim.


 
exhaustDate
string or null <date-time> 
This identifies the exhaustion date for the disability claim.


 
physicianReturnToWork
string or null <date-time> 
This is the Return to Work date identified by the Physician at the start of disability.This may or may not be the actual date the member returns to work.


 
disabilityPayThroughDay
integer or null <int32> 
This identifies the disability pay-through day for this claim.


 
overpaymentTotal
number or null <double> 
This will track the total overpayment amount for the disability claim.


 
overpaymentDeduction
number or null <double> 
This will track the deduction amount for overpayments.


 
overpaymentExCode
string or null
This is the explanation code for the overpayment during the disability.


 
paymentDuration
integer or null <int32> 
This will identify the duration of payments for the disability (e.g., Weekly, Monthly).


 
processByDisabilityDate
boolean
This will identify if the claim needs to be processed based on the disability date.


 
disability_Date
string or null <date-time> 
This identifies the actual disability date for this claim.


 
diagnosticCodeType
string or null
This identifies the diagnostic code type for this claim.


 
preview
boolean
This flag indicates if the options being sent will only product a list of payments in memory and not create them in the database.  Allows front-end to review their options before actually creating the payments.


 
Array of objects or null (VBA_DisabilityAdvisorDeduction) 
This is the list of any deductions that will be applied to each payment.


 
Responses 
200
Success


401
Unauthorized


post/disability-advisor-create-claim
Request samples 
{
  • "description": "string",
  • "sickTime": true,
  • "sickTimeFrom": "2019-08-24T14:15:22Z",
  • "sickTimeThru": "2019-08-24T14:15:22Z",
  • "sickTimeExCode": "string",
  • "vacation": true,
  • "vacationFrom": "2019-08-24T14:15:22Z",
  • "vacationThru": "2019-08-24T14:15:22Z",
  • "vacationExCode": "string",
  • "salaryContinuation": true,
  • "salaryContinuationFrom": "2019-08-24T14:15:22Z",
  • "salaryContinuationThru": "2019-08-24T14:15:22Z",
  • "salaryContinuationExCode": "string",
  • "partialDisability": true,
  • "partialDisabilityHours": true,
  • "imageNumber": "string",
  • "imageNumber2": "string",
  • "imageNumber3": "string",
  • "imageNumber4": "string",
  • "receivedDate": "2019-08-24T14:15:22Z",
  • "lastDayWorked": "2019-08-24T14:15:22Z",
  • "diagnosis1": "string",
  • "diagnosis2": "string",
  • "dateOfSurgery": "2019-08-24T14:15:22Z",
  • "waitingPeriod": 0,
  • "rollupWaitingPeriod": true,
  • "admitDate": "2019-08-24T14:15:22Z",
  • "applyExtension": true,
  • "applyExtensionExCode": "string",
  • "closureEffectiveDate": "2019-08-24T14:15:22Z",
  • "dateFirstAttended": "2019-08-24T14:15:22Z",
  • "disabledByPhysician": "2019-08-24T14:15:22Z",
  • "dob": "2019-08-24T14:15:22Z",
  • "duringEmployment": true,
  • "surgery": 0,
  • "typeOfSurgery": "string",
  • "disabilityType": "string",
  • "typeOfDelivery": "string",
  • "numberOfPayments": 0,
  • "waiveWaitingPeriod": true,
  • "stateTax": 0.1,
  • "federalWithheld": 0.1,
  • "fica": 0.1,
  • "subscriberID": "string",
  • "memberSeq": "string",
  • "firstName": "string",
  • "lastName": "string",
  • "groupID": "string",
  • "planID": "string",
  • "planType": "string",
  • "planTypeLTD": true,
  • "exceedReturnToWork": true,
  • "exceedMax": true,
  • "followupDate": "2019-08-24T14:15:22Z",
  • "followupExCode": "string",
  • "includeReturnToWork": true,
  • "scd": true,
  • "paymentInterval": 0,
  • "surgeryExCode": "string",
  • "jobType": "string",
  • "waitingPeriodExCode": "string",
  • "includeWaitingPeriod": true,
  • "maxDisability": 0,
  • "includeInMax": true,
  • "firstDayHospital": true,
  • "liabilityInjury": true,
  • "pay_To": "string",
  • "mail_To": "string",
  • "exCode": "string",
  • "hospitalized": true,
  • "pregnancy": true,
  • "dischargeDate": "2019-08-24T14:15:22Z",
  • "expectedTypicalDuration": 0,
  • "dateOfDelivery": "2019-08-24T14:15:22Z",
  • "returnToWork": "2019-08-24T14:15:22Z",
  • "ltdEffectiveDate": "2019-08-24T14:15:22Z",
  • "ltdPacketDate": "2019-08-24T14:15:22Z",
  • "depSSDIEndDate": "2019-08-24T14:15:22Z",
  • "lastPhysicianWarrantDate": "2019-08-24T14:15:22Z",
  • "exhaustDate": "2019-08-24T14:15:22Z",
  • "physicianReturnToWork": "2019-08-24T14:15:22Z",
  • "disabilityPayThroughDay": 0,
  • "overpaymentTotal": 0.1,
  • "overpaymentDeduction": 0.1,
  • "overpaymentExCode": "string",
  • "paymentDuration": 0,
  • "processByDisabilityDate": true,
  • "disability_Date": "2019-08-24T14:15:22Z",
  • "diagnosticCodeType": "string",
  • "preview": true,
  • "deductions": [
    ]
}
Response samples 
{
  • "data": {
    },
  • "error": {
    },
  • "debug": {
    }
}
Sync ClaimBatch Disability Advanced API 
Send in a ClaimBatch record and have all other ClaimBatch records remaining in Batch syncd to the Disability values on that submitted header.


SecurityapiKeyAuth and bearerAuth 
Request 
query Parameters
batchNumber
required
integer <int32> 
Batch Number


 
batchClaim
required
integer <int32> 
Batch Claim


 
header Parameters
vbasoftware-database
required
string
Target database


 
Responses 
202
Accepted for processing


401
Unauthorized


post/disability-claim-sync-header
Request samples 
Generate Claim Invoice Advanced API 
Creates a Claim Invoice and attaches a list of Claims.


SecurityapiKeyAuth and bearerAuth 
Request 
header Parameters
vbasoftware-database
required
string
Target database


 
Request Body schema: 
required
object (ClaimInvoice) 
 
claimNumbers
Array of integers or null <int32> 
 
Responses 
200
Success


401
Unauthorized


post/claim-invoice-generate
Request samples 
{
  • "claimInvoice": {
    },
  • "claimNumbers": [
    ]
}
Response samples 
{
  • "data": [
    ],
  • "error": {
    },
  • "debug": {
    }
}