Creates a new ClaimPreBatch
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
A flag indicating a claim is an Advanced EOB and not a claim for payment. Part of the No Surprise Act. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Medicare Resubmission code for the claim. Indicated in Box 22 of the claim report.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
The Occurrence Date associated to the assigned Occurrence Codes.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
The occurrence span indicator for the Occurrence Span From and Thru dates.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
This flag indicates the dental claim is for orthodontics. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Additional procedure code (ICD10 Diagnosis) values for this claim submission.
Date associated with the additional procedure code.
Date associated with the additional procedure code.
Date associated with the additional procedure code.
Date associated with the additional procedure code.
Date associated with the additional procedure code.
Date associated with the additional procedure code.
Date associated with the additional procedure code.
Date associated with the additional procedure code.
Date associated with the additional procedure code.
Date associated with the additional procedure code.
Date associated with the additional procedure code.
Date associated with the additional procedure code.
Date associated with the additional procedure code.
Date associated with the additional procedure code.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
A claim reference number used in conjunction with the Medicare Resubmission code. Indicated in Box 22 of the claim report.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
The ID of the pricing organization. Data is obtained in segment HCP04 on an 837.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
The date of a previous prosthetic or crown applied, if there was one.
This flag indicates if this claim is for the replacement of a prosthesis. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
COB total for all claim detail lines Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
Archive storage table for tracking initial entry of Claim information. Not to be used externally.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
Archive storage table for tracking initial entry of Claim information. Not to be used externally. Note: This field is marked as NOT NULL in the database and therefore required by the API.
- VBAPI productionhttps://vbapi.vbasoftware.com/vbasoftware/claim-prebatches
curl -i -X POST \
https://vbapi.vbasoftware.com/vbasoftware/claim-prebatches \
-H 'Authorization: Bearer <YOUR_JWT_HERE>' \
-H 'Content-Type: application/json' \
-H 'vbasoftware-database: string' \
-H 'x-api-key: YOUR_API_KEY_HERE' \
-d '{
"claimPreBatch_Key": 0,
"aeoB_Claim": true,
"accident_Date": "2019-08-24T14:15:22Z",
"account_Key": 0,
"adjusted_From": 0,
"admission_Date": "2019-08-24T14:15:22Z",
"admission_Diagnostic_Code": "string",
"admission_Hour": "string",
"admission_Source": "string",
"admit_Date": "2019-08-24T14:15:22Z",
"advance_Pay": true,
"advice_To_Pay": true,
"all_Docs_Rec_Date": "2019-08-24T14:15:22Z",
"ambulance_DropOff_Address": "string",
"ambulance_DropOff_Address2": "string",
"ambulance_DropOff_City": "string",
"ambulance_DropOff_Location": "string",
"ambulance_DropOff_Org_Name": "string",
"ambulance_DropOff_State": "string",
"ambulance_DropOff_Zip": "string",
"ambulance_PickUp_Address": "string",
"ambulance_PickUp_Address2": "string",
"ambulance_PickUp_City": "string",
"ambulance_PickUp_Location": "string",
"ambulance_PickUp_State": "string",
"ambulance_PickUp_Zip": "string",
"appliance_Placed_Date": "2019-08-24T14:15:22Z",
"assumed_Care_Date": "2019-08-24T14:15:22Z",
"attend_Provider_Address": "string",
"attend_Provider_Address2": "string",
"attend_Provider_City": "string",
"attend_Provider_Federal_ID": "string",
"attend_Provider_First_Name": "string",
"attend_Provider_Last_Name": "string",
"attend_Provider_MAID": "string",
"attend_Provider_NPI": "string",
"attend_Provider_Org_Name": "string",
"attend_Provider_Phone": "string",
"attend_Provider_State": "string",
"attend_Provider_Taxonomy": "string",
"attend_Provider_Zip": "string",
"attended_Physician_Date": "2019-08-24T14:15:22Z",
"batch_Claim": 0,
"batch_Number": 0,
"beneficiary_ID": "string",
"bill_Provider_Address": "string",
"bill_Provider_Address2": "string",
"bill_Provider_City": "string",
"bill_Provider_Federal_ID": "string",
"bill_Provider_First_Name": "string",
"bill_Provider_Last_Name": "string",
"bill_Provider_MAID": "string",
"bill_Provider_NPI": "string",
"bill_Provider_Org_Name": "string",
"bill_Provider_Phone": "string",
"bill_Provider_State": "string",
"bill_Provider_Taxonomy": "string",
"bill_Provider_Zip": "string",
"billed_Amount": 0.1,
"calculate_Interest": true,
"capitation_Claim": true,
"claim_837_COB": "s",
"claim_ID": "string",
"claim_Priority": "s",
"claim_Status": "string",
"claim_Type": "string",
"closure_Effective_Date": "2019-08-24T14:15:22Z",
"condition_Code1": "string",
"condition_Code10": "string",
"condition_Code11": "string",
"condition_Code12": "string",
"condition_Code13": "string",
"condition_Code14": "string",
"condition_Code15": "string",
"condition_Code16": "string",
"condition_Code17": "string",
"condition_Code18": "string",
"condition_Code19": "string",
"condition_Code2": "string",
"condition_Code20": "string",
"condition_Code21": "string",
"condition_Code22": "string",
"condition_Code23": "string",
"condition_Code24": "string",
"condition_Code3": "string",
"condition_Code4": "string",
"condition_Code5": "string",
"condition_Code6": "string",
"condition_Code7": "string",
"condition_Code8": "string",
"condition_Code9": "string",
"coverage_Start": "2019-08-24T14:15:22Z",
"current_Illness_Date": "2019-08-24T14:15:22Z",
"drG_Code": "stri",
"drG_Quantity": 0.1,
"death_Cert_Rec_Date": "2019-08-24T14:15:22Z",
"delivery_Date": "2019-08-24T14:15:22Z",
"delivery_Type": "s",
"dep_SSDI_End_Date": "2019-08-24T14:15:22Z",
"diagnostic_Code1": "string",
"diagnostic_Code10": "string",
"diagnostic_Code11": "string",
"diagnostic_Code12": "string",
"diagnostic_Code13": "string",
"diagnostic_Code14": "string",
"diagnostic_Code15": "string",
"diagnostic_Code16": "string",
"diagnostic_Code17": "string",
"diagnostic_Code18": "string",
"diagnostic_Code19": "string",
"diagnostic_Code2": "string",
"diagnostic_Code20": "string",
"diagnostic_Code21": "string",
"diagnostic_Code22": "string",
"diagnostic_Code23": "string",
"diagnostic_Code24": "string",
"diagnostic_Code3": "string",
"diagnostic_Code4": "string",
"diagnostic_Code5": "string",
"diagnostic_Code6": "string",
"diagnostic_Code7": "string",
"diagnostic_Code8": "string",
"diagnostic_Code9": "string",
"disability_Date": "2019-08-24T14:15:22Z",
"disability_End_Date": "2019-08-24T14:15:22Z",
"disability_Type": "string",
"disabled_By_Physician": "2019-08-24T14:15:22Z",
"discharge_Date": "2019-08-24T14:15:22Z",
"discharge_Hour": "string",
"division_ID": "string",
"eCode_Diagnostic_Code": "string",
"eCode_Diagnostic_Code10": "string",
"eCode_Diagnostic_Code11": "string",
"eCode_Diagnostic_Code12": "string",
"eCode_Diagnostic_Code2": "string",
"eCode_Diagnostic_Code3": "string",
"eCode_Diagnostic_Code4": "string",
"eCode_Diagnostic_Code5": "string",
"eCode_Diagnostic_Code6": "string",
"eCode_Diagnostic_Code7": "string",
"eCode_Diagnostic_Code8": "string",
"eCode_Diagnostic_Code9": "string",
"epsdT_Condition_Indicator1": "str",
"epsdT_Condition_Indicator2": "str",
"epsdT_Condition_Indicator3": "str",
"epsdT_Referral_Given": "s",
"entry_Date": "2019-08-24T14:15:22Z",
"entry_User": "string",
"error_Beneficiary": "s",
"ex_Code1": "string",
"ex_Code2": "string",
"ex_Code3": "string",
"ex_Code4": "string",
"exhaust_Date": "2019-08-24T14:15:22Z",
"expected_Typical_Duration": 0,
"ficA_Percent": 0.1,
"federal_Withheld": 0.1,
"filing_Indicator": "st",
"followUp_Date": "2019-08-24T14:15:22Z",
"followUp_Ex_Code": "string",
"freq_Code": "string",
"group_ID": "string",
"hearing_Vision_RX_Date": "2019-08-24T14:15:22Z",
"image_File_Location": "string",
"image_File_Location2": "string",
"image_File_Location3": "string",
"image_File_Location4": "string",
"initial_Treatment_Date": "2019-08-24T14:15:22Z",
"insured_Address": "string",
"insured_Address2": "string",
"insured_Alternate_ID": "string",
"insured_Birth_Date": "2019-08-24T14:15:22Z",
"insured_City": "string",
"insured_Employer_ID": "string",
"insured_First_Name": "string",
"insured_ID": "string",
"insured_Last_Name": "string",
"insured_Phone": "string",
"insured_Policy_Number": "string",
"insured_SSN": "string",
"insured_Sex": "s",
"insured_State": "string",
"insured_Zip": "string",
"job_Type": "st",
"ltD_Effective_Date": "2019-08-24T14:15:22Z",
"ltD_Packet_Date": "2019-08-24T14:15:22Z",
"last_Day_Worked": "2019-08-24T14:15:22Z",
"last_Physician_Warrant_Date": "2019-08-24T14:15:22Z",
"last_Seen_Date": "2019-08-24T14:15:22Z",
"liability_Injury": true,
"mail_To": "s",
"member_Seq": "st",
"months_Of_Treatment": 0,
"network_ID": "string",
"occupational": true,
"occurrence_Code1": "string",
"occurrence_Code10": "string",
"occurrence_Code11": "string",
"occurrence_Code12": "string",
"occurrence_Code13": "string",
"occurrence_Code14": "string",
"occurrence_Code15": "string",
"occurrence_Code16": "string",
"occurrence_Code17": "string",
"occurrence_Code18": "string",
"occurrence_Code19": "string",
"occurrence_Code2": "string",
"occurrence_Code20": "string",
"occurrence_Code21": "string",
"occurrence_Code22": "string",
"occurrence_Code23": "string",
"occurrence_Code24": "string",
"occurrence_Code3": "string",
"occurrence_Code4": "string",
"occurrence_Code5": "string",
"occurrence_Code6": "string",
"occurrence_Code7": "string",
"occurrence_Code8": "string",
"occurrence_Code9": "string",
"occurrence_Date1": "2019-08-24T14:15:22Z",
"occurrence_Date10": "2019-08-24T14:15:22Z",
"occurrence_Date11": "2019-08-24T14:15:22Z",
"occurrence_Date12": "2019-08-24T14:15:22Z",
"occurrence_Date13": "2019-08-24T14:15:22Z",
"occurrence_Date14": "2019-08-24T14:15:22Z",
"occurrence_Date15": "2019-08-24T14:15:22Z",
"occurrence_Date16": "2019-08-24T14:15:22Z",
"occurrence_Date17": "2019-08-24T14:15:22Z",
"occurrence_Date18": "2019-08-24T14:15:22Z",
"occurrence_Date19": "2019-08-24T14:15:22Z",
"occurrence_Date2": "2019-08-24T14:15:22Z",
"occurrence_Date20": "2019-08-24T14:15:22Z",
"occurrence_Date21": "2019-08-24T14:15:22Z",
"occurrence_Date22": "2019-08-24T14:15:22Z",
"occurrence_Date23": "2019-08-24T14:15:22Z",
"occurrence_Date24": "2019-08-24T14:15:22Z",
"occurrence_Date3": "2019-08-24T14:15:22Z",
"occurrence_Date4": "2019-08-24T14:15:22Z",
"occurrence_Date5": "2019-08-24T14:15:22Z",
"occurrence_Date6": "2019-08-24T14:15:22Z",
"occurrence_Date7": "2019-08-24T14:15:22Z",
"occurrence_Date8": "2019-08-24T14:15:22Z",
"occurrence_Date9": "2019-08-24T14:15:22Z",
"occurrence_Span_Code": "string",
"occurrence_Span_Code10": "string",
"occurrence_Span_Code11": "string",
"occurrence_Span_Code12": "string",
"occurrence_Span_Code13": "string",
"occurrence_Span_Code14": "string",
"occurrence_Span_Code15": "string",
"occurrence_Span_Code16": "string",
"occurrence_Span_Code17": "string",
"occurrence_Span_Code18": "string",
"occurrence_Span_Code19": "string",
"occurrence_Span_Code2": "string",
"occurrence_Span_Code20": "string",
"occurrence_Span_Code21": "string",
"occurrence_Span_Code22": "string",
"occurrence_Span_Code23": "string",
"occurrence_Span_Code24": "string",
"occurrence_Span_Code3": "string",
"occurrence_Span_Code4": "string",
"occurrence_Span_Code5": "string",
"occurrence_Span_Code6": "string",
"occurrence_Span_Code7": "string",
"occurrence_Span_Code8": "string",
"occurrence_Span_Code9": "string",
"occurrence_Span_From": "2019-08-24T14:15:22Z",
"occurrence_Span_From10": "2019-08-24T14:15:22Z",
"occurrence_Span_From11": "2019-08-24T14:15:22Z",
"occurrence_Span_From12": "2019-08-24T14:15:22Z",
"occurrence_Span_From13": "2019-08-24T14:15:22Z",
"occurrence_Span_From14": "2019-08-24T14:15:22Z",
"occurrence_Span_From15": "2019-08-24T14:15:22Z",
"occurrence_Span_From16": "2019-08-24T14:15:22Z",
"occurrence_Span_From17": "2019-08-24T14:15:22Z",
"occurrence_Span_From18": "2019-08-24T14:15:22Z",
"occurrence_Span_From19": "2019-08-24T14:15:22Z",
"occurrence_Span_From2": "2019-08-24T14:15:22Z",
"occurrence_Span_From20": "2019-08-24T14:15:22Z",
"occurrence_Span_From21": "2019-08-24T14:15:22Z",
"occurrence_Span_From22": "2019-08-24T14:15:22Z",
"occurrence_Span_From23": "2019-08-24T14:15:22Z",
"occurrence_Span_From24": "2019-08-24T14:15:22Z",
"occurrence_Span_From3": "2019-08-24T14:15:22Z",
"occurrence_Span_From4": "2019-08-24T14:15:22Z",
"occurrence_Span_From5": "2019-08-24T14:15:22Z",
"occurrence_Span_From6": "2019-08-24T14:15:22Z",
"occurrence_Span_From7": "2019-08-24T14:15:22Z",
"occurrence_Span_From8": "2019-08-24T14:15:22Z",
"occurrence_Span_From9": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru10": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru11": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru12": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru13": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru14": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru15": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru16": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru17": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru18": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru19": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru2": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru20": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru21": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru22": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru23": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru24": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru3": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru4": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru5": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru6": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru7": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru8": "2019-08-24T14:15:22Z",
"occurrence_Span_Thru9": "2019-08-24T14:15:22Z",
"onset_Similar_Illness_Date": "2019-08-24T14:15:22Z",
"oper_Provider_Address": "string",
"oper_Provider_Address2": "string",
"oper_Provider_City": "string",
"oper_Provider_Federal_ID": "string",
"oper_Provider_First_Name": "string",
"oper_Provider_Last_Name": "string",
"oper_Provider_MAID": "string",
"oper_Provider_NPI": "string",
"oper_Provider_Org_Name": "string",
"oper_Provider_Phone": "string",
"oper_Provider_State": "string",
"oper_Provider_Taxonomy": "string",
"oper_Provider_Zip": "string",
"orthodontics_Treatment": true,
"other_Insurance": true,
"other_Procedure_Code1": "string",
"other_Procedure_Code10": "string",
"other_Procedure_Code11": "string",
"other_Procedure_Code12": "string",
"other_Procedure_Code13": "string",
"other_Procedure_Code14": "string",
"other_Procedure_Code15": "string",
"other_Procedure_Code16": "string",
"other_Procedure_Code17": "string",
"other_Procedure_Code18": "string",
"other_Procedure_Code19": "string",
"other_Procedure_Code2": "string",
"other_Procedure_Code20": "string",
"other_Procedure_Code21": "string",
"other_Procedure_Code22": "string",
"other_Procedure_Code23": "string",
"other_Procedure_Code3": "string",
"other_Procedure_Code4": "string",
"other_Procedure_Code5": "string",
"other_Procedure_Code6": "string",
"other_Procedure_Code7": "string",
"other_Procedure_Code8": "string",
"other_Procedure_Code9": "string",
"other_Procedure_Date1": "2019-08-24T14:15:22Z",
"other_Procedure_Date10": "2019-08-24T14:15:22Z",
"other_Procedure_Date11": "2019-08-24T14:15:22Z",
"other_Procedure_Date12": "2019-08-24T14:15:22Z",
"other_Procedure_Date13": "2019-08-24T14:15:22Z",
"other_Procedure_Date14": "2019-08-24T14:15:22Z",
"other_Procedure_Date15": "2019-08-24T14:15:22Z",
"other_Procedure_Date16": "2019-08-24T14:15:22Z",
"other_Procedure_Date17": "2019-08-24T14:15:22Z",
"other_Procedure_Date18": "2019-08-24T14:15:22Z",
"other_Procedure_Date19": "2019-08-24T14:15:22Z",
"other_Procedure_Date2": "2019-08-24T14:15:22Z",
"other_Procedure_Date20": "2019-08-24T14:15:22Z",
"other_Procedure_Date21": "2019-08-24T14:15:22Z",
"other_Procedure_Date22": "2019-08-24T14:15:22Z",
"other_Procedure_Date23": "2019-08-24T14:15:22Z",
"other_Procedure_Date3": "2019-08-24T14:15:22Z",
"other_Procedure_Date4": "2019-08-24T14:15:22Z",
"other_Procedure_Date5": "2019-08-24T14:15:22Z",
"other_Procedure_Date6": "2019-08-24T14:15:22Z",
"other_Procedure_Date7": "2019-08-24T14:15:22Z",
"other_Procedure_Date8": "2019-08-24T14:15:22Z",
"other_Procedure_Date9": "2019-08-24T14:15:22Z",
"partial_Disability": true,
"patient_Account": "string",
"patient_Address": "string",
"patient_Address2": "string",
"patient_Birth_Date": "2019-08-24T14:15:22Z",
"patient_City": "string",
"patient_First_Name": "string",
"patient_ID": "string",
"patient_Last_Name": "string",
"patient_Phone": "string",
"patient_Reason_for_Visit_Diagnostic_Code1": "string",
"patient_Reason_for_Visit_Diagnostic_Code2": "string",
"patient_Reason_for_Visit_Diagnostic_Code3": "string",
"patient_Relationship": "string",
"patient_Sex": "s",
"patient_Signature": true,
"patient_Signature_Date": "2019-08-24T14:15:22Z",
"patient_State": "string",
"patient_Status": "string",
"patient_Zip": "string",
"payToPlan_Address": "string",
"payToPlan_Address2": "string",
"payToPlan_City": "string",
"payToPlan_Claim_Office_Num": "string",
"payToPlan_ID": "string",
"payToPlan_NAIC": "string",
"payToPlan_Name": "string",
"payToPlan_State": "string",
"payToPlan_Zip": "string",
"payTo_Address": "string",
"payTo_Address2": "string",
"payTo_City": "string",
"payTo_State": "string",
"payTo_Zip": "string",
"payee_ID": "string",
"payor_Claim_Control_Number": "string",
"payor_ID": "string",
"physician_Return_To_Work": "2019-08-24T14:15:22Z",
"place_Of_Service": "strin",
"plan_ID": "string",
"plan_Provider": "s",
"plan_Year": "string",
"present_On_Admission1": "s",
"present_On_Admission10": "s",
"present_On_Admission11": "s",
"present_On_Admission12": "s",
"present_On_Admission13": "s",
"present_On_Admission14": "s",
"present_On_Admission15": "s",
"present_On_Admission16": "s",
"present_On_Admission17": "s",
"present_On_Admission18": "s",
"present_On_Admission19": "s",
"present_On_Admission2": "s",
"present_On_Admission20": "s",
"present_On_Admission21": "s",
"present_On_Admission22": "s",
"present_On_Admission23": "s",
"present_On_Admission24": "s",
"present_On_Admission3": "s",
"present_On_Admission4": "s",
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}'