PokitDok Platform claims API request

corbin_claims_api_request.json

{
    "billing_provider": {
        "address": {
            "address_lines": [
                "1703 John B White Blvd, Unit A"
            ], 
            "city": "SPARTANBURG", 
            "state": "SC", 
            "zipcode": "29301"
        }, 
        "first_name": "CHRISTINA", 
        "last_name": "BERTOLAMI", 
        "npi": "1619131232", 
        "tax_id": "271636007", 
        "taxonomy_code": "207Q00000X"
    }, 
    "claim": {
        "patient_paid_amount": 220.0, 
        "place_of_service": "office", 
        "service_lines": [
            {
                "charge_amount": 25.0, 
                "diagnosis_codes": [
                    "V70.0"
                ], 
                "procedure_code": "80053", 
                "service_date": "2014-09-30", 
                "unit_count": 1.0
            }, 
            {
                "charge_amount": 25.0, 
                "diagnosis_codes": [
                    "V70.0"
                ], 
                "procedure_code": "85027", 
                "service_date": "2014-09-30", 
                "unit_count": 1.0
            }, 
            {
                "charge_amount": 25.0, 
                "diagnosis_codes": [
                    "V70.0"
                ], 
                "procedure_code": "80061", 
                "service_date": "2014-09-30", 
                "unit_count": 1.0
            }, 
            {
                "charge_amount": 30.0, 
                "diagnosis_codes": [
                    "V82.9"
                ], 
                "procedure_code": "86706", 
                "service_date": "2014-09-30", 
                "unit_count": 1.0
            }, 
            {
                "charge_amount": 30.0, 
                "diagnosis_codes": [
                    "V82.9"
                ], 
                "procedure_code": "86703", 
                "service_date": "2014-09-30", 
                "unit_count": 1.0
            }, 
            {
                "charge_amount": 30.0, 
                "diagnosis_codes": [
                    "V82.9"
                ], 
                "procedure_code": "86704", 
                "service_date": "2014-09-30", 
                "unit_count": 1.0
            }, 
            {
                "charge_amount": 30.0, 
                "diagnosis_codes": [
                    "V82.9"
                ], 
                "procedure_code": "86803", 
                "service_date": "2014-09-30", 
                "unit_count": 1.0
            }, 
            {
                "charge_amount": 25.0, 
                "diagnosis_codes": [
                    "V70.0"
                ], 
                "procedure_code": "86141", 
                "service_date": "2014-09-30", 
                "unit_count": 1.0
            }
        ], 
        "total_charge_amount": 220.0
    }, 
    "subscriber": {
        "address": {
            "address_lines": [
                "XXXXXXXXXXXXXXXXXXXX"
            ], 
            "city": "XXXXXXXXXXXXXXXX", 
            "state": "XX", 
            "zipcode": "XXXXX"
        }, 
        "birth_date": "19XX-XX-XX", 
        "first_name": "Brian", 
        "gender": "male", 
        "last_name": "Corbin", 
        "member_id": "WXXXXXXXXX"
    }, 
    "trading_partner_id": "aetna", 
    "transaction_code": "chargeable"
}