What claims data does the model check to make predictions?

The professional claim JSON attributes we list below will affect a Claims Lifecycle prediction if their data is missing or incorrect in the request:

  • Trading Partner Service ID (tradingPartnerServiceId, also known as Payer ID)
  • claimFilingCode
  • patientState
  • facilityCode
  • claimFrequencyCode
  • benefitsAssignmentCertificationIndicator
  • procedureCode
  • procedureCodeQualifier
  • medicalRecordNumber

Any Claims code value that uses a limited number of allowed values may have an effect on predictions of success. Ensure correct values get applied to any coding values for any claim. Check the OpenAPI API reference page for Professional Claims to see specifics.

These professional claims attributes may change based on future versions of that API. You can see examples of these values below in What does a typical Claims Lifecycle API request look like?.

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