What does a typical Claim Status API response look like?

Responses to our Medical Network APIs can be lengthy due to the many data points that a payer or trading partner provides in the query response. Our APIs translate back and forth between JSON and X12 EDI when the information departs into, and returns from, the medical network. We also support Raw X12 APIs should you wish to directly communicate using that data format.

See the topic Contents of the Claim Status API Response for more information about the contents of the Claim Status response data.

{
    "controlNumber": "000000001",
    "tradingPartnerServiceId": "serviceId",
    "providers": [
        {
            "organizationName": "TestProvider",
            "taxId": "0123456789",
            "providerType": "BillingProvider"
        },
        {
            "organizationName": "happy doctors group",
            "npi": "1760854442",
            "providerType": "ServiceProvider"
        }
    ],
    "subscriber": {
        "firstName": "johnone",
        "lastName": "doeone",
        "memberId": "0000000000"
    },
    "claims": [
        {
            "claimStatus": {
                "statusCategoryCode": "F1",
                "statusCategoryCodeValue": "Finalized/Payment-The claim/line has been paid.",
                "statusCode": "65",
                "statusCodeValue": "Claim/line has been paid.",
                "entityCode": "1E",
                "entity": "Health Maintenance Organization (HMO)",
                "effectiveDate": "20170415",
                "submittedAmount": "1229",
                "amountPaid": "219",
                "paidDate": "20170415",
                "checkIssueDate": "20170415",
                "checkNumber": "1111111",
                "trackingNumber": "000000001",
                "claimServiceDate": "20160722",
                "tradingPartnerClaimNumber": "AAAAAAAAAAA1"
            }
        },
        {
            "claimStatus": {
                "statusCategoryCode": "F3",
                "statusCategoryCodeValue": "Finalized/Revised - Adjudication information has been changed",
                "statusCode": "101",
                "statusCodeValue": "Claim was processed as adjustment to previous claim.",
                "entityCode": "1E",
                "entity": "Health Maintenance Organization (HMO)",
                "effectiveDate": "20170412",
                "submittedAmount": "1229",
                "amountPaid": "184.05",
                "trackingNumber": "C1234567891028297LL",
                "claimServiceDate": "20160722",
                "tradingPartnerClaimNumber": "AAAAAAAAAAA2"
            }
        },
        {
            "claimStatus": {
                "statusCategoryCode": "F3",
                "statusCategoryCodeValue": "Finalized/Revised - Adjudication information has been changed",
                "statusCode": "101",
                "statusCodeValue": "Claim was processed as adjustment to previous claim.",
                "entityCode": "1E",
                "entity": "Health Maintenance Organization (HMO)",
                "effectiveDate": "20161201",
                "submittedAmount": "1229",
                "amountPaid": "219",
                "trackingNumber": "C1234567891028297LL",
                "claimServiceDate": "20160722",
                "tradingPartnerClaimNumber": "AAAAAAAAAAA3"
            }
        }
    ],
    "reassociationKey": "000000001",
    "status": "success"
}

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