Claims

Before you start

NexHealth reads financial data from the health record system only on request. To turn it on for your API key, email [email protected]. Sandbox locations have it on.
Every request needs a bearer token from POST /authenticates. See Authentication.
Requests take the practice's subdomain and, for most endpoints, a location_id. See Institutions, syncs, and locations.

Overview

The claims endpoints let you read insurance claims for patient services. Practices use claims to get insurance reimbursements and share key information with insurance providers. A claim usually has a line item for each procedure performed, along with billing information. A practice can send a claim to more than one insurance provider.

Example use cases

Show live insurance claim statuses in a patient portal. Patients can see each claim's status: submitted, paid or denied. This cuts confusion and support calls.
Find claims still open after 30 days and create follow-up tasks for billing teams automatically. This helps practices reduce insurance aging and speed up cash flow.

Sample response

{
  "code": true,
  "description": null,
  "error": null,
  "data": {
    "id": 10,
    "location_id": 1,
    "patient_id": 1002,
    "provider_id": 101,
    "guarantor_id": 1001,
    "status": "sent",
    "received_at": "2024-06-10T15:16:57.000Z",
    "sent_at": "2024-06-03T11:23:12.000Z",
    "note": "Claim was sent to the insurance company",
    "primary_insurance_plan_id": 10021,
    "secondary_insurance_plan_id": 10021,
    "date_of_service": "2024-06-03",
    "totals": {
      "amount_billed_to_insurance": {
        "amount": "62.00",
        "currency": "USD"
      },
      "estimated_insurance_payment": {
        "amount": "62.00",
        "currency": "USD"
      },
      "insurance_payment": {
        "amount": "62.00",
        "currency": "USD"
      },
      "write_off": {
        "amount": "62.00",
        "currency": "USD"
      }
    },
    "deleted_at": "2022-01-01T00:00:00Z",
    "patient": {
      ...
    },
    "provider": {
      ...
    },
    "guarantor": {
      ...
    },
    "charge_payouts": [ { ... } ], "charges": [ { ... } ] },
  "count": null
}