@oystehr/sdk/src/resources/types/ClaimCMS1500.ts

Oystehr SDK

// AUTOGENERATED -- DO NOT EDIT

import { ClaimAddress } from './ClaimAddress';
import { ClaimDate } from './ClaimDate';
import { ClaimDatePeriod } from './ClaimDatePeriod';
import { ClaimDateWithQualifier } from './ClaimDateWithQualifier';
import { ClaimId } from './ClaimId';
import { ClaimName } from './ClaimName';

export interface ClaimCMS1500 {
  _1_insuranceProgram:
    | 'MEDICARE'
    | 'MEDICAID'
    | 'TRICARE'
    | 'CHAMPVA'
    | 'GROUP_HEALTH_PLAN'
    | 'FECA_BLK_LUNG'
    | 'OTHER';
  _1a_insuredIdNumber: string;
  _2_patientName: ClaimName;
  _3_patientBirthDate: ClaimDate;
  _3_patientSex: 'M' | 'F';
  _4_insuredName?: ClaimName;
  _5_patientAddress: ClaimAddress;
  _6_patientRelationshipToInsured?: 'Self' | 'Spouse' | 'Child' | 'Other';
  _7_insuredAddress?: ClaimAddress;
  _9_otherInsuredName?: ClaimName;
  _9a_otherInsuredPolicyOrGroupNumber?: string;
  _9d_otherInsuredInsurancePlanNameOrProgramName?: string;
  _10_patientConditionRelations?: {
    _a_employment?: boolean;
    _b_autoAccident?: boolean;
    _b_autoAccidentState?: string;
    _c_otherAccident?: boolean;
  };
  _10d_claimCodes?: string[];
  _11_insuredPolicyGroupOrFecaNumber?: string;
  _11a_insuredDateOfBirth?: ClaimDate;
  _11a_insuredSex?: 'M' | 'F';
  _11b_otherClaimId?: string;
  _11c_insurancePlanNameOrProgramName?: string;
  _11d_anotherHealthBenefitPlan: boolean;
  _12_patientSignedDate?: ClaimDate;
  _14_dateOfCurrentIllness?: ClaimDateWithQualifier;
  _15_otherDate?: ClaimDateWithQualifier;
  _16_patientUnableToWorkPeriod?: ClaimDatePeriod;
  _17_referringProvider: {
    qualifier: string;
    name: ClaimName;
    _a_otherId?: ClaimId;
    _b_npiId: string;
  };
  _18_hospitalizationDates?: ClaimDatePeriod;
  _19_additionalClaimInformation?: string;
  _20_outsideLab?: {
    purchased?: boolean;
    charges?: number;
  };
  _21_diagnosis: {
    icdIndicator: string;
    codes: string[];
  };
  _22_resubmission?: {
    code: string;
    originalReferenceNumber: string;
  };
  _23_priorAuthorizationNumber?: string;
  _24_services: {
    _a_datesOfService: ClaimDatePeriod;
    _b_placeOfService: string;
    _c_emergency?: boolean;
    _d_procedures: {
      cptOrHcpcs: string;
      modifiers?: string[];
    };
    _e_diagnosisPointer: string;
    _f_charges: number;
    _g_daysOrUnits: number;
    _h_epsdtAndFamilyPlan?: {
      epsdt?: string;
      familyPlan?: boolean;
    };
    _j_renderingProviderId: {
      otherId?: ClaimId;
      npiId: string;
    };
    supplementalInformation?: string;
  }[];
  _25_federalTaxIdNumber: {
    value: string;
    type: 'SSN' | 'EIN';
  };
  _26_patientAccountNumber?: string;
  _27_acceptAssignment?: boolean;
  _28_totalCharge: number;
  _29_amountPaid?: number;
  _31_physicianSignedDate: ClaimDate;
  _32_serviceFacilityLocationInfo: {
    name: string;
    address: ClaimAddress;
    _a_npiId?: string;
    _b_otherId?: ClaimId;
  };
  _33_billingProviderInfoAndPhone: {
    name: string;
    address: ClaimAddress;
    _a_npiId: string;
    _b_otherId?: ClaimId;
  };
}