Patients

Get a patient

GET/api/v1/patients/{id}

One patient with coverage as last verified, and their newest checks, claims (void transactions left out) and payments on any of their claims (up to 25 of each), by ID and state. A patient of another organization or mode is not found. Open charges: the charges of the open claims, plus what the patient owes on the paid, denied and reconciled ones, where the payer's remittance says.

Needs a key with read permission.

Request

Path parameters

Path parameters
Name	Type	Required	Description
id	string	required	A patient ID (pat_...).

Response

The patient. Status 200.

Response fields
Name	Type	Description
id	string	An ID that starts with pat_.
object	string	Always `patient`.
first_name	string	As first seen on a check or claim.
last_name	string	As first seen on a check or claim.
date_of_birth	string (date)
office_id	string or null	Office, primary insurance and member ID are those of the newest completed check or claim.
primary_insurance	object or null	The payer of the newest completed check or claim.
primary_insurance.id	string	An ID that starts with pyr_.
primary_insurance.payer_id	string	The payer's own payer ID.
primary_insurance.name	string
member_id	value	The member ID of the newest completed check or claim.
coverage	object or null	Coverage as last verified: the result of the newest completed check, in the Eligibility screen's words, with its date. Verified: the payer answered that check in the last 30 days. Inactive: that answer says the coverage is inactive. Null when no check of the patient has completed.
coverage.check_id	string	An ID that starts with elg_.
coverage.checked_at	string (date-time)
coverage.outcome	string	One of: `answered`, `rejected`, `payer_unavailable`, `error`.
coverage.status	string or null	One of: `active`, `inactive`, `unknown`.
coverage.label	string	The result in words, as the Eligibility screen says it.
coverage.verified	boolean	True when the payer answered this check in the last 30 days.
open_claims	integer	Open claims: the patient's claims not paid, denied, reconciled or voided (drafts included; predeterminations and void transactions are not claims here).At least -9007199254740991.
open_charges	object	Open charges: the charges of the open claims, plus what the patient owes on the paid, denied and reconciled ones, where the payer's remittance says.
open_charges.total	string	An amount in dollars, as a decimal string with two places (such as "113.60").Matches `^-?\d+\.\d{2}$`.
open_charges.claims	string	The charges of the open claims.Matches `^-?\d+\.\d{2}$`.
open_charges.patient_owes	string	What the patient owes on the paid, denied and reconciled claims, where known.Matches `^-?\d+\.\d{2}$`.
created_at	string (date-time)	When Claim House first saw the patient.
checks	array of object	The newest checks about the patient (up to 25), newest first.
checks[].id	string	An ID that starts with elg_.
checks[].state	string	One of: `pending`, `completed`.
checks[].outcome	string or null	One of: `answered`, `rejected`, `payer_unavailable`, `error`.
checks[].status	string or null	One of: `active`, `inactive`, `unknown`.
checks[].label	string
checks[].payer_id	string	An ID that starts with pyr_.
checks[].created_at	string (date-time)
claims	array of object	The newest claims for the patient, never a void transaction (up to 25), newest first.
claims[].id	string	An ID that starts with clm_.
claims[].kind	string	One of: `claim`, `predetermination`.
claims[].state	string	One of: `draft`, `validated`, `needs_attention`, `queued`, `submitted`, `accepted_clearinghouse`, `accepted_payer`, `rejected`, `voided`, `paid`, `denied`, `reconciled`, `returned`.
claims[].charge	string	An amount in dollars, as a decimal string with two places (such as "113.60").Matches `^-?\d+\.\d{2}$`.
claims[].payer_id	string	An ID that starts with pyr_.
claims[].created_at	string (date-time)
claims[].updated_at	string (date-time)
payments	array of object	The newest payments, denials and reversals on any of the patient's claims (never a predetermination's estimate; applied false: replaced by a later remittance) (up to 25), newest first.
payments[].id	string	An ID that starts with erc_.
payments[].era_id	string	An ID that starts with era_.
payments[].claim_id	string	An ID that starts with clm_.
payments[].outcome	string	paid, denied or reversal: the remittance rows that moved the claim (never an estimate or a status row).One of: `paid`, `denied`, `reversal`.
payments[].paid	string	An amount in dollars, as a decimal string with two places (such as "113.60").Matches `^-?\d+\.\d{2}$`.
payments[].patient_responsibility	string	An amount in dollars, as a decimal string with two places (such as "113.60").Matches `^-?\d+\.\d{2}$`.
payments[].payment_date	string (date) or null
payments[].applied	boolean	Whether the payment stands on the claim (a later remittance can replace it).

Errors

Errors
HTTP status	Code	What it means
401	UNAUTHORIZED	A valid API key is required. Send it as "Authorization: Bearer <key>".
403	PERMISSION_DENIED	This API key is not allowed to do that.
404	NOT_FOUND	Not found.
422	INVALID_REQUEST	The request is not valid.
504	TIMEOUT	The request took too long to finish. It may still have taken effect: look it up before sending it again with a new Idempotency-Key. What it made is found with GET /api/v1/eligibility?request_id=<this request_id>, and the same filter on /api/v1/claims and /api/v1/attachments (a key with read permission).
500	INTERNAL	Something went wrong on our side. Quote the request ID if you contact us.

Example

Example request

Shell

curl "https://sandbox.myclaimhouse.com/api/v1/patients/pat_01JM000000E00800000000004K" \
  -H "Authorization: Bearer $CLAIMHOUSE_KEY"

Example response: 200

JSON

{
  "id": "pat_01JM000000E00800000000004K",
  "object": "patient",
  "first_name": "Alex",
  "last_name": "Example",
  "date_of_birth": "1985-04-12",
  "office_id": "off_01JM000000E008000000000003",
  "primary_insurance": {
    "id": "pyr_01JM000000E008000000000004",
    "payer_id": "00000",
    "name": "Example Dental Plan"
  },
  "member_id": "CH-ACTIVE-FULL",
  "coverage": {
    "check_id": "elg_01JM000000E00800000000000G",
    "checked_at": "2026-09-24T20:55:00.430000+00:00",
    "outcome": "answered",
    "status": "active",
    "label": "Active",
    "verified": true
  },
  "open_claims": 0,
  "open_charges": {
    "total": "205.20",
    "claims": "0.00",
    "patient_owes": "205.20"
  },
  "created_at": "2026-03-10T15:30:00.430000+00:00",
  "checks": [
    {
      "id": "elg_01JM000000E00800000000000G",
      "state": "completed",
      "outcome": "answered",
      "status": "active",
      "label": "Active",
      "payer_id": "pyr_01JM000000E008000000000004",
      "created_at": "2026-03-10T15:30:00.250000+00:00"
    }
  ],
  "claims": [
    {
      "id": "clm_01JM000000E00800000000002G",
      "kind": "claim",
      "state": "paid",
      "charge": "1140.00",
      "payer_id": "pyr_01JM000000E008000000000004",
      "created_at": "2026-09-24T21:00:00.120000+00:00",
      "updated_at": "2026-09-24T21:00:00.310000+00:00"
    }
  ],
  "payments": [
    {
      "id": "erc_01JM000000E00800000000003H",
      "era_id": "era_01JM000000E00800000000003G",
      "claim_id": "clm_01JM000000E00800000000002G",
      "outcome": "paid",
      "paid": "820.80",
      "patient_responsibility": "205.20",
      "payment_date": "2026-09-24",
      "applied": true
    }
  ]
}

A patient of another organization or mode: 404

JSON

{
  "error": "NOT_FOUND",
  "message": "Patient not found",
  "errors": [],
  "request_id": "req_01JM000000E008000000000010"
}