Guides

The directory Claim House keeps of the people in your checks and claims, one record each, with coverage as last verified, open claims and open charges; how a record is made, the same-person rule and its limit, and search by POST.

A patient record ties the eligibility checks, claims and payments of one person together. Claim House makes it from the checks and claims you send; your practice management system stays the system of record, so there is no adding or importing patients here. A record is never edited by hand: it follows what you send.

How a record is made#

Claim House links every completed eligibility check and every claim to the person it is about, and makes that person's record the first time it sees them. The check and claim objects carry the link as patient_id (pat_...).

• One person is one record per organization and mode: the same family name, given name and date of birth, compared with case, spacing, punctuation, accents and a suffix such as Jr or III left out. A different member ID never splits a person (coverage changes).
• Two different people with the same name and date of birth share one record. A person with no date of birth, or with a name that has no letters or digits to compare (written in another script), is linked to no record.
• The person is the patient: the dependent when the check or claim names one, else the subscriber.
• A check is linked when it completes; a claim when it is made, and again when its patient's name or date of birth is changed. A record left with no checks or claims stays until the test data is reset.
• Office, primary insurance and member ID are those of the newest completed check or claim.
• 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.
• Open claims: the patient's claims not paid, denied, reconciled or voided (drafts included; predeterminations and void transactions are not claims here).
• 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.

The record keeps the name as it was first seen. A test key sees the patients of test mode and a live key those of live mode; another organization's patients are never found. In test mode every patient is a synthetic one from your sandbox requests, and resetting the test data removes them.

curl "https://sandbox.myclaimhouse.com/api/v1/eligibility" \
  -H "Authorization: Bearer $CLAIMHOUSE_KEY" \
  -H "Idempotency-Key: $(uuidgen)" \
  -H "Content-Type: application/json" \
  -d @- <<EOF
{
  "office_id": "$OFFICE_ID",
  "payer_id": "$PAYER_ID",
  "subscriber": {
    "first_name": "Pat",
    "last_name": "Example",
    "date_of_birth": "1985-04-12",
    "member_id": "CH-ACTIVE-FULL"
  }
}
EOF

The completed check's patient_id is the patient's record.

List and read patients#

GET /patients lists the patients newest first (by when Claim House first saw them), filtered by office_id and by coverage: verified (verified in last 30 days), unverified (unverified), inactive (inactive).

curl "https://sandbox.myclaimhouse.com/api/v1/patients?coverage=verified&limit=25" -H "Authorization: Bearer $CLAIMHOUSE_KEY"

GET /patients/{id} gives one patient with their newest checks, claims (void transactions left out) and payments on any of their claims, up to 25 of each, by ID and state: read each by its ID for the detail.

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

Search by POST#

A patient's name, date of birth and member ID never go in an address, where proxies and logs keep them. POST /patients/search takes them in its body: name (words, each found in the family or given name, accents and punctuation ignored), date_of_birth and member_id (on any of the patient's checks or claims); all that are given must match. It only reads: it needs a key with read and no Idempotency-Key, and nothing of it is kept. The request log records its path only.

curl "https://sandbox.myclaimhouse.com/api/v1/patients/search" \
  -H "Authorization: Bearer $CLAIMHOUSE_KEY" \
  -H "Content-Type: application/json" \
  -d '{"name": "pat example", "date_of_birth": "1985-04-12"}'

A body with nothing to look for answers 422 with required on name.

curl "https://sandbox.myclaimhouse.com/api/v1/patients/search" \
  -H "Authorization: Bearer $CLAIMHOUSE_KEY" \
  -H "Content-Type: application/json" \
  -d '{}'

No import, no adding#

There is no endpoint or screen to add, edit or import a patient: your practice management system is the record, and Claim House keeps only what your checks and claims say. To correct a patient's name or date of birth, correct the claim (an edit links it again) or send a new check.