Table of Contents

Note
We are releasing Insurance API v2 in Q4, 2023

Check Eligibility and Claims Submission Workflow

You have patient’s demographics information and patient’s insurance information.

You want to check if the patient is eligible for the procedure / visit.

...

Steps

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Example Request

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Example Response

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Contact the VSee team to configure which insurers you want to support. Once configured, use https://vsee.atlassian.net/wiki/spaces/VD/pages/55083127/Insurance+API#GET-%2Finsurance%2F to pull the list which will also contain insurer_id.

...

Code Block
curl --location --request GET 'https://api-vclinic.vseepreview.com/vc/dev/api_v3/insurances/' \ --header 'X-ApiToken: xxxx'

...

Code Block

language	json

{
    "data": {
        "insurers": [
            {
                "id": "car7551",
                "name": "AETNA"
            },
            {
                "id": "car7414",
                "name": "AETNA BETTER HEALTH OF ILLINOIS"
            },
            {
                "id": "car11406",
                "name": "ANTHEM BLUE SHIELD"
            },
            {
                "id": "car7147",
                "name": "CIGNA HEALTH CARE"
            },
            {
                "id": "car7580",
                "name": "MONTGOMERY HEALTH INSURANCE"
            },
            {
                "id": "car7556",
                "name": "HEALTH CHOICE ARIZONA"
            }
        ]
    }
}

...

Create a VSee Clinic user via https://vsee.atlassian.net/wiki/spaces/VD/pages/14942243/User+API#POST-%2Fusers%2Fsso

As a response you will receive patient data on VSee side.

...

Code Block

curl --location --request POST 'https://api-vclinic.vseepreview.com/vc/dev/api_v3/users/sso' \
--header 'X-AccountCode: vclinic' \
--header 'X-ApiKey: xxx' \
--header 'X-ApiSecret: xxx' \
--header 'X-ApiToken: xxx' \
--form 'first_name="Edward"' \
--form 'last_name="VSee"' \
--form 'type="200"' \
--form 'code="edward+001.vclinic@vseelab.com"' \
--form 'email="edward+001.vclinic@vseelab.com"' \
--form 'dob="1986-01-01"' \
--form 'gender="1"' \
--form 'street_addr="2868 Tully Street"' \
--form 'state="Detroit"' \
--form 'city="MI"' \
--form 'zip="48226"' \
--form 'insurance__primary__carrier_code="car11400"' \
--form 'insurance__primary__subscriber_num="10000022"' \
--form 'insurance__primary__group_number="test"' \
--form 'insurance__primary__card_front="card_front_url"' \
--form 'insurance__primary__card_back="card_back_url"' \
--form 'insurance__secondary__carrier_code="car11406"' \
--form 'insurance__secondary__group_number="XX1243"' \
--form 'insurance__secondary__subscriber_num="5678"' \
--form 'insurance__secondary__card_front="card_front_url"' \
--form 'insurance__secondary__card_back="card_back_url"' \
--form 'insurance__patient__respparty="self"' \
--form 'insurance__patient__guarantor_name="Edward VSee"' \
--form 'insurance__patient__guarantor_dob="1986-01-01"' \
--form 'insurance__patient__guarantor_city="NY"' \
--form 'insurance__patient__guarantor_zip="10001"' \
--form 'insurance__patient__guarantor_address="test"' \
--form 'extra__th_id="123456"'

...

Code Block

language	json

{
    "data": {
        "id": "132407",
        "code": "edward+001.vclinic@vseelab.com",
        "first_name": "Edward",
        "last_name": "VSee",
        "full_name": "Edward VSee",
        "username": "edward+001.vclinic@vseelab.com",
        "vseeid": "ccpreview+6258012d656449b8b5e73ad964457b1f",
        "dob": "1986-01-01",
        "email": "edward+001.vclinic@vseelab.com",
        "gender": 1,
        "active": true,
        "tos": false,
        "status": 20,
        "subtype": "",
        "street_addr": "2868 Tully Street",
        "state": "Detroit",
        "city": "MI",
        "zip": "48226",
        "timezone": "America/Los_Angeles",
        "email_verified": true,
        "insurance": {
            "primary": {
                "carrier_code": "car11400",
                "subscriber_num": "10000022",
                "group_number": "test"
            },
            "patient": {
                "respparty": "self",
                "guarantor_name": "Edward VSee",
                "guarantor_city": "NY",
                "guarantor_zip": "10001",
                "guarantor_address": "test"
            },
            "guarantor_dob": "1986-01-01"
        },
        "account_code": "vclinic",
        "clinics": [
            "vclinic"
        ],
        "created": 1649934637,
        "token": {
            "user_id": "132407",
            "token": "xxxx",
            "expiry": 1650021037,
            "created": 1649934637,
            "user_type": "200",
            "refresh_token": {
                "user_id": "132407",
                "token": "xxxx",
                "expiry": 1652526637,
                "created": 1649934637
            }
        }
    }
}

...

Run Insurance API (Draft) | POST-/users/:id/:carrier_code/eligibility to trigger the eligibility check for the given user_id. The eligibility check may take some time. A cron job will be created. The cron job will run after 10 seconds and the response will be saved in the user_data.insurance.{primary/secondary}.eligibility_response

Use the Token provided with your API Credentials for the X-ApiToken header.

...

Code Block
curl --location --request POST 'https://api-vclinic.vseepreview.com/vc/dev/api_v3/users/132407/car7556/eligibility' \ --header 'X-AccountCode: vclinic' \ --header 'X-ApiToken: xxxx'

...

Code Block

language	json

{
    "data": {
        "eligibility_id": "2505465",
        "carrier_code": "car7556"
    }
}

...

Receive a webhook request with eligibility_response message which will contain the result of the eligibility check. Skip this step if the clinic doesn’t have webhook.

...

Code Block

language	json

{
  "id": "62583ab3-8cfc-4a47-b6c9-272850e631f8",
  "type": "eligibility.checked",
  "created": 1649949363,
  "account_code": "vclinic",
  "data": {
    "eligibility_id": "2505464",
    "member_id": "132407",
    "eligibility_response": "No response received by clearinghouse",
    "external_member_id": "5991794"
  }
}

...

If the user is eligible, trigger a claim submission process for the member_id https://vsee.atlassian.net/wiki/spaces/VD/pages/55083127/Insurance+API#POST-%2Finsurance%2Fclaims

...

Code Block

curl --location --request POST 'https://api-vclinic.vseepreview.com/vc/devapi_v3/insurances/claims' \
--header 'X-AccountCode: vclinic' \
--header 'X-ApiKey: xxx' \
--header 'X-ApiSecret: xxx' \
--header 'X-ApiToken: xxx' \
--data-raw '{
    "member_id": "2186945",
    "date_of_service": "08/19/2022",
    "location": "41",
    "charge_list": [
        {
            "procedure_code": "10022",
            "units": 1,
            "diagnosis_code": "Z20.822 R05.9"
        },
         {
            "procedure_code": "10022",
            "units": 1,
            "diagnosis_code": "Z20.822"
        }
    ]
}'

...

Code Block

language	json

{
  "data": {
    "id": "82828",
  }
}

...

Receive a webhook request which will contain the result of the claim.

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TBD

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TBD

POST /users/:id/edit

https://api-vclinic.vseepreview.com/vc/dev/api_v3/users/:id/edit

Update patient insurance information.

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Request

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Response

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Code Block

curl --location --request POST 'https://api-vclinic.vseepreview.com/vc/dev/api_v3/users/123407/edit' \
--header 'X-ApiToken: xxxx' \
--form 'first_name="Edward"' \
--form 'last_name="VSee"' \
--form 'dob="1986-01-01"' \
--form 'gender="1"' \
--form 'street_addr="2868 Tully Street"' \
--form 'state="Detroit"' \
--form 'city="MI"' \
--form 'zip="48226"' \
--form 'insurance__primary__carrier_code="car11400"' \
--form 'insurance__primary__subscriber_num="10000022"' \
--form 'insurance__primary__group_number="test"' \
--form 'insurance__primary__card_front="card_front_url"' \
--form 'insurance__primary__card_back="card_back_url"' \
--form 'insurance__secondary__carrier_code="car11406"' \
--form 'insurance__secondary__group_number="XX1243"' \
--form 'insurance__secondary__subscriber_num="5678"' \
--form 'insurance__secondary__card_front="card_front_url"' \
--form 'insurance__secondary__card_back="card_back_url"' \
--form 'insurance__patient__respparty="self"' \
--form 'insurance__patient__guarantor_name="Edward VSee"' \
--form 'insurance__patient__guarantor_dob="1986-01-01"' \
--form 'insurance__patient__guarantor_city="NY"' \
--form 'insurance__patient__guarantor_zip="10001"' \
--form 'insurance__patient__guarantor_address="test"' \
--form 'extra__th_id="123456"'

...

Code Block

language	json

{
    "data": {
        "id": "132407",
        "code": "edward+001.vclinic@vseelab.com",
        "first_name": "Edward",
        "last_name": "VSee",
        "full_name": "Edward VSee",
        "username": "edward+001.vclinic@vseelab.com",
        "vseeid": "ccpreview+6258012d656449b8b5e73ad964457b1f",
        "dob": "1986-01-01",
        "email": "edward+001.vclinic@vseelab.com",
        "gender": 1,
        "active": true,
        "tos": false,
        "status": 20,
        "subtype": "",
        "street_addr": "2868 Tully Street",
        "state": "Detroit",
        "city": "MI",
        "zip": "48226",
        "timezone": "America/Los_Angeles",
        "email_verified": true,
        "insurance": {
            "primary": {
                "carrier_code": "car7556",
                "subscriber_num": "234234",
                "insurance_order": 1
            },
            "secondary": {
                "carrier_code": "car11406",
                "group_number": "XX1243",
                "subscriber_num": "5678",
                "insurance_order": 2
            },
            "patient": {
                "respparty": "self"
            }
        },
        "account_code": "vclinic",
        "clinics": [
            "vclinic"
        ],
        "created": 1649934637
    }
}

POST /me

https://api-vclinic.vseepreview.com/vc/dev/api_v3/me.json

Setup the required patient insurance information for eligibility check.

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Request

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Response

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Code Block

curl --location --request POST 'https://api-vclinic.vseepreview.com/vc/dev/api_v3/me.json' \
--header 'X-ApiToken: xxxx' \
--form 'insurance.primary_carrier_code="car7556"' \
--form 'insurance.respparty="self"' \
--form 'insurance.primary_subscriber_num="234234"' \
--form 'insurance.group_number="test 3"' \
--form 'insurance.secondary_carrier_code="car11406"' \
--form 'insurance.secondary_group_number="XX1243"' \
--form 'insurance.secondary_subscriber_num="5678"'

...

Code Block

language	json

{
    "data": {
        "id": "132407",
        "code": "edward+001.vclinic@vseelab.com",
        "first_name": "Edward",
        "last_name": "VSee",
        "full_name": "Edward VSee",
        "username": "edward+001.vclinic@vseelab.com",
        "vseeid": "ccpreview+6258012d656449b8b5e73ad964457b1f",
        "dob": "1986-01-01",
        "email": "edward+001.vclinic@vseelab.com",
        "gender": 1,
        "active": true,
        "tos": false,
        "status": 20,
        "subtype": "",
        "street_addr": "2868 Tully Street",
        "state": "Detroit",
        "city": "MI",
        "zip": "48226",
        "timezone": "America/Los_Angeles",
        "email_verified": true,
        "insurance": {
            "primary": {
                "carrier_code": "car7556",
                "subscriber_num": "234234",
                "insurance_order": 1
            },
            "secondary": {
                "carrier_code": "car11406",
                "group_number": "XX1243",
                "subscriber_num": "5678",
                "insurance_order": 2
            },
            "patient": {
                "respparty": "self"
            }
        },
        "account_code": "vclinic",
        "clinics": [
            "vclinic"
        ],
        "created": 1649934637
    }
}

Required Insurance Information

Code Block

FirstName - first_name
LastName - last_name
DOB - dob
Gender - gender
Address - street_addr
City - city
State - state
ZipCode - zip

Relationship to Insured - insurance.respparty (e.g self, child, spouse, other)

// Primary Insurance Fields
Primary Insurance - insurance.primary_carrier_code (insurer_id)
Primary Insurance Group Number - insurance.primary_group_number
Primary Insurance Subscriber Number - insurance.primary_subscriber_num
Primary Insurance Card Front - insurance.primary_card_front
Primary Insurance Card Back - insurance.primary_card_back

// Secondary Insurance Fields
Secondary Insurance - insurance.secondary_carrier_code (insurer_id)
Secondary Insurance Group Number - insurance.secondary_group_number
Secondary Insurance Subscriber Number - insurance.secondary_subscriber_num
Secondary Insurance Card Front - insurance.secondary_card_front
Secondary Insurance Card Back - insurance.secondary_card_back

If Relationship to Insured is child, spouse, other:
Guarantor Name - insurance.guarantor_name
Guarantor DOB  - insurance.guarantor_dob
Guarantor Address1 - insurance.guarantor_address
Guarantor City - insurance.guarantor_city
Guarantor State - insurance.guarantor_state
Guarantor Zip -  - insurance.guarantor_zip

POST /users/:id/:carrier_code/eligibility

https://api-vclinic.vseepreview.com/vc/next/api_v3/users/:id/:carrier_code/eligibility

Check insurance eligibility for the given patient. This assumes all required insurance data is saved for this user.

Set insurance data with https://vsee.atlassian.net/wiki/spaces/VD/pages/14942243/User+API#POST-%2Fme

VSee will create a patient record in AdvancedMD as needed if it’s not existing yet.

Result

Since the check may take up to 5 seconds to 1 minute, a webhook eligibility.checked is triggered when it is ready.

Response

Code Block

language	json

{
    "data": {
        "eligibility_id": "2505465",
        "carrier_code": "car7556"
    }
}

In case of error / missing data we should display a proper error message.

Raw Data in user_datas

It will populate the user’s primary insurance or secondary insurance eligibility response fields when response received from the 3rd party.

...

language	json

...

Table of Contents

API v2

Retrieve data list

`GET api_v3/insurances/list/insurers`

`GET api_v3/insurances/list/billing_modifiers`

`GET api_v3/insurances/list/dxs`

`GET api_v3/insurances/list/procedures`

Create / update delete / retrieve insurance detail

Sample insurance schema:

Code Block

			"insurance": [
				{
					"name": "Insurance",
					"code": "insurance",
					"card_type": "primary",
					"next": {
						"title": "Next"
					},
					"sections": [
						{
							"code": "insurance",
							"default_value": [
								"carrier_code",
								"subscriber_num",
								"group_number"
							],
							"prefill_mapping": {
								"respparty": {
									"self": {
										"guarantor_name": "full_name",
										"guarantor_dob": "dob",
										"guarantor_address": "street_addr",
										"guarantor_city": "city",
										"guarantor_zip": "zip",
										"guarantor_state": "state"
									}
								}
							},
							"schema": {
								"has_ins": {
									"type": "string",
									"title": "",
									"required": true,
									"enum": [
										"Yes",
										"No"
									],
									"default": "No"
								},
								"carrier_code": {
									"type": "string",
									"title": "Primary Insurance Company Name",
									"required": true,
									"prefill": {
										"user_attr": "insurance.primary.carrier_code"
									},
									"preload": {
										"url": "https://api-vclinic.vsee.me/claims_v2/api_v3/insurances/list/insurers",
										"format": {
											"data": {
												"id": "id",
												"text": "text"
											}
										}
									}
								},
								"carrier_name_others": {
									"type": "string",
									"title": "Other Insurance",
									"required": true,
									"prefill": {
										"user_attr": "insurance.primary.carrier_name_others"
									}
								},
								"subscriber_num": {
									"type": "string",
									"title": "Policy Number / Subscriber ID",
									"required": true,
									"prefill": {
										"user_attr": "insurance.primary.subscriber_num"
									}
								},
								"group_number": {
									"type": "string",
									"title": "Group Number",
									"prefill": {
										"user_attr": "insurance.patient.group_number"
									}
								},
								"respparty": {
									"type": "string",
									"title": "Patient Relationship to Policy Holder",
									"required": true,
									"enum": [
										"",
										"self",
										"child",
										"spouse",
										"other"
									],
									"prefill": {
										"user_attr": "insurance.patient.respparty"
									}
								},
								"guarantor_first_name": {
									"type": "string",
									"title": "Insured First Name",
									"required": true,
									"prefill": {
										"user_attr": "first_name",
										"only": "self"
									}
								},
								"guarantor_last_name": {
									"type": "string",
									"title": "Insured Last Name",
									"required": true,
									"prefill": {
										"user_attr": "last_name",
										"only": "self"
									}
								},
								"guarantor_middle_name": {
									"type": "string",
									"title": "Insured Middle Name",
									"prefill": {
										"user_attr": "extra.middle_name",
										"only": "self"
									},
									"required": false
								},
								"guarantor_dob": {
									"type": "string",
									"title": "Insured Date of Birth",
									"required": true,
									"format": "yyyy-mm-dd",
									"prefill": {
										"user_attr": "dob",
										"only": "self"
									}
								},
								"guarantor_address": {
									"type": "string",
									"title": "Insured Address",
									"required": true,
									"prefill": {
										"user_attr": "street_addr"
									}
								},
								"guarantor_city": {
									"type": "string",
									"title": "Insured City",
									"required": true,
									"prefill": {
										"user_attr": "city"
									}
								},
								"guarantor_zip": {
									"type": "string",
									"title": "Insured Zip",
									"required": true,
									"prefill": {
										"user_attr": "zip"
									}
								},
								"guarantor_state": {
									"type": "string",
									"title": "Insured State",
									"required": true,
									"enum": [
										"",
										"AK",
										"AL",
										"AR",
										"AZ",
										"CA",
										"CO",
										"CT",
										"DC",
										"DE",
										"FL",
										"GA",
										"HI",
										"IA",
										"ID",
										"IL",
										"IN",
										"KS",
										"KY",
										"LA",
										"MA",
										"MD",
										"ME",
										"MI",
										"MN",
										"MO",
										"MS",
										"MT",
										"NC",
										"ND",
										"NE",
										"NH",
										"NJ",
										"NM",
										"NV",
										"NY",
										"OH",
										"OK",
										"OR",
										"PA",
										"RI",
										"SC",
										"SD",
										"TN",
										"TX",
										"UT",
										"VA",
										"VT",
										"WA",
										"WI",
										"WV",
										"WY"
									],
									"prefill": {
										"user_attr": "state"
									}
								},
								"card_front": {
									"type": "string",
									"title": "Upload Insurance Card (Front)",
									"required": true,
									"prefill": {
										"user_attr": "insurance.primary.card_front"
									}
								},
								"card_back": {
									"type": "string",
									"title": "Upload Insurance Card (Back)",
									"required": true,
									"prefill": {
										"user_attr": "insurance.primary.card_back"
									}
								},
								"consent": {
									"type": "string",
									"required": true,
									"title": "I give the <a href='#'>authorization to bill insurance</a>"
								}
							},
							"form": [
								{
									"type": "help",
									"helpvalue": "We wish to offer clarity on how BabyLiveAdvice (BLA) bills you/your insurance for services you received, please read the following before making a payment selection.<br /><br />Although we do accept your insurance information as a method to facilitate payment for BLA, We do not know (in real-time) details about your co-payment, deductible, or out-of-pocket expenses, which may affect insurance coverage and compensation for billed services.  Our billed rates are based on coding rates set by our contract with your insurance. They range between $150-$350  (depending on codes and visit type). These rates, however, are not the same as our discounted cash visit rates. If you have insurance with high deductibles or out-of-pocket expenses, your insurance company may choose to apply the entire billed amount towards your deductible, and you will be responsible for the full billed amount in the future.<br /><br />For parents with high deductibles, out of pocket expenses or those who wish to avoid higher payments beyond the insurance billing option, we offer a discounted cash payment option. Our cash prices per visit are extremely competitive compared to current market rates of private providers or consultants, and they are discounted by 60% from our billable rates.<br /><br />Once we bill your insurance, we are unable to revert back to cash payment rates, and by law, we are required to collect the full amount applied toward your deductible or co-pay from you.<br /><br />"
								},
								{
									"key": "has_ins",
									"type": "radios",
									"notitle": true,
									"titleMap": {
										"Yes": "I would like to use my insurance",
										"No": "I would like to pay upfront for this visit (cash payment)"
									},
									"toggleMap": {
										"Yes": {
											"form": [
												{
													"type": "help",
													"helpvalue": "<i style='color: red'>If you choose OTHER, you are required to upload the front and back pictures of your insurance card.</i>"
												},
												{
													"key": "carrier_code",
													"placeholder": "Type first 3 letters to search",
													"type": "select2",
													"titleMap": {
														"car7551": "AETNA"
													},
													"htmlClass": "col-md-6 col-xs-6 col-sm-12",
													"toggleMap": {
														"OTHER": {
															"form": [
																{
																	"key": "carrier_name_others",
																	"placeholder": "Other Insurance",
																	"type": "text"
																}
															],
															"htmlClass": "col-md-6 col-xs-6 col-sm-12"
														}
													}
												},
												{
													"key": "subscriber_num",
													"placeholder": "Enter Policy Number / Subscriber ID*",
													"type": "text",
													"htmlClass": "col-md-6 col-xs-6 col-sm-12"
												},
												{
													"key": "group_number",
													"placeholder": "Enter Group Number",
													"type": "text",
													"htmlClass": "col-md-6 col-xs-6 col-sm-12"
												},
												{
													"key": "respparty",
													"placeholder": "Select relationship",
													"titleMap": {
														"self": "Self",
														"child": "Child",
														"spouse": "Spouse",
														"other": "Others"
													},
													"type": "select",
													"htmlClass": "col-md-6 col-xs-6 col-sm-12"
												},
												{
													"key": "guarantor_first_name",
													"placeholder": "Enter Insured First Name*",
													"type": "text",
													"htmlClass": "col-md-6 col-xs-6 col-sm-12"
												},
												{
													"key": "guarantor_last_name",
													"placeholder": "Enter Insured Last Name*",
													"type": "text",
													"htmlClass": "col-md-6 col-xs-6 col-sm-12"
												},
												{
													"key": "guarantor_middle_name",
													"placeholder": "Enter Insured Middle Name",
													"type": "text",
													"htmlClass": "col-md-6 col-xs-6 col-sm-12"
												},
												{
													"key": "guarantor_dob",
													"type": "datepicker",
													"htmlClass": "col-md-6 col-xs-6 col-sm-12"
												},
												{
													"key": "guarantor_address",
													"placeholder": "Enter address",
													"type": "text",
													"htmlClass": "col-md-6 col-xs-6 col-sm-12"
												},
												{
													"key": "guarantor_city",
													"placeholder": "Enter city",
													"type": "text",
													"htmlClass": "col-md-6 col-xs-6 col-sm-12"
												},
												{
													"key": "guarantor_zip",
													"placeholder": "Enter Zip",
													"type": "text",
													"htmlClass": "col-md-6 col-xs-6 col-sm-12"
												},
												{
													"key": "guarantor_state",
													"type": "select",
													"titleMap": {
														"AL": "Alabama",
														"AK": "Alaska",
														"AZ": "Arizona",
														"AR": "Arkansas",
														"CA": "California",
														"CO": "Colorado",
														"CT": "Connecticut",
														"DE": "Delaware",
														"DC": "District of Columbia",
														"FL": "Florida",
														"GA": "Georgia",
														"HI": "Hawaii",
														"ID": "Idaho",
														"IL": "Illinois",
														"IN": "Indiana",
														"IA": "Iowa",
														"KS": "Kansas",
														"KY": "Kentucky",
														"LA": "Louisiana",
														"ME": "Maine",
														"MD": "Maryland",
														"MA": "Massachusetts",
														"MI": "Michigan",
														"MN": "Minnesota",
														"MS": "Mississippi",
														"MO": "Missouri",
														"MT": "Montana",
														"NE": "Nebraska",
														"NV": "Nevada",
														"NH": "New Hampshire",
														"NJ": "New Jersey",
														"NM": "New Mexico",
														"NY": "New York",
														"NC": "North Carolina",
														"ND": "North Dakota",
														"OH": "Ohio",
														"OK": "Oklahoma",
														"OR": "Oregon",
														"PA": "Pennsylvania",
														"RI": "Rhode Island",
														"SC": "South Carolina",
														"SD": "South Dakota",
														"TN": "Tennessee",
														"TX": "Texas",
														"UT": "Utah",
														"VT": "Vermont",
														"VA": "Virginia",
														"WA": "Washington",
														"WV": "West Virginia",
														"WI": "Wisconsin",
														"WY": "Wyoming"
													},
													"htmlClass": "col-md-6 col-xs-6 col-sm-12"
												},
												{
													"key": "card_front",
													"title": "Upload Insurance Card (Front)",
													"type": "attachments",
													"id": "cardFrontArea",
													"height": "100px",
													"single": true,
													"htmlClass": "col-md-12 col-xs-12 col-sm-12"
												},
												{
													"key": "card_back",
													"title": "Upload Insurance Card (Back)",
													"type": "attachments",
													"id": "cardBackArea",
													"height": "100px",
													"single": true,
													"htmlClass": "col-md-12 col-xs-12 col-sm-12"
												},
												{
													"key": "consent",
													"htmlClass": "col-md-12 col-xs-12 col-sm-12",
													"type": "checkbox",
													"notitle": true,
													"inlinetitle": "I give the <a target='_blank' href='https://api-vclinic.vsee.me/files/view/65f07a66-59b4-4b00-a111-05c10adc645d'>authorization to bill insurance</a>"
												},
												{
													"type": "label",
													"label": "Your insurance will be verified but we still need your credit card information in case of deductible or co payment requirements in the next screen."
												}
											]
										}
									}
								}
							]
						}
					]
				},
				{
					name: "Insurance",
					card_type: "secondary",
					schema: {},
					form: {}
               }
},			]

`GET api_v3/users/{user_id}/insurances`

Expand

title	Response

Code Block

language	json

{
    "data": [
        {
            "consent": false,

"Name

"group_number":

{

"sdf",
            "subscriber_number": "ad",

"card_front": {
                "

Name

id":

{

"6552fbe8-d848-491f-8310-08de0a7d6499",
                "fullpath": "https://api-vclinic.vsee.me/files/view/6552fbe8-d848-491f-8310-08de0a7d6499?auth_code=1b41e14a509dc23ec0a496c65583fff972541a77&time=1699944950",
                "is_deletable": false

"@NM101_EntityIdentifierCode": "IL"

},
            "card_back": {

"id": "6552fbec-4994-4743-8328-0e380a7d6499",
                "

@NM102_EntityTypeQualifier

fullpath": "

1

https://api-vclinic.vsee.me/files/view/6552fbec-4994-4743-8328-0e380a7d6499?auth_code=1b41e14a509dc23ec0a496c65583fff972541a77&time=1699944950",
                "is_deletable": false

},

@NM103

guarantor_

LastOrOrganizationalName

name": "

VSEE

as",
            "guarantor_dob": "2023-11-06",

"guarantor_address": "as",
            "

@NM104

guarantor_

FirstName

city": "

EDWARD

as",
            "guarantor_state": "AR",

"guarantor_zip": "as",

@NM108

card_

IdentificationCodeQualifier

type": "

MI

primary",
            "eligibility": {
                "status": "inactive"
            },
            "

@NM109

insurer_

IdentificationCode

code": "

234234

car7777",         
            "insurer_name": "ANTHEM BLUE CROSS",

"responsible_party": "child"
        },
        {
            "consent": false,
            "group_number": "sdf",
            "

EligibilityOrBenefitInformation

subscriber_number": "ad",

{

            "card_front": {
                "id": "6552fbe8-d848-491f-8310-08de0a7d6499",
                "fullpath": "https://api-vclinic.vsee.me/files/view/6552fbe8-d848-491f-8310-08de0a7d6499?auth_code=1b41e14a509dc23ec0a496c65583fff972541a77&time=1699944950",

"EligibilityOrBenefitInformation":

{

            "is_deletable": false
            },
            "card_back": {
                "

EligibilityOrBenefitInformation

id":

{

"6552fbec-4994-4743-8328-0e380a7d6499",
                "fullpath": "https://api-vclinic.vsee.me/files/view/6552fbec-4994-4743-8328-0e380a7d6499?auth_code=1b41e14a509dc23ec0a496c65583fff972541a77&time=1699944950",
                "is_deletable": false
            },
            "

@EB01

guarantor_

EligibilityOrBenefitInformationCode

name": "

V

as",
            "guarantor_dob": "2023-11-06",
            "guarantor_address": "as",
            "guarantor_city": "as",
            "guarantor_state": "AR",

},

       "guarantor_zip": "as",
            "card_type": "secondary",
            "eligibility": {
                "status": "inactive"

"MessageTexts":

{

         },
            "insurer_code": "car7777",         
            "insurer_name": "ANTHEM BLUE CROSS",
            "

MSGSegment

responsible_party":

{

"child"
        }
    ],
    "version":

"2.0"
}

`POST api_v3/users/{user_id}/insurances/import`

Post in array
If there is primary existed, update else insert

Expand

title	Request payload

Code Block

language	json

{
    "insurances": [
        {

"consent": false,
            "

@MSG01

group_

FreeFormMessageText

number": "

The payer response contains invalid or non compliant data.(70002)"

sdf",
            "subscriber_number": "ad",
            "card_front": "6552fbe8-d848-491f-8310-08de0a7d6499",

}

"card_back": "6552fbec-4994-4743-8328-0e380a7d6499",
            "guarantor_name": "as",
            "guarantor_dob": "2023-11-06",

}

        "guarantor_address": "as",
            "guarantor_city": "as",
            "guarantor_state": "AR",
            "guarantor_zip": "as",

}

           "insurer_code": "car7777",         
            "insurer_name": "ANTHEM BLUE CROSS",

}

 "responsible_party": "child"
        },
        {
            "consent": false,

}

  "group_number": "sdf",

"subscriber_number": "ad",
            "card_front": "6552fbe8-d848-491f-8310-08de0a7d6499",

}

    "card_back": "6552fbec-4994-4743-8328-0e380a7d6499",
            "guarantor_name": "as",
            "guarantor_dob": "2023-11-06",

}

         "guarantor_address": "as",
            "guarantor_city": "as",

},

    "guarantor_state": "AR",
            "guarantor_zip": "as",
            "insurer_code": "

FunctionalGroupTrailer

car7777"

:

{

        
            "insurer_name": "ANTHEM BLUE CROSS",
            "

@GE01

responsible_

NumberOfTransactionSets

party": "

1

child"

,


        }
    ]
}

Expand

title	Response

Code Block

language	json

{
    "data": [
        {

"@GE02_GroupControlNumber":

"314159265"

    "consent": false,
            "group_number": "sdf",

}

"subscriber_number": "ad",
            "card_front": {

InterchangeControlTrailer

id":

{

"6552fbe8-d848-491f-8310-08de0a7d6499",

"fullpath": "https://api-vclinic.vsee.me/files/view/6552fbe8-d848-491f-8310-08de0a7d6499?auth_code=1b41e14a509dc23ec0a496c65583fff972541a77&time=1699944950",
                "

@IEA01

is_

NumberOfFunctionalGroups

deletable":

"1",

false

},

"@IEA02_InterchangeControlReference

"card_back":

"000000001"

{
                "id": "6552fbec-4994-4743-8328-0e380a7d6499",

}

  "fullpath": "https://api-vclinic.vsee.me/files/view/6552fbec-4994-4743-8328-0e380a7d6499?auth_code=1b41e14a509dc23ec0a496c65583fff972541a77&time=1699944950",
                "is_deletable": false

}

},

}

"guarantor_name": "as",
            "guarantor_dob": "2023-11-06",

}

"guarantor_address": "as",
            "

secondary

guarantor_city":

{

"as",
            "

carrier

guarantor_

code

state": "

car11406

AR",

group

guarantor_

number

zip": "

asdasd

as",

subscriber

card_

num

type": "

aaaaa

primary",

"insurance_order

"eligibility":

2

},

    "status": "pending"

"patient":

{

    },
            "

respparty

insurer_code": "

self

car7777",         
            "

member

insurer_

id

name": "

5991794

ANTHEM BLUE CROSS",

response

responsible_party

_id

": "

6858376

child"
        },

}

},

account_code

consent":

"vclinic"

false,
            "

clinics

group_number":

[

"sdf",

"vclinic"

"subscriber_number": "ad",

],

 "card_front": {

"created":

1649934637

}

Webhook

Code Block

language	json

{

   "id": "

62583ab3

6552fbe8-

8cfc

d848-

4a47

491f-

b6c9

8310-

272850e631f8

08de0a7d6499",

"type": "eligibility.checked",

created

fullpath":

1649949363, "account_code": "vclinic"

"https://api-vclinic.vsee.me/files/view/6552fbe8-d848-491f-8310-08de0a7d6499?auth_code=1b41e14a509dc23ec0a496c65583fff972541a77&time=1699944950",

"data":

{

"eligibility_id":

"2505464",

"member_id": "132407",

eligibility

is_

response

deletable":

"No response

false

received

by

clearinghouse",

"external_member_id":

"5991794"

}

Eligibility Responses List

eligibility_response may be one of the following:

Code Block

Success / Reject reason not found
Authorized quantity exceeded
Required application data missing
Input Errors
Out of Network
Authorization/Access restrictions
Unable to respond at current time.
Invalid/Missing provider information
Invalid/Missing provider name
Invalid/Missing provider speciality
Invalid/Missing provider phone number
Invalid/Missing provider state
Invalid/Missing referring provider identification number
Provider is not primary care physician
Provider ineligible for inquiries
Provider not on file
Service dates not within provider plan enrollment
Inquired benefit inconsistent with provider type
Inappropriate date
Invalid/Missing dates of service
Invalid/Missing date of birth
Date of birth follows date of service
Date of death preceeds dates of service
Date of service not within allowable inquiry period
Date of service in future
Invalid/Missing patient ID
Invalid/Missing patient name
Invalid/Missing patient gender code
Patient not found
Inconsistent with patient age.
Inconsistent with patient gender.
Patient birth date does not match that for the patient in the
Invalid/Missing subscriber/insured ID
Invalid/Missing subscriber/insured name
Invalid/Missing subscriber/insured gender code
Subscriber/Insured not found
Duplicate Subscriber/Insured ID number
Subscriber found, patient not found
Subscriber/Insured not in Group/Plan identified
Invalid participant identification
invalid or missing provider address
Payer name or identifier missing
Certification Information Missing
No response received by clearinghouse
Expiremental service or procedure.
Authorization number not found.
Requires primary care physician authorization.
Invalid/Missing diagnosis codes.
Invalid/Missing procedure codes.
Additional patient condition information required.
Certification information does not match patient.
Requires medical review.
Invalid authorization number format.
Missing authorization number.

Rejection reason and codes

Code Block

'04' => 'Authorized quantity exceeded',
'15' => 'Required application data missing',
'33' => 'Input Errors',
'35' => 'Out of Network',
'41' => 'Authorization/Access restrictions',
'42' => 'Unable to respond at current time.',
'43' => 'Invalid/Missing provider information',
'44' => 'Invalid/Missing provider name',
'45' => 'Invalid/Missing provider speciality',
'46' => 'Invalid/Missing provider phone number',
'47' => 'Invalid/Missing provider state',
'48' => 'Invalid/Missing referring provider identification number',
'49' => 'Provider is not primary care physician',
'50' => 'Provider ineligible for inquiries',
'51' => 'Provider not on file',
'52' => 'Service dates not within provider plan enrollment',
'53' => 'Inquired benefit inconsistent with provider type',
'56' => 'Inappropriate date',
'57' => 'Invalid/Missing dates of service',
'58' => 'Invalid/Missing date of birth',
'60' => 'Date of birth follows date of service',
'61' => 'Date of death preceeds dates of service',
'62' => 'Date of service not within allowable inquiry period',
'63' => 'Date of service in future',
'64' => 'Invalid/Missing patient ID',
'65' => 'Invalid/Missing patient name',
'66' => 'Invalid/Missing patient gender code',
'67' => 'Patient not found',
'69' => 'Inconsistent with patient age.',
'70' => 'Inconsistent with patient gender.',
'71' => 'Patient birth date does not match that for the patient in the database',
'72' => 'Invalid/Missing subscriber/insured ID',
'73' => 'Invalid/Missing subscriber/insured name',
'74' => 'Invalid/Missing subscriber/insured gender code',
'75' => 'Subscriber/Insured not found',
'76' => 'Duplicate Subscriber/Insured ID number',
'77' => 'Subscriber found, patient not found',
'78' => 'Subscriber/Insured not in Group/Plan identified',
'79' => 'Invalid participant identification',
'97' => 'invalid or missing provider address',
'T4' => 'Payer name or identifier missing',
'T5' => 'Certification Information Missing',
'80' => 'No response received by clearinghouse',
'98' => 'Expiremental service or procedure.',
'AA' => 'Authorization number not found.',
'AE' => 'Requires primary care physician authorization.',
'AF' => 'Invalid/Missing diagnosis codes.',
'AG' => 'Invalid/Missing procedure codes.',
'AO' => 'Additional patient condition information required.',
'CI' => 'Certification information does not match patient.',
'E8' => 'Requires medical review.',
'IA' => 'Invalid authorization number format.',
'MA' => 'Missing authorization number.'

GET /insurances/

https://api-vclinic.vseepreview.com/vc/next/api_v3/insurance/

Get the available list of insurers for patient to pick from.

Is it stored in clinic Raw settings.

Output

A list of supported insurers.

“id” here is AMD’s payer ID. “name” is readable name.

Code Block

language	json

{ "data": {

,
            "card_back": {
                "id": "6552fbec-4994-4743-8328-0e380a7d6499",
                "fullpath": "https://api-vclinic.vsee.me/files/view/6552fbec-4994-4743-8328-0e380a7d6499?auth_code=1b41e14a509dc23ec0a496c65583fff972541a77&time=1699944950",
                "is_deletable": false
            },
            "guarantor_name": "as",
            "guarantor_dob": "2023-11-06",
            "guarantor_address": "as",
            "guarantor_city": "as",
            "guarantor_state": "AR",
            "guarantor_zip": "as",
            "card_type": "secondary",
            "eligibility": {
                "status": "pending"
            },
            "insurer_code": "car7777",         
            "insurer_name": "ANTHEM BLUE CROSS",
            "responsible_party": "child"
        }
    ],
    "version": "2.0"
}

`POST api_v3/users/{user_id}/insurances/{card_type|primary|secondary}`

If the insurance schema doesn’t have card_type, we should set it as primary as default. ( Duong Dang )

Expand

title	Request payload

Code Block

language	json

{
    "consent": false,
    "group_number": "sdf",
    "subscriber_number": "ad",
    "card_front": "6552fbe8-d848-491f-8310-08de0a7d6499",
    "card_back": "6552fbec-4994-4743-8328-0e380a7d6499",
    "guarantor_name": "as",
    "guarantor_dob": "2023-11-06",
    "guarantor_address": "as",
    "guarantor_city": "as",
    "guarantor_state": "AR",
    "guarantor_zip": "as",
    "insurer_code": "car7777",         
    "insurer_name": "ANTHEM BLUE CROSS",
    "responsible_party": "child"
}

Expand

title	Response

Code Block

language	json

{
    "data": {
        "consent": false,
        "group_number": "sdf",
        "subscriber_number": "ad",
        "card_front": {
            "id": "6552fbe8-d848-491f-8310-08de0a7d6499",
            "fullpath": "https://api-vclinic.vsee.me/files/view/6552fbe8-d848-491f-8310-08de0a7d6499?auth_code=1b41e14a509dc23ec0a496c65583fff972541a77&time=1699944950",
            "is_deletable": false
        },
        "card_back": {
            "id": "6552fbec-4994-4743-8328-0e380a7d6499",
            "fullpath": "https://api-vclinic.vsee.me/files/view/6552fbec-4994-4743-8328-0e380a7d6499?auth_code=1b41e14a509dc23ec0a496c65583fff972541a77&time=1699944950",
            "is_deletable": false
        },
        "guarantor_name": "as",
        "guarantor_dob": "2023-11-06",
        "

insurers

guarantor_address":

[

"as",
        "guarantor_city": "as",

{

"guarantor_state": "AR",
        "

id

guarantor_zip": "

car7551

as",
        "card_type": "primary",
        "

name

eligibility":

"AETNA"

},

"status": "inactive"
        },

{

      "insurer_code": "car7777",

id

insurer_name": "

car7414

ANTHEM BLUE CROSS",        
        "

name

responsible_party": "

AETNA BETTER HEALTH OF ILLINOIS

child"
    },
    "version":

},

"2.0"
}

`GET api_v3/users/{user_id}/insurances/{card_type|primary|secondary}`

Expand

title	Response

Code Block

language	json

{
    "data": {

{

"consent": false,
        "

id

group_number": "

car11406

sdf",

name

subscriber_number": "

ANTHEM BLUE SHIELD

ad",

"card_front": {

},

{

"id": "6552fbe8-d848-491f-8310-08de0a7d6499",
            "

id

fullpath": "

car7147",

https://api-vclinic.vsee.me/files/view/6552fbe8-d848-491f-8310-08de0a7d6499?auth_code=1b41e14a509dc23ec0a496c65583fff972541a77&time=1699944950",
            "

name

is_deletable":

"CIGNA

false

HEALTH

CARE"

},

"card_back": {


            "id": "

car7580

6552fbec-4994-4743-8328-0e380a7d6499",

name

fullpath": "

MONTGOMERY HEALTH INSURANCE" }, {

https://api-vclinic.vsee.me/files/view/6552fbec-4994-4743-8328-0e380a7d6499?auth_code=1b41e14a509dc23ec0a496c65583fff972541a77&time=1699944950",
            "

id

is_deletable": false

"car7556",

        },
        "guarantor_name": "

HEALTH CHOICE ARIZONA

as",
        "guarantor_dob": "2023-11-06",

}

]

"guarantor_address": "as",

}

POST /insurance/claims

https://api-vclinic.vseepreview.com/vc/next/api_v3/insurance/claims

...

Request

...

Response

...

 "guarantor_city": "as",
        "guarantor_state": "AR",
        "

...

guarantor_

...

zip": "

...

as",
        "

...

card_

...

type": "

...

primary",

...

"eligibility": {
            "status": "

...

inactive"
        },
        "

...

insurer_

...

code":

...

"car7777",

...

insurer_

...

name": "

...

ANTHEM BLUE CROSS",

...

responsible_party":

...

"child"

...

},
    "

...

version": "

...

2.0"
}

`DELETE api_v3/users/{user_id}/insurances/{card_type}`

Expand

title	Response (204)

Eligibility check

`POST api_v3/users/{user_id}/insurances/primary/eligibility/check` 14 Nov 2023

Check and return queue status and current eligibility status
Known issue: every post will submit new check (to optimize later)

Expand

title	Response 1 (200 OK)

Code Block

language	json

{
    "data": {

...

job_

...

id": "

...

6552fefa-e620-4caa-9990-26940a7d6499",

...

status": "

...

pending"

...

Expand

title	Response 2 (429 Too Many Requests)

Code Block

language	json

...

{
    "

...

code":

...

429,

...

`Claims collection`

Code Block

claims.type

claims.account_code

claims.visit_id //optional claims.member_id claims.status claims.advancedmd.date_of_service // all input fields claims.advancedmd.visit_id

`Input`

...

Parameter Name

...

Type

...

Description

...

visit_id

...

String

...

…

...

date_of_service

...

12/1/2021

...

location

...

41

...

procedure_code

...

U0003;U0005

...

units

...

1

...

diagnosis_code

...

Z20.822;R05.9

`Output`

Code Block

{

 "message": "Started at Tue, 14 Nov 2023 12:05:00 +0700"
}

`GET api_v3/users/{user_id}/insurances/primary/eligibility`

Return queue status and current eligibility status

Expand

title	Response 1

Code Block

language	json

{
    "data": {

"id": "82828",

}

`Webhook`

Code Block

{ "

"job_id": "

5c34979c

655300b4-

30dc

2378-

496c

4ec7-

8cd3

98bf-

6eb9925862c1

34b50a7d6499",

"type":

"claims.updated",

visit_id

status":

1546950556,

"account_code": "vclinic",

"pending"

"data":

}
}

Expand

title	Response 2

Code Block

language	json

"claim_id

"data":

"28540", "member_id": "60610",

{
        "status": "active"
    }
}

Versions Compared

Old Version 50

New Version 51

Key

Check Eligibility and Claims Submission Workflow

POST /users/:id/edit

POST /me

Required Insurance Information

POST /users/:id/:carrier_code/eligibility

Result

Response

Raw Data in user_datas

API v2

Retrieve data list

`GET api_v3/insurances/list/insurers`

`GET api_v3/insurances/list/billing_modifiers`

`GET api_v3/insurances/list/dxs`

`GET api_v3/insurances/list/procedures`

Create / update delete / retrieve insurance detail

`GET api_v3/users/{user_id}/insurances`

`POST api_v3/users/{user_id}/insurances/import`

Webhook

Eligibility Responses List

Rejection reason and codes

GET /insurances/

Output

`POST api_v3/users/{user_id}/insurances/{card_type|primary|secondary}`

`GET api_v3/users/{user_id}/insurances/{card_type|primary|secondary}`

POST /insurance/claims

`DELETE api_v3/users/{user_id}/insurances/{card_type}`

Eligibility check

`POST api_v3/users/{user_id}/insurances/primary/eligibility/check` 14 Nov 2023

`Claims collection`

`Input`

`Output`

`GET api_v3/users/{user_id}/insurances/primary/eligibility`

`Webhook`

Page Comparison

Versions Compared

Old Version 50

New Version 51

Key

Check Eligibility and Claims Submission Workflow

POST /users/:id/edit

POST /me

Required Insurance Information

POST /users/:id/:carrier_code/eligibility

Result

Response

Raw Data in user_datas

API v2

Retrieve data list

GET api_v3/insurances/list/insurers

GET api_v3/insurances/list/billing_modifiers

GET api_v3/insurances/list/dxs

GET api_v3/insurances/list/procedures

Create / update delete / retrieve insurance detail

GET api_v3/users/{user_id}/insurances

POST api_v3/users/{user_id}/insurances/import

Webhook

Eligibility Responses List

Rejection reason and codes

GET /insurances/

Output

POST api_v3/users/{user_id}/insurances/{card_type|primary|secondary}

GET api_v3/users/{user_id}/insurances/{card_type|primary|secondary}

POST /insurance/claims

DELETE api_v3/users/{user_id}/insurances/{card_type}

Eligibility check

POST api_v3/users/{user_id}/insurances/primary/eligibility/check 14 Nov 2023

Claims collection

Input

Output

GET api_v3/users/{user_id}/insurances/primary/eligibility

Webhook

`GET api_v3/insurances/list/insurers`

`GET api_v3/insurances/list/billing_modifiers`

`GET api_v3/insurances/list/dxs`

`GET api_v3/insurances/list/procedures`

`GET api_v3/users/{user_id}/insurances`

`POST api_v3/users/{user_id}/insurances/import`

`POST api_v3/users/{user_id}/insurances/{card_type|primary|secondary}`

`GET api_v3/users/{user_id}/insurances/{card_type|primary|secondary}`

`DELETE api_v3/users/{user_id}/insurances/{card_type}`

`POST api_v3/users/{user_id}/insurances/primary/eligibility/check` 14 Nov 2023

`Claims collection`

`Input`

`Output`

`GET api_v3/users/{user_id}/insurances/primary/eligibility`

`Webhook`