Sha256: 134bac8eec16e2e6fa352c54d7377a0561a9ab753c8ab2a63a32480906bb1f3d
Contents?: true
Size: 1.03 KB
Versions: 16
Compression:
Stored size: 1.03 KB
Contents
{
"transaction_code": "chargeable",
"trading_partner_id": "MOCKPAYER",
"billing_provider": {
"taxonomy_code": "207Q00000X",
"first_name": "Jerome",
"last_name": "Aya-Ay",
"npi": "1467560003",
"address": {
"address_lines": ["8311 WARREN H ABERNATHY HWY"],
"city": "SPARTANBURG",
"state": "SC",
"zipcode": "29301"
},
"tax_id": "123456789"
},
"subscriber": {
"first_name": "Jane",
"last_name": "Doe",
"member_id": "W000000000",
"address": {
"address_lines": ["123 N MAIN ST"],
"city": "SPARTANBURG",
"state": "SC",
"zipcode": "29301"
},
"birth_date": "1970-01-01",
"gender": "female"
},
"claim": {
"total_charge_amount": 60.0,
"service_lines": [
{
"procedure_code": "99213",
"charge_amount": 60.0,
"unit_count": 1.0,
"diagnosis_codes": ["487.1"],
"service_date": "2014-06-01"
}
]
},
"payer": {
"organization_name": "Acme Ins Co",
"plan_id": "1234567890"
}
}
Version data entries
16 entries across 16 versions & 1 rubygems