athenahealth integration

Add Insurance Policy

Perform Add Insurance Policy through athenahealth.

View as Markdown

athena_add_patient_insurance

writeathenahealth

Inputs

patient_id
expressionrequired
Patient Id
Required literal value or workflow expression.
insurance_package_id
expressionrequired
Insurance Package Id
Required literal value or workflow expression.
id_number
expressionrequired
Id Number
Required literal value or workflow expression.
sequence_number
select
Sequence Number
Optional selected identifier or value.
Default: "1"
Options: Primary ("1"), Secondary ("2"), Tertiary ("3")
policy_number
expression
Policy Number
Optional literal value or workflow expression.
issue_date
expression
Issue Date
Optional literal value or workflow expression.
expiration_date
expression
Expiration Date
Optional literal value or workflow expression.
insurance_product_type_id
select
Insurance Product Type Id
Optional selected identifier or value.
Options: Leave unset (""), HMO ("1"), PPO ("2"), POS ("3"), EPO ("6"), INDEMNITY ("4"), OTHER ("5"), Behavioral health ("8"), Contracts ("19"), Legal ("20"), MVA ("18"), Medicaid CHIP ("12"), Medicaid HMO ("10"), Medicaid PCCM ("11"), Medicaid-Traditional ("13"), Medicare B-Traditional ("21"), Medicare HMO ("14"), Medicare POS ("23"), Medicare PPO ("15"), Medicare Private FFS ("22"), Medicare Supplemental Plan ("16"), Radiology ("9"), Vision ("7"), Workers Comp ("17")
copay_type_id
expression
Copay Type Id
Optional literal value or workflow expression.
copay
expression
Copay
Optional literal value or workflow expression.
coinsurance_percent
expression
Coinsurance Percent
Optional literal value or workflow expression.
notes
textarea
Notes
Optional text value.
relationship_to_insured_id
select
Relationship To Insured Id
Optional selected identifier or value.
Default: "1"
Options: Self ("1"), Spouse ("2"), Child ("3"), Child (Mother's Insurance) ("27"), Child (Father's Insurance) ("28"), Child (Ins. not Financially Respons.) ("25"), Child (Mother's Ins., Ins. not Financially Respons.) ("29"), Child (Father's Ins., Ins. not Financially Respons.) ("30"), Stepson or Stepdaughter ("11"), Stepson or Stepdaughter (Stepmother's Insurance) ("31"), Stepson or Stepdaughter (Stepfather's Insurance) ("32"), Foster Child ("9"), Mother ("18"), Father ("19"), Parent ("34"), Stepparent ("35"), Grandparent ("5"), Grandchild ("6"), Sibling ("33"), Aunt or Uncle ("36"), Nephew or Niece ("7"), Life Partner ("26"), Significant Other ("17"), Employee ("12"), Ward ("10"), Charge of a Caretaker ("37"), Handicapped Dependent ("14"), Sponsored Dependent ("15"), Dependent of a Minor Dependent ("16"), Emancipated Minor ("21"), Organ Donor ("22"), Cadaver Donor ("23"), Injured Plaintiff ("24"), Other ("4"), Unknown ("13")
insured_entity_type_id
select
Insured Entity Type Id
Optional selected identifier or value.
Options: Leave unset (""), Person ("1"), Non-person entity ("2")
insured_id_number
expression
Insured Id Number
Optional literal value or workflow expression.
insured_first_name
expression
Insured First Name
Optional literal value or workflow expression.
insured_last_name
expression
Insured Last Name
Optional literal value or workflow expression.
insured_middle_initial
expression
Insured Middle Initial
Optional literal value or workflow expression.
insured_name_suffix
expression
Insured Name Suffix
Optional literal value or workflow expression.
insured_date_of_birth
expression
Insured Date Of Birth
Optional literal value or workflow expression.
insured_sex
select
Insured Sex
Optional selected identifier or value.
Options: Leave unset (""), Female ("F"), Male ("M")
insured_ssn
expression
Insured Ssn
Optional literal value or workflow expression.
insured_address_line_1
expression
Insured Address Line 1
Optional literal value or workflow expression.
insured_address_line_2
expression
Insured Address Line 2
Optional literal value or workflow expression.
insured_city
expression
Insured City
Optional literal value or workflow expression.
insured_state
select
Insured State
Optional selected identifier or value.
Options: Leave unset (""), AA-Armed Forces Americas ("AA"), AE-Armed Forces Africa ("AE"), AK-Alaska ("AK"), AL-Alabama ("AL"), AP-Armed Forces Pacific ("AP"), AR-Arkansas ("AR"), AS-American Samoa ("AS"), AZ-Arizona ("AZ"), CA-California ("CA"), CO-Colorado ("CO"), CT-Connecticut ("CT"), DC-District of Columbia ("DC"), DE-Delaware ("DE"), FL-Florida ("FL"), FM-Federated States of Micronesia ("FM"), GA-Georgia ("GA"), GU-Guam ("GU"), HI-Hawaii ("HI"), IA-Iowa ("IA"), ID-Idaho ("ID"), IL-Illinois ("IL"), IN-Indiana ("IN"), KS-Kansas ("KS"), KY-Kentucky ("KY"), LA-Louisiana ("LA"), MA-Massachusetts ("MA"), MD-Maryland ("MD"), ME-Maine ("ME"), MH-Marshall Islands ("MH"), MI-Michigan ("MI"), MN-Minnesota ("MN"), MO-Missouri ("MO"), MP-Northern Mariana Islands ("MP"), MS-Mississippi ("MS"), MT-Montana ("MT"), NC-North Carolina ("NC"), ND-North Dakota ("ND"), NE-Nebraska ("NE"), NH-New Hampshire ("NH"), NJ-New Jersey ("NJ"), NM-New Mexico ("NM"), NV-Nevada ("NV"), NY-New York ("NY"), OH-Ohio ("OH"), OK-Oklahoma ("OK"), OR-Oregon ("OR"), PA-Pennsylvania ("PA"), PR-Puerto Rico ("PR"), PW-Palau ("PW"), RI-Rhode Island ("RI"), SC-South Carolina ("SC"), SD-South Dakota ("SD"), TN-Tennessee ("TN"), TX-Texas ("TX"), UT-Utah ("UT"), VA-Virginia ("VA"), VI-Virgin Islands ("VI"), VT-Vermont ("VT"), WA-Washington ("WA"), WI-Wisconsin ("WI"), WV-West Virginia ("WV"), WY-Wyoming ("WY")
insured_zip
expression
Insured Zip
Optional literal value or workflow expression.
insured_country_id
expression
Insured Country Id
Optional literal value or workflow expression.
eligibility_mode
select
Eligibility Mode
Optional selected identifier or value.
Default: "CHECKELIGIBILITYTODAY"
Options: Check eligibility today ("CHECKELIGIBILITYTODAY"), Check eligibility for a date of service ("CHECKELIGIBILITY"), Record an eligibility answer we already have ("SETELIGIBILITY")
eligibility_service_date
expression
Eligibility Service Date
Optional literal value or workflow expression.
eligible
select
Eligible
Optional selected identifier or value.
Options: Leave unset (""), Eligible ("Y"), Ineligible ("N")
eligibility_reason_id
select
Eligibility Reason Id
Optional selected identifier or value.
Options: Leave unset (""), In Process ("INPROCESS"), Patient Call ("PATIENTCALL"), Payer Call ("PAYORCALL"), Payer Report ("PAYORREPORT"), Payer Website ("PAYORWEBSITE"), Practice Override ("PRACTICEOVERRIDE")
additional_form_fields
json
Additional Form Fields
Optional JSON value.
write_enabled
boolean
Write Enabled
Optional true-or-false value.
Default: false

Outputs

successSuccess
submittedSubmitted
write_skippedWrite Skipped
skip_reasonSkip Reason
patient_insurance_idPatient Insurance Id
patient_idPatient Id
insurance_package_idInsurance Package Id
insurance_package_nameInsurance Package Name
sequence_numberSequence Number
athenaAthena
submitted_field_countSubmitted Field Count
errorError
error_messageError Message
failure_phaseFailure Phase
error_codeError Code
retryableRetryable

Output schema completeness: best_effort_declared

Safety

External effect: write
Confirmation recommended: No
Retry safe: No
Dry run supported: No

Schemas

These schemas are first-pass authoring guidance. Runtime validation remains authoritative.

Input schema

{
  "type": "object",
  "required": [
    "patient_id",
    "insurance_package_id",
    "id_number"
  ],
  "properties": {
    "copay": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "notes": {
      "type": "string",
      "description": "Optional text value.",
      "x-workflow-field-type": "textarea"
    },
    "eligible": {
      "enum": [
        "",
        "Y",
        "N"
      ],
      "type": "string",
      "description": "Optional selected identifier or value.",
      "x-workflow-field-type": "select"
    },
    "id_number": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "issue_date": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_id": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_sex": {
      "enum": [
        "",
        "F",
        "M"
      ],
      "type": "string",
      "description": "Optional selected identifier or value.",
      "x-workflow-field-type": "select"
    },
    "insured_ssn": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_zip": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_city": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "copay_type_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_state": {
      "enum": [
        "",
        "AA",
        "AE",
        "AK",
        "AL",
        "AP",
        "AR",
        "AS",
        "AZ",
        "CA",
        "CO",
        "CT",
        "DC",
        "DE",
        "FL",
        "FM",
        "GA",
        "GU",
        "HI",
        "IA",
        "ID",
        "IL",
        "IN",
        "KS",
        "KY",
        "LA",
        "MA",
        "MD",
        "ME",
        "MH",
        "MI",
        "MN",
        "MO",
        "MP",
        "MS",
        "MT",
        "NC",
        "ND",
        "NE",
        "NH",
        "NJ",
        "NM",
        "NV",
        "NY",
        "OH",
        "OK",
        "OR",
        "PA",
        "PR",
        "PW",
        "RI",
        "SC",
        "SD",
        "TN",
        "TX",
        "UT",
        "VA",
        "VI",
        "VT",
        "WA",
        "WI",
        "WV",
        "WY"
      ],
      "type": "string",
      "description": "Optional selected identifier or value.",
      "x-workflow-field-type": "select"
    },
    "policy_number": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "write_enabled": {
      "type": "boolean",
      "default": false,
      "description": "Optional true-or-false value.",
      "x-workflow-field-type": "boolean"
    },
    "expiration_date": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "sequence_number": {
      "enum": [
        "1",
        "2",
        "3"
      ],
      "type": "string",
      "default": "1",
      "description": "Optional selected identifier or value.",
      "x-workflow-field-type": "select"
    },
    "eligibility_mode": {
      "enum": [
        "CHECKELIGIBILITYTODAY",
        "CHECKELIGIBILITY",
        "SETELIGIBILITY"
      ],
      "type": "string",
      "default": "CHECKELIGIBILITYTODAY",
      "description": "Optional selected identifier or value.",
      "x-workflow-field-type": "select"
    },
    "insured_id_number": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_last_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_country_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_first_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "coinsurance_percent": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_name_suffix": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insurance_package_id": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "eligibility_reason_id": {
      "enum": [
        "",
        "INPROCESS",
        "PATIENTCALL",
        "PAYORCALL",
        "PAYORREPORT",
        "PAYORWEBSITE",
        "PRACTICEOVERRIDE"
      ],
      "type": "string",
      "description": "Optional selected identifier or value.",
      "x-workflow-field-type": "select"
    },
    "insured_date_of_birth": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "additional_form_fields": {
      "description": "Optional JSON value.",
      "x-workflow-field-type": "json"
    },
    "insured_address_line_1": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_address_line_2": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insured_entity_type_id": {
      "enum": [
        "",
        "1",
        "2"
      ],
      "type": "string",
      "description": "Optional selected identifier or value.",
      "x-workflow-field-type": "select"
    },
    "insured_middle_initial": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "eligibility_service_date": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insurance_product_type_id": {
      "enum": [
        "",
        "1",
        "2",
        "3",
        "6",
        "4",
        "5",
        "8",
        "19",
        "20",
        "18",
        "12",
        "10",
        "11",
        "13",
        "21",
        "14",
        "23",
        "15",
        "22",
        "16",
        "9",
        "7",
        "17"
      ],
      "type": "string",
      "description": "Optional selected identifier or value.",
      "x-workflow-field-type": "select"
    },
    "relationship_to_insured_id": {
      "enum": [
        "1",
        "2",
        "3",
        "27",
        "28",
        "25",
        "29",
        "30",
        "11",
        "31",
        "32",
        "9",
        "18",
        "19",
        "34",
        "35",
        "5",
        "6",
        "33",
        "36",
        "7",
        "26",
        "17",
        "12",
        "10",
        "37",
        "14",
        "15",
        "16",
        "21",
        "22",
        "23",
        "24",
        "4",
        "13"
      ],
      "type": "string",
      "default": "1",
      "description": "Optional selected identifier or value.",
      "x-workflow-field-type": "select"
    }
  },
  "additionalProperties": false
}

Output schema

{
  "type": "object",
  "properties": {
    "error": {},
    "athena": {},
    "success": {},
    "retryable": {},
    "submitted": {},
    "error_code": {},
    "patient_id": {},
    "skip_reason": {},
    "error_message": {},
    "failure_phase": {},
    "write_skipped": {},
    "sequence_number": {},
    "insurance_package_id": {},
    "patient_insurance_id": {},
    "submitted_field_count": {},
    "insurance_package_name": {}
  },
  "additionalProperties": true
}

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