ClaimSoft integration

Resolve Payer

Perform Resolve Payer through ClaimSoft.

View as Markdown

claimsoft_resolve_payer

readclaimsoft

Inputs

policy_data
expressionrequired
Policy Data
Required literal value or workflow expression.
patient_state
expression
Patient State
Optional literal value or workflow expression.
billing_location
expression
Billing Location
Optional literal value or workflow expression.
payer_code_source
expression
Payer Code Source
Optional literal value or workflow expression.
payer_plan
expression
Payer Plan
Optional literal value or workflow expression.
payer_card_state
expression
Payer Card State
Optional literal value or workflow expression.
payer_name_truncated
expression
Payer Name Truncated
Optional literal value or workflow expression.
card_insurance_type
expression
Card Insurance Type
Optional literal value or workflow expression.
member_number
expression
Member Number
Optional literal value or workflow expression.
reviewed_payer_id
expression
Reviewed Payer Id
Optional literal value or workflow expression.
reviewed_payer_confirmed
expression
Reviewed Payer Confirmed
Optional literal value or workflow expression.

Outputs

successSuccess
payer_idPayer Id
payer_namePayer Name
confidenceConfidence
reasoningReasoning
policy_dataPolicy Data
errorError
failure_reasonFailure Reason
candidate_countCandidate Count
match_methodMatch Method

Output schema completeness: best_effort_declared

Safety

External effect: read
Confirmation recommended: No
Retry safe: Yes
Dry run supported: No

Schemas

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

Input schema

{
  "type": "object",
  "required": [
    "policy_data"
  ],
  "properties": {
    "payer_plan": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "policy_data": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "member_number": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_state": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "billing_location": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "payer_card_state": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "payer_code_source": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "reviewed_payer_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "card_insurance_type": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "payer_name_truncated": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "reviewed_payer_confirmed": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    }
  },
  "additionalProperties": false
}

Output schema

{
  "type": "object",
  "properties": {
    "error": {},
    "success": {},
    "payer_id": {},
    "reasoning": {},
    "confidence": {},
    "payer_name": {},
    "policy_data": {},
    "match_method": {},
    "failure_reason": {},
    "candidate_count": {}
  },
  "additionalProperties": true
}

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