POST api/claimadjustment/{claimNo}
Creates a new claim adjustment for a specified claim.
Request Information
URI Parameters
| Name | Description | Type | Additional information |
|---|---|---|---|
| claimNo |
The claim number representing a paid claim that has not been reversed. |
integer |
Required |
Body Parameters
The claim adjustment model object supplied in the request body that is to be added. **Validation Requirements:** - The ClaimNo should represent a paid claim that has not been reversed. - Either RxCPersonID or both CardholderID and DateOfBirth should be provided. - If RxcPersonID is provided, the member should match the member on the claim. - If the CardHolderID and DateOfBirth are provided, both of those values should match the member’s values on the claim. - The PatientPayAmount and PlanPaidAmount should sum to zero.
ClaimAdjustmentModel| Name | Description | Type | Additional information |
|---|---|---|---|
| RxCPersonID |
Gets or sets the RxClearinghouse Person ID. **Member Identification Requirement:** Either RxCPersonID *or* both and must be provided. If RxCPersonID is provided: It must correspond to a member in the company.The member's ID must match the MemberID on the claim. |
integer |
None. |
| DateOfBirth |
Gets or sets the member's Date of Birth. **Member Identification Requirement:** Required if is provided. If both and DateOfBirth are provided: They must match the member associated with the claim. |
date |
None. |
| CardholderID |
Gets or sets the member's cardholder ID. **Member Identification Requirement:** Required if is provided. If both CardholderID and are provided: They must match the member associated with the claim. |
string |
None. |
| PlanPaidAmount |
Gets or sets the amount paid by the plan. **Financial Balance Requirement:** The sum of PlanPaidAmount and must equal zero. |
decimal number |
None. |
| PatientPayAmount |
Gets or sets the amount paid by the patient. **Financial Balance Requirement:** The sum of and PatientPayAmount must equal zero. |
decimal number |
None. |
| AmountAppliedToPeriodicDeductible |
Gets or sets the amount applied to the periodic deductible. |
decimal number |
None. |
| AmountEligibleTowardsDeductible |
Gets or sets the amount eligible towards the deductible. |
decimal number |
None. |
| AmountEligibleTowardsOutOfPocketLimit |
Gets or sets the amount eligible towards the out-of-pocket limit. |
decimal number |
None. |
| PlanIncentiveAmount |
Gets or sets the plan incentive amount. |
decimal number |
None. |
| AmountOfCopay |
Gets or sets the amount of copay. |
decimal number |
None. |
| AmountOfCoinsurance |
Gets or sets the amount of coinsurance. |
decimal number |
None. |
| AmountOfCopayCoinsurance |
Gets or sets the combined amount of copay and coinsurance. |
decimal number |
None. |
| AmountAttributedToProductSelection |
Gets or sets the amount attributed to product selection. |
decimal number |
None. |
| AmountExceedingPeriodicBenefitMaximum |
Gets or sets the amount exceeding the periodic benefit maximum. |
decimal number |
None. |
| Note |
Gets or sets additional notes. |
string |
None. |
| Url |
Gets or sets the link representing a link back to the resource |
string |
None. |
| ID |
Gets or sets the identifier for the resource |
integer |
None. |
Request Formats
application/json, text/json, application/json-patch+json
{
"url": "sample string 14",
"id": 15,
"rxCPersonID": 1,
"dateOfBirth": "2025-05-30T21:11:05.0450371-05:00",
"cardholderID": "sample string 1",
"planPaidAmount": 2.0,
"patientPayAmount": 3.0,
"amountAppliedToPeriodicDeductible": 4.0,
"amountEligibleTowardsDeductible": 5.0,
"amountEligibleTowardsOutOfPocketLimit": 6.0,
"planIncentiveAmount": 7.0,
"amountOfCopay": 8.0,
"amountOfCoinsurance": 9.0,
"amountOfCopayCoinsurance": 10.0,
"amountAttributedToProductSelection": 11.0,
"amountExceedingPeriodicBenefitMaximum": 12.0,
"note": "sample string 13"
}
application/x-www-form-urlencoded
Sample not available.
Response Information
Resource Description
If successful, returns the claim adjustment model with the ID of the new record populated.
ClaimAdjustmentResponseModel| Name | Description | Type | Additional information |
|---|---|---|---|
| RxCPersonID |
Gets or sets the RxClearinghouse Person ID |
integer |
None. |
| DateOfBirth |
Gets or sets the member's Date of Birth. |
date |
None. |
| CardholderID |
Gets or sets the member's cardholder Id |
string |
None. |
| PlanPaidAmount |
Gets or sets the amount paid by the plan. |
decimal number |
None. |
| PatientPayAmount |
Gets or sets the amount paid by the patient. |
decimal number |
None. |
| AmountAppliedToPeriodicDeductible |
Gets or sets the amount applied to the periodic deductible. |
decimal number |
None. |
| AmountEligibleTowardsDeductible |
Gets or sets the amount eligible towards the deductible. |
decimal number |
None. |
| AmountEligibleTowardsOutOfPocketLimit |
Gets or sets the amount eligible towards the out-of-pocket limit. |
decimal number |
None. |
| PlanIncentiveAmount |
Gets or sets the plan incentive amount. |
decimal number |
None. |
| AmountOfCopay |
Gets or sets the amount of copay. |
decimal number |
None. |
| AmountOfCoinsurance |
Gets or sets the amount of coinsurance. |
decimal number |
None. |
| AmountOfCopayCoinsurance |
Gets or sets the amount of copay and coinsurance combined. |
decimal number |
None. |
| AmountAttributedToProductSelection |
Gets or sets the amount attributed to product selection. |
decimal number |
None. |
| AmountExceedingPeriodicBenefitMaximum |
Gets or sets the amount exceeding the periodic benefit maximum. |
decimal number |
None. |
| Note |
Gets or sets additional notes. |
string |
None. |
| CreatedOn |
Gets or sets created on timestamp. |
date |
None. |
| Url |
Gets or sets the link representing a link back to the resource |
string |
None. |
| ID |
Gets or sets the identifier for the resource |
integer |
None. |
Response Formats
application/json, text/json, application/json-patch+json
{
"url": "sample string 14",
"id": 15,
"rxCPersonID": 1,
"dateOfBirth": "2025-05-30T21:11:05.0450371-05:00",
"cardholderID": "sample string 1",
"planPaidAmount": 2.0,
"patientPayAmount": 3.0,
"amountAppliedToPeriodicDeductible": 4.0,
"amountEligibleTowardsDeductible": 5.0,
"amountEligibleTowardsOutOfPocketLimit": 6.0,
"planIncentiveAmount": 7.0,
"amountOfCopay": 8.0,
"amountOfCoinsurance": 9.0,
"amountOfCopayCoinsurance": 10.0,
"amountAttributedToProductSelection": 11.0,
"amountExceedingPeriodicBenefitMaximum": 12.0,
"note": "sample string 13",
"createdOn": "2025-05-30T21:11:05.0450371-05:00"
}