Hank.ai Claim Maker

Claim Maker JSON Export Specification

Introduction

This document provides details of the json schema for ClaimMaker export.

JSON Schema Export
"3894_513244_FACILITY_2023-01-17_MARTEL, BEATRICE A": { "batch_id": <int>, //batch id in Claim Maker "claim": [ //array of multiple claims/”line items”. see Example (click here) { "box19": "", "customField1": "", "customField2": "", "customField3": "", "customField4": "", "customField5": "", "entities": [ // single entity represents a single line item [combination of CPT/ASA/ICD(s)/Modifier(s)/Practitioner] { "code": “12345”, //string. the value for this entity "order": 0, //int. the order of the value in the ‘type’ group "type": “SurgCPT”, //string. examples: SurgCPT/AnesCPT/ICD10/Modifier/Practitioner/PractitionerNPI "unitValue": 0, //int. the ASA base unit value. only applies to type==’AnesCPT’ }, … ], "order": 1, //int. order represents order of the line item in the claim from 1 to N }, … ], "created_date": "2023-01-18", //YYYY-MM-DD "date_of_service": "2023-01-17", //YYYY-MM-DD "id": 513244, //internal ID "meta": { "refURL": "https://claimmaker.hank.ai/app/code/batch/123/job/456”, //direct url to open the case in HANK Claim Maker "created": "2023-01-18 10:00:40", //YYYY-MM-DD HH:MM:SS. datetime case was created in Claim Maker "entireTimeSpent": 62, "hasDemographics": false, "isDataEntered": false, "isManuallyCreated": false, "lastUpdated": "2023-01-21 20:00", //YYYY-MM-DD HH:MM:SS. datetime case was last modified in HANK Claim Maker "lastUpdatedExport": "", "schemaVersion": "2.0.3", "source": "extractor", "timeSpent": 36 }, "note": "", //any case-related information provided to or from revenue cycle personnel. this does NOT hold clinical notes or medical records. "patient_full_name": "", //patient full name "patient_info": { "guarantor": { "address": { //Example below "city": "", "state": "", "street1": "", "street2": "", "zip": "" }, "dob": "1986-06-04", //date of birth of guarantor. timestamp. YYYY-MM-DD "email": "", "employer": { "address": { "city": "", "state": "", "street1": "", "street2": "", "zip": "" }, "name": "", "phone": "" }, "first": "", "fullName": "", "homePhone": "", "language": "", "last": "", "maritalStatus": "", "middle": "", "mobilePhone": "", "relationship": "", "sex": "", "ssn": "", "workPhone": "" }, "insurance": [ //list of insurance plans for the patient, in order, from primary through N { "insuranceID": "XXXXXXXXXXXXX", "address": { "city": "", "state": "", "street1": "", "street2": "", "zip": "" }, "authorizationNumber": "", "company": "", "groupId": "", "phone": "", "plan": "", "policyId": "", "subscriber": { "address": { "city": "", "state": "", "street1": "", "street2": "", "zip": "" }, "dob": "", "email": "", "employer": { "address": { "city": "", "state": "", "street1": "", "street2": "", "zip": "" }, "name": "", "phone": "" }, "first": "", "fullName": "", "homePhone": "", "language": "", "last": "", "maritalStatus": "", "middle": "", "mobilePhone": "", "relationship": "", "sex": "", "ssn": "", "workPhone": "" } } ], "patient": { "accn": "", "address": { "city": "", "state": "", "street1": "", "street2": "", "zip": "" }, "dob": "", //YYYY-MM-DD. patient’s date of birth "email": "", "employer": { "address": { "city": "", "state": "", "street1": "", "street2": "", "zip": "" }, "name": "", "phone": "" }, "encn": "", "first": "", "fullName": "", "homePhone": "", "language": "", "last": "", "maritalStatus": "", "middle": "", "mobilePhone": "", "mrn": "", "primaryCareProvider": "", "relationship": "", "sex": "", "ssn": "", "workPhone": "" } }, "provider_correlation_id": "", //internal use "provider_facility": "FACILITY", //string. name of the facility where this encounter occurred "schedule": { "admitDate": "", //YYYY-MM-DD. date of admission to facility "anType": “General”, //string. primary anesthesia type. General/MAC/Spinal/etc "anesthesiaStaff": [ //list of dicts of providers for the encounter. includes their role, name, start time, end time, and a flag for whether they were marked as the primary provider for the case or not { "endTime": "",//HH:MM. provider end time as appears on document "isResponsibleProvider": true, //boolean. true/false. was this provider marked as the provider responsible for the case "provider": "", //string. provider name "providerNPI": "XXXXXX", "role": "", //string. holds providers role, such as CRNA, SUPERVISING, MD, etc "startTime": "" //HH:MM. provider start time as appears on document } ], "asa": "", //string. ASA classification 1 through 6 "class": "", "diagnosis": "", //string. short diagnosis description provided as rationale for surgical procedure "difficultIntubation": true, //boolean. true/false, "dischargeDate": "", //YYYY-MM-DD. date of discharge from facility "emergent": false, //boolean. true/false, "endTime": "",//HH:MM. anesthesia end time as appears on document "procedure": "", //string. short surgical description "recSigned": true, //boolean. was the medical record signed by a provider. true/false, "room": "", //string. OR location room "startTime": "", //HH:MM. anesthesia start time as appears on document "surgeon": "" //string. surgeon name "surgeonNPI": "XXXXXXX" }, "state": "", //internal use. does NOT represent US states "status": "", //internal use }, //FUTURE CONSIDERATIONS [NOT SUPPORTED] - Case Documentation "input": { "entities_metadata": [ { "text": "...", //Will contain text unless documentId is present which is located on S3 "textLength": <int>, //size of text "noteType": "AnesProcNotes/AnesIntraop/AnesPostEval/AnesPreEval/BillingDetails” "inputType": "json", "documentId": "", //if not json, then will be pointing to s3 identifier "noteHeader": "", //type of note "inputSource": "extractor", //Internal use only "userAttached": false, //internal use only "lastModifiedTime": "" //string represents timestamp }, … ], "documentId": "", //document home location "dateDemographics": "" //string represents timestamp } }

HOW TO Traverse the Claim Entities to Recreate the Claim

  1. Iterate over the “claim” list to get a list of line item dictionaries
  • Sort the list of line item dictionaries by value in the line item “order” key, ascending
  • Iterate over the line item dictionaries
  • Iterate over the entities and group them by “type” (SurgCPT, AnesCPT, …)
  • Sort each group by the value in the entities “order” key, ascending
  • Extract the “code” value for each entity

After doing the above, you’ll have a list of line items that hold lists of the SurgCPT, AnesCPT, ICD10, Modifiers, and Practitioner with the values for each in order

Example of Export with Values

{ "3894_513244_FACILITY_2023-01-17_MARTEL, BEATRICE A": { "batch_id": 3894, "documentIds": [ "hank-ai-clients:client.com/facility/processed/AnesIntraop_fj3489f.pdf", "hank-ai-clients:client.com/facility/processed/MARTEL, B_01-17-2023.pdf", "hank-ai-clients:client.com/facility/processed/MARTEL, B_facesheet.pdf" ], "claim": [ { "box19": "", "customField1": "1723703735", "customField2": "XX404, 4256F, XX430, G2149", "customField3": "", "customField4": "", "customField5": "", "entities": [ { "code": "29880", "order": 0, "type": "SurgCPT", "unitValue": 0 }, { "code": "01400", "order": 0, "type": "AnesCPT", "unitValue": 4 }, { "code": "S83.242A", "order": 0, "type": "ICD10", "unitValue": 0 }, { "code": "I50.1", "order": 1, "type": "ICD10", "unitValue": 0 }, { "code": "59", "order": 0, "type": "Modifier", "unitValue": 0 }, { "code": "Jim Smith, MD", "order": 0, "type": "Practitioner", "unitValue": 0 }, { "code": "XXXXXX", "order": 0, "type": "PractitionerNPI", "unitValue": 0 } ], "order": 1 } ], "created_date": "2023-01-18", "date_of_service": "2023-01-17", "id": 513244, "meta": { "created": "2023-01-18 10:00:40", "entireTimeSpent": 62, "hasDemographics": false, "isDataEntered": false, "isManuallyCreated": false, "lastUpdated": "2023-01-21 20:00", "lastUpdatedExport": "", "schemaVersion": "2.0.3", "source": "extractor", "timeSpent": 36 }, "note": "", "patient_full_name": "MARTEL, BEATRICE A", "patient_info": { "guarantor": { "address": { "city": "BRANSON", "state": "WA", "street1": "51 BEAUREMONT DR", "street2": "", "zip": "67891" }, "dob": "1986-06-04", "email": "beatriceemail at email.com", "employer": { "address": { "city": "BRANSON", "state": "WA", "street1": "ONE MEDICAL CENTER DRIVE", "street2": "", "zip": "29876" }, "name": "SAMPLE MEMORIAL HOSPITAL", "phone": "+1 555-650-5000" }, "first": "BEATRICE", "fullName": "MARTEL, BEATRICE A", "homePhone": "", "language": "", "last": "MARTEL", "maritalStatus": "SINGLE", "middle": "A", "mobilePhone": "+1 555-359-7465", "relationship": "SELF", "sex": "F", "ssn": "XXX-XX-9999", "workPhone": "" }, "insurance": [ { "insuranceID": "XXXXXXXXXXXXX", "address": { "city": "LONDON", "state": "KY", "street1": "ATTN: CLAIMS PROCESSING DEPT PO BOX 7387", "street2": "", "zip": "40742-7387" }, "authorizationNumber": "", "company": "AMERIHEALTH CARITAS MANAGED\nMEDICAID", "groupId": "", "phone": "+1 888-599-1479", "plan": "AMERIHEALTH CARITAS NH", "policyId": "98765678", "subscriber": { "address": { "city": "", "state": "", "street1": "", "street2": "", "zip": "" }, "dob": "1986-06-04", "email": "", "employer": { "address": { "city": "", "state": "", "street1": "", "street2": "", "zip": "" }, "name": "", "phone": "" }, "first": "BEATRICE", "fullName": "MARTEL, BEATRICE A", "homePhone": "", "language": "", "last": "MARTEL", "maritalStatus": "", "middle": "A", "mobilePhone": "", "relationship": "SELF", "sex": "", "ssn": "", "workPhone": "" } } ], "patient": { "accn": "", "address": { "city": "BRANSON", "state": "WA", "street1": "51 BEAUREMONT DR", "street2": "", "zip": "67891" }, "dob": "1986-06-04", "email": "beatriceemail at email.com", "employer": { "address": { "city": "BRANSON", "state": "WA", "street1": "ONE MEDICAL CENTER DRIVE", "street2": "", "zip": "29876" }, "name": "MEMORIAL HOSPITAL", "phone": "+1 555-650-5000" }, "encn": "", "first": "BEATRICE", "fullName": "MARTEL, BEATRICE A", "homePhone": "", "language": "", "last": "MARTEL", "maritalStatus": "SINGLE", "middle": "A", "mobilePhone": "+1 555-359-7465", "mrn": "98756987", "primaryCareProvider": "BRANSON FAMILY PRACTICE 555-448-3122", "relationship": "SELF", "sex": "F", "ssn": "XXX-XX-9999", "workPhone": "" } }, "provider_correlation_id": "hank-ai-clients:bluelakesolutions.com/facility/processed/DailyCases20230117.csv", "provider_facility": "FACILITY", "schedule": { "admitDate": "", "anType": "general", "anesthesiaStaff": [ { "endTime": "15:54", "isResponsibleProvider": true, "provider": "WATKINS, MICHAEL R, CRNA", "providerNPI": "XXXXXX", "role": "CRNA", "startTime": "14:43" } ], "asa": "2", "class": "Hospital Outpatient Surgery", "diagnosis": "Chronic pain of left knee [M25.562, G89.29\nTear of medial meniscus of left knee, current, unspecified tear type, initial encounter [S83.242A", "difficultIntubation": false, "dischargeDate": "", "emergent": false, "endTime": "15:54", "procedure": "ARTHROSCOPY WITH MENISCECTOMY, LAT.& MEDIAL WITH SHAVING (WRVU 7.39) [29880], MODIFIER SMITH & NEPHEW ENDOSCOPY - FLOW 50 / WERE WOLF", "recSigned": true, "room": "OR 02", "startTime": "14:43", "surgeon": "HOUDE, JOHN P", "surgeonNPI": "XXXXXXX" }, "state": "CodeCompleted", "status": "OK" } }

There are two main use cases:

Electronic Records

  • providerNPI, surgeonNPI, insuranceID: Hank.ai will maintain the IDs for Insurance, Provider [NPI], and Surgent [NPI] as available
  • User Experience: Electronic records should work as is today based on existing mapping

Paper Records [Mobile]

  • providerNPI – hash ID that is constructed from the name
  • surgeonNPI – hash ID that is constructed from the name
  • insuranceID – hash ID that is facility name, company name, PO Box, Plan
  • User Experience: Initially mapping will have to be implemented at first.
  • Hank.ai: In about 10-12 weeks there should be a solution.