Q: Is there a way to see the JSON mapping or get some insight into EDI – JSON translations?
A: We provide JSON-to-EDI mapping documentation, so you can quickly find out the EDI segments and loops that map to each JSON attribute in the API. Utilize the Developer’s Portal, a free resource for our technical documentation. The link to the JSON-to-EDI mapping can be found here.
Q: Do you have a sandbox that I can test before signing a contract?
A: Yes, we do. Please sign up here for a sandbox test environment to familiarize yourself with our APIs without signing a contract without any financial obligations. For more information, see API testing environments. We provide a list of predefined fields and values for sandbox that you can use for testing a variety of responses by using API URLs and endpoints.
Q: What's the difference between Professional Claims and Institutional Claims?
A:
• Professional billing typically uses the 837p transaction (or the CMS-1500 form in hard copy)
• Institutional billings use the 837i transaction
We support both types of electronic claims and transactions. Institutional billing may sometimes encompass collections while professional claims and billing typically do not.
Professional billing controls the billing of claims generated for work performed by physicians, suppliers and other non-institutional providers for both outpatient and inpatient services. One commonality: Our APIs help support and automate insurance coding for both Institutional and Professional Claims.