POST  api/bill/new Back to API Home

Submits new bill. Accepts input parameters in JSON format. Multiple service lines can be sent in nested JSON. Returns submitted bill details with assigned Bill ID. Bills submitted with this end point will be in drafted mode until you attach required documents to it. You can attach documents to bill using api/bill/ID/{billID}/attach end point. A successful bill submission sends you an assigned bill ID in response. By using that bill id you can attach documents.

Resource URL

https://www.efilenysclaims.com/NYSIF/api/bill/new

Request Format

Request format should be JSON.

Parameters

required conditionally A valid claim number to be associated with bill. Claim number will be validated over received claims from NYSIF. You can skip this by providing Policy Number.
required conditionally A valid policy number to be associated with bill. Policy number will be validated over received claims from NYSIF. You can skip this by providing Claim Number.
conditionally A valid entity number to be associated with policy number. Entity number is required if bill associated with Policy Number.
required Valid ICD9 codes to be associated with bill. Use comma separator to send multiple diagnosis codes. Usually CMS1500 and C4 bills accept up to 4 (1 through 4) diagnosis codes where as UB04 bills accept up to 18 diagnosis codes. All are validated individually and sends error if any of them is invalid. For HCFA 1500 bills (CMS1500 or C4 with Bill date > April 1st 2014), you can send up to 12 diagnosis codes (A through L). We allow ICD10 codes for service date > OCT 1st 2015.
optional Date of creation of Bill. Valid format is MM/DD/YYYY. If not given, considers current date as bill creation date.
required Indicates the bill type. It can be any of the three values "CMS1500", "C4" and "UB04". A bill will be submitted to NYSIF with this bill type.
optional A valid provider NPI Number to be associated with bill.
optional Provider WCB Authorization Number to be associated with bill.
required conditionally Provider billing tax id should be a 9-digit number. You can skip this by providing NPI or WCB, in such cases it will be taken from enrolled provider.
required conditionally Provider SSN should be a 9-digit number. You can skip this by providing NPI or WCB, in such cases it will be taken from enrolled provider.
required conditionally Provider billing zip should be a 5-digit number. You can skip this by providing NPI or WCB, in such cases it will be taken from enrolled provider.
required conditionally Provider Treating Provider License Number should be a 6-digit number. This field is required if SSN is provided and You can skip this by providing NPI or WCB, in such cases it will be taken from provider.
optional Billing Reference value to be associated with bill.
optional Admission Date of patient and will be considered only if bill type is "UB04". A valid format is "MM/DD/YYYY".
optional Discharge Date of patient and will be considered only if bill type is "UB04". A valid format is "MM/DD/YYYY". And it should be greater than or equal to Admission date (if given).
optional A valid ICD9 code and will be considered only if bill type is "UB04".
optional A valid drug code and will be considered only if bill type is "UB04".
optional A valid PAS Rate and will be considered only if bill type is "UB04" and service date is < OCT 1st 2015.
optional Value code should be 24 and will be considered only if bill type is "UB04" and service date is > OCT 1st 2015.
required A valid EAPG code and it will be considered only if bill type is "UB04" and service date is > OCT 1st 2015.
optional A valid Procedure Code and will be considered only if bill type is "UB04".
optional A valid Procedure Code and will be considered only if bill type is "UB04".
optional A valid Procedure Code and will be considered only if bill type is "UB04".
optional A valid Procedure Code and will be considered only if bill type is "UB04".
optional A valid Procedure Code and will be considered only if bill type is "UB04".
optional A valid Procedure Code and will be considered only if bill type is "UB04".
required Type of Bill should be a max of 4-digit number. It will be considered only if bill type is "UB04".
conditionally Service location medical facility name is required if Wcb Submission Required Flag is true.
required Service location Address1.
required Service location Address2.
required Service location City.
required Service location State.
required Service location Zip code.
optional Service location Zip plus.
conditional Required for UB04 bills when service date is OCT 1st 2015 and forward.
optional Estimated Amount Due, required for UB04 bills .
required A JSON of 'n' number of service lines. At least one service line is required.
optional A boolean value true/false. If true, system will generate bill document. You don't need to upload bill document. And applicable only for CMS1500 and UB04 bills.
optional A boolean value true/false. If true, system will submit the bill to WCB. Additional properties are required for WCB submission.


Additional properties to generate Bill Document   |  Additional properties for WCB Submission
required Name of the JSON object with following properties to generate bill document. This is required if "generateBillDocument" value is set to "true".
required Name of the JSON object with following properties in order to submit the bill to WCB. This is required if "wcbSubmissionRequired" value is set to "true".


CMS1500
optional Insurance Type. Pass code or value
medicare = Medicaremedicaid = Medicaid
champus = Tricare Champuschampva = Champva
group = Group Health Planfeca = FECA BLK LUNG
other = Other
optional Insured's ID Number (for Insurance Type)
optional Insured's last name.
optional Insured's first name.
optional Insured's middle name.
optional Patient's date of birth in "mm/dd/yyyy" format.
optional Patient's Sex. M or F
optional Patient's Address(No. and Street).
optional Patient's City.
optional Patient's State. A valid US state.
optional Patient's zip. Should be a 5-digit number.
optional Patient's Telephone. A valid 10 digit phone number.
optional Patient relationship to Insured. Pass one of the values.
01 = Spouse 18 = Self 19 = Child G8 = Other
optional Insured's address(No. and street).
optional Insured's City.
optional Insured's State. Should be a valid US state.
optional Insured's Zip. Should be a 5-digit number.
optional Insured's Telephone. A valid 10 digit phone number.
optional Insured's Policy Number.
optional Insured's date of birth in "mm/dd/yyyy" format.
optional Insured's Sex. M or F
optional Insured's insurance plan name.
optional Pass "Yes" if there is another health benefit plan.
optional Other Insured's Last name. It is considered if "otherHealthBenefitPlan" is set to "Yes".
optional Other Insured's First name. It is considered if "otherHealthBenefitPlan" is set to "Yes".
optional Other Insured's Middle name. It is considered if "otherHealthBenefitPlan" is set to "Yes".
optional Other Insured's Policy Number.
optional Other Insured's Plan or Program name. It is considered if "otherHealthBenefitPlan" is set to "Yes".
optional If patient condition is related to employment, pass "Yes" to this property.
optional If patient condition is related to Auto Accident, pass "Yes" to this property.
optional If patient condition is related to Other Accident, pass "Yes" to this property.
optional Auto accident state. Please provide it if patient condition is related to Auto Accident.
optional DOI Qual.
optional Other Date (if patient has had same or similar, give first date). Should be a valid date in "mm/dd/yyyy" format.
optional Other DOI Qual.
optional Date Patient unable to work From. Should be a valid date in "mm/dd/yyyy" format.
optional Date Patient unable to work To. Should be a valid date in "mm/dd/yyyy" format.
optional Hospitalization Date From. Should be a valid date in "mm/dd/yyyy" format.
optional Hospitalization Date To. Should be a valid date in "mm/dd/yyyy" format.
optional Outside Lab Flag. Pass "Yes" or "No".
optional Outside Lab charges.
optional Resubmission Code.
optional Prior Authorizations Number.
optional Provider Accept Assignment flag. Pass "Yes" or "No".
optional Name of Referring provider or other source.
optional Referring provider NPI.
required Patient or Authorized Person's Signature (Medical Release). Pass "Yes" or "No".
required Patient or Authorized Person's Signature date. A valid date in format "mm/dd/yyyy".
required Insured's or Authorized Person's Signature (Payment). Pass "Yes" or "No".
required Signature of Physician or Supplier. Pass "Yes" or "No".
required Signature date of Physician or Supplier. A valid date in format "mm/dd/yyyy".


UB04
optional Medical Record number.
optional Admission Hour. A 2-digit code indicating time. You can pass code.
1:00 a.m. - 01 2:00 a.m. - 02 3:00 a.m. - 03 4:00 a.m. - 04
5:00 a.m. - 05 6:00 a.m. - 06 7:00 a.m. - 07 8:00 a.m. - 08
9:00 a.m. - 09 10:00 a.m. - 10 11:00 a.m. - 11 12:00 noon - 12
1:00 p.m. - 13 2:00 p.m. - 14 3:00 p.m. - 15 4:00 p.m. - 16
5:00 p.m. - 17 6:00 p.m. - 18 7:00 p.m. - 19 8:00 p.m. - 20
9:00 p.m. - 21 10:00 p.m. - 22 11:00 p.m. - 23 12:00 p.m. - 00
optional Admission Type. You can pass code.
1 = Emergency 2 = Urgent 3 = Elective
4 = Newborn 5 = Trauma 9 = Information Not Available
optional Source of Admission. You can pass either code or value.
1 = Physician Referral 2 = Clinic Referral
3 = HMO Referral 4 = Transfer from Hospital
5 = Transfer from SNF 6 = Transfer From Another
       Health Care Facility
7 = Emergency Room 8 = Court/Law Enforcement
9 = Information Not Available
optional Discharge Hour. Similar to admitHour.
optional Discharge Type. You can pass code.
01 = Discharged to home or self care (routine discharge)
02 = Discharged/transferred to another short-term general hospital
03 = Discharged/transferred to skilled nursing facility (SNF)
04 = Discharged/transferred to an intermediate care facility (ICF)
05 = Discharged/transferred to another type of institution
06 = Discharged/transferred to home under care of organized home health service organization
07 = Left against medical advice
09 = Admitted as an inpatient to this hospital(Medicare Outpatient Only)
20 = Expired (or did not recover - Christian Science patient)
30 = Still a patient
40 = Expired at home
41 = Expired in a medical facility; e.g., hospital, SNF, ICF, or free-standing hospice (Medicare Hospice Care Only)
42 = Expired - place unknown (Medicare Hospice Care Only)
43 = Discharged to Federal Health Care Facility
50 = Hospice - Home
51 = Hospice - Medical Facility
61 = Discharge to Hospital Based Swing Bed
62 = Discharged to Inpatient Rehab
63 = Discharged to Long Term Care Hospital
64 = Discharged to Nursing Facility
65 = Discharged to Psychiatric Hospital
66 = Discharged to Critical Access Hospital
optional Condition Codes. Should be 2-digit alpha-numeric values. You can pass up to 11 codes with comma separator.
optional Accident State. Should be a valid US state.
optional Accident Date. Should be a valid date in format "mm/dd/yyyy".
optional Occurrence codes for section 'a' in bill document. You can pass code and date with '|' separator and multiple occurrence codes with comma separator. You can pass up to 4 occurrence pairs for section 'a'. Eg:- code1|09/09/2014,code2|09/10/2014,code3|09/11/2014,code4|09/12/2014
optional Occurrence codes for section 'b' in bill document. Similar to "occurrenceCodesA". You can pass up to 4 occurrence pairs for section 'b'.
optional Occurrence code spans for section 'a' in bill document. You can pass code, from and through with '|' separator and multiple occurrence span codes with comma separator. You can pass up to 2 occurrence span pairs for section 'a'. Eg:- code1|09/10/2014|09/11/2014,code2|09/11/2014|09/12/2014
optional Occurrence code spans for section 'b' in bill document. Similar to "occurrenceSpansA". You can pass up to 2 occurrence span pairs for section 'b'.
optional Value codes for section 'a' in bill document. You can pass code and amount with '|' separator and multiple value codes with comma separator. You can pass up to 3 value codes for section 'a'. Eg:- valueCode1|100.22,valueCode2|122.12,valueCode3|146.36
optional Value codes for section 'b' in bill document. Similar to "valueCodesA". You can pass up to 3 value codes for section 'b'.
optional Value codes for section 'c' in bill document. Similar to "valueCodesA". You can pass up to 3 value codes for section 'c'.
optional Value codes for section 'd' in bill document. Similar to "valueCodesA". You can pass up to 3 value codes for section 'd'.
optional Other Provider Identifier.
optional Payer Name for section 'A'.
optional Payer Name for section 'B'.
optional Payer Name for section 'C'.
optional Health plan id for section 'A'.
optional Health plan id for section 'B'.
optional Health plan id for section 'C'.
optional Release of Info for section 'A'. Should be "Yes" or "No"
optional Release of Info for section 'B'. Should be "Yes" or "No"
optional Release of Info for section 'C'. Should be "Yes" or "No"
optional Assignment of Benefits for section 'A'. Should be "Yes" or "No"
optional Assignment of Benefits for section 'B'. Should be "Yes" or "No"
optional Assignment of Benefits for section 'C'. Should be "Yes" or "No"
optional Prior Payments for section 'A'.
optional Prior Payments for section 'B'.
optional Prior Payments for section 'C'.
optional Insured's last name for section 'A'.
optional Insured's last name for section 'B'.
optional Insured's last name for section 'C'.
optional Insured's first name for section 'A'.
optional Insured's first name for section 'B'.
optional Insured's first name for section 'C'.
optional Insured's Relation to Patient for section 'A'. You can pass code.
01 = Spouse 18 = Self 19 = Child
20 = Employee 21 = Unknown 39 = Organ Donor
40 = Cadaver Donor 53 = Life Partner G8 = Other Relationship
optional Insured's Relation to Patient for section 'B'. Similar to "patientRelA".
optional Insured's Relation to Patient for section 'C'. Similar to "patientRelA".
optional Insured's Unique ID for section 'A'.
optional Insured's Unique ID for section 'B'.
optional Insured's Unique ID for section 'C'.
optional Insured's Group Name for section 'A'.
optional Insured's Group Name for section 'B'.
optional Insured's Group Name for section 'C'.
optional Insured's Group No. for section 'A'.
optional Insured's Group No. for section 'B'.
optional Insured's Group No. for section 'C'.
optional Treatment authorization code for section 'A'.
optional Treatment authorization code for section 'B'.
optional Treatment authorization code for section 'C'.
optional Document Control Number for section 'A'.
optional Document Control Number for section 'B'.
optional Document Control Number for section 'C'.
optional Employer Name for section 'A'.
optional Employer Name for section 'B'.
optional Employer Name for section 'C'.
optional Patient Reason for Visit. Should be a valid ICD9 code.
optional External Cause of Injury Code. Should be a valid ICD9 code.
optional Remarks.
optional 81cc codes. You can send up to 4 values with comma separator.
optional Attending Provider Last Name.
optional Attending Provider First Name.
optional Operating Provider NPI/ID.
optional Attending Provider Qualifier.
optional Operating Provider Last Name.
optional Operating Provider First Name.
optional Operating Provider NPI/ID.
optional Operating Provider Qualifier.
optional Other Provider1 Last Name.
optional Other Provider1 First Name.
optional Other Provider1 NPI/ID.
optional Other Provider1 Qualifier.
optional Other Provider2 Last Name.
optional Other Provider2 First Name.
optional Other Provider2 NPI/ID.
optional Other Provider2 Qualifier.
optional Insured's ID Number (for Insurance Type)
required Insured's last name.
required Insured's first name.
optional Insured's middle name.
required Patient's date of birth in "mm/dd/yyyy" format.
optional Patient's Sex. M or F
required Patient's Address(No. and Street).
required Patient's City.
required Patient's State. A valid US state.
required Patient's zip. Should be a 5-digit number.
optional Patient's Telephone. A valid 10 digit phone number.
required Insured's address(No. and street).
required Insured's City.
required Insured's State. Should be a valid US state.
required Insured's Zip. Should be a 5-digit number.
optional Insured's Telephone. A valid 10 digit phone number.
required Pass "Yes" if there is another health benefit plan.
optional Other Insured's Last name. It is considered if "otherHealthBenefitPlan" is set to "Yes".
optional Other Insured's First name. It is considered if "otherHealthBenefitPlan" is set to "Yes".
optional Other Insured's Middle name. It is considered if "otherHealthBenefitPlan" is set to "Yes".
optional Other Insured's Policy Number.
optional Other Insured's Plan or Program name. It is considered if "otherHealthBenefitPlan" is set to "Yes".
optional If patient condition is related to employment, pass "Yes" to this property.
required If patient condition is related to Auto Accident, pass "Yes" to this property.
required If patient condition is related to Other Accident, pass "Yes" to this property.
optional Auto accident state. Please provide it if patient condition is related to Auto Accident.
optional Other Date (if patient has had same or similar, give first date). Should be a valid date in "mm/dd/yyyy" format.
optional Date Patient unable to work From. Should be a valid date in "mm/dd/yyyy" format.
optional Date Patient unable to work To. Should be a valid date in "mm/dd/yyyy" format.
optional Hospitalization Date From. Should be a valid date in "mm/dd/yyyy" format.
optional Hospitalization Date To. Should be a valid date in "mm/dd/yyyy" format.
optional Outside Lab Flag. Pass "Yes" or "No".
optional Outside Lab charges.
optional Resubmission Code.
optional Prior Authorizations Number.
optional Provider Accept Assignment flag. Pass "Yes" or "No".
required This value can be either DQ or DN or DK.
required Name of Referring provider or other source.
conditional Referring provider NPI. Required if qualifier is DQ.
conditional Referring provider Other Id. Required if qualifier is DQ.
required Report Type value. It can be 06 or 09. Value 06 represents Initial Report and 09 represents Progress Report.
required Patient or Authorized Person's Signature date. A valid date in format "mm/dd/yyyy".
required Signature date of Physician or Supplier. A valid date in format "mm/dd/yyyy".
required Billing Provider Name. Required if the provider is not enrolled previously.
required Billing Provider Address. Required if the provider is not enrolled previously.
required Billing Provider City. Required if the provider is not enrolled previously.
required Billing Provider State. Required if the provider is not enrolled previously.
required Billing Provider Telephone. Required if the provider is not enrolled previously.
optional Service Facility Name. Required if not given while bill submission.
Conditional Billing Provider NPI Number required, if exist.
Conditional Treating Provider NPI Number, if exist.
Conditional Treating Provider License number is Required if Treating Provider NPI is not known.
Conditional Billing Provider License number is required if Billing Provider NPI is not known


required A valid service from date is required. Valid format is "MM/DD/YYYY".
required conditionally Required for bills of type "UB04". And will be ignored for other bills. A valid Revenue Code can be 2 or 3 digit number.
required conditionally Required for bills of type "CMS1500" and "C4". It should be a valid procedure code if provided. And you can ignore procedure code if NDC code is given for "CMS1500" and "C4".
required Required for bills of type "CMS1500" and "C4". And will be ignored for "UB04" bills. A valid Service Place can be represented with 2 digit number.
optional A valid modifier to be associated with procedure code. Send multiple modifiers with comma separator. All will be validated individually over the procedure code and return error if any of them is invalid.
required conditionally A valid dx poniter is required for bill types "CMS1500" and "C4". It will be ignored for bill type "UB04". Send multiple dx pointers with comma separator. All dx pointers will be validated with diagnosis codes individually and returns error if any of them is invalid. For HCFA 1500 bills (CMS1500 or C4 with Bill date > April 1st 2014), please send values A through L instead of 1 through 4.
optional Service days/units should be a positive integer. Default value is "1".
optional A valid amount value for this service line.
required conditionally A valid NDC code is required if Procedure code is empty for bill types "CMS1500" and "C4". It will be ignored for "UB04" bills.
optional A valid ndcQty can be positive integer. And will be ignored for bill type "UB04".
required conditionally Required for Anesthesia procedure codes. It should be empty for other procedure codes. And it will be ignored for bill type "UB04".
required conditionally Required for Anesthesia procedure codes. It should be empty for other procedure codes. And it will be ignored for bill type "UB04".
optional This field will be considered while generating bill document. And it is applicable only for bill type "UB04".


required conditionally Required for bills associated with policy number. And will be ignored for other bills.
required conditionally Required for bills associated with policy number. And will be ignored for other bills.
required conditionally Required for bills associated with policy number. And will be ignored for other bills. Valid format is "MM/DD/YYYY".

Example Request: No Bill Document   |  Example Request: Generated Bill Document

POST https://www.efilenysclaims.com/NYSIF/api/bill/new

{
    "claimNumber": "65182255",
    "diagnosisCode": "00.01,00.10",
    "billCreationDt": "02/19/2014",
    "billType": "CMS1500",
    "billingReference": "123456789",
    "treatingZip": "28305",
    "billingZip": "28304",
    "billingTaxId": "999999999",
    "treatingProviderLicense": "123456",
    "providerNpi": "1497758544",
    "services": [
        {
            "procedure": "0001F",
            "servicePlace": "12",
            "serviceModifiers": "21,26",
            "dxPointer": "A,B",
            "serviceDays": "1",
            "billedAmount": "$100.00",
            "serviceFromDt": "02/19/2014"
        },
         {
            "procedure": "0002F",
            "servicePlace": "13",
            "serviceModifiers": "21,23",
            "dxPointer": "A",
            "serviceDays": "1",
            "billedAmount": "$120.00",
            "serviceFromDt": "02/19/2014"
        }
    ]
}
Error Response

For invalid requests (Eg:- a request with invalid request format will be refused by server), a string error message will be sent in response and with response code 4xx or 5xx. For data validation failures (Eg:- a valid request format but with insufficient data), a JSON string will be sent in response with key "errors". Multiple error messages are separated with comma. Each error message contains a description of failure.

{
    "errors": [
        "Type of bill is required. Valid values are CMS1500, C4 and UB04"
    ]
}