Claim


Table of contents

    Overview

    A Claim is a plan managed claim directed to NDIA that is associated with a provider invoice. To call the Claim endpoint, use one of the URLs from the following tables:

    URL GET PUT POST DELETE
    https://api.mypcorp.com/claim ✔ ✔
    https://api.mypcorp.com/claim/{ClaimGuid} ✔

    NB: Currently, Claim endpoint only accepts GET and POST requests. PUT and DELETE requests will be available in the future.

    GET

    The following table illustrates which fields can be included when receiving a GET response.

    NB: Nested properties are hidden by default. To expand all nested properties, add $expand=* to the URL. To expand a specific nested property, set the property name after $expand= (i.e. $expand=LineItems).

    Claim
    Field Name Description
    ClaimGuid
    Guid (Identifier)     		The Claim’s id.
    ClaimNumber
    string    		 Claim number of the Claim.
    ProviderInvoiceReference
    string    		 Reference number of the provider invoice the Claim is linked to.
    ExternalInvoiceNumber
    string    		 Invoice number for a third party accounting package (i.e. Xero, MYOB).
    StartDate
    Date    		 Start date of the Claim.
    EndDate
    Date    		 End date of the Claim.
    DueDate
    Date    		 Payment due date of the Claim.
    PaymentDate
    DateTime    		 Payment date of the Claim.
    Total
    decimal    		 Total amount of the Claim.
    Resubmitted
    boolean    		 Indicates whether the Claim has been resubmitted or not.
    GeniusStatus
    string    		 Status of the Claim on GENIUS.
    Possible values are:
    “AwaitingStaffApproval”
    “SubmittedToLanternPay”
    “OnHold”
    “Approved”
    “NdiaClaimed”
    “NdiaFullyPaid”
    “NdiaPartiallyPaid”
    “LanternPayCancellationRequested”
    “LanternPayCancelled”
    “LanternPayRejected”
    SendPaymentTo
    string     		Entity that gets the payment of the claim. SendPaymentTo feature applies only to LanternPay users.
    Possible values are:
    “Provider”
    “Client”
    “PlanManager”
    “SupportCoordinator”
    “ClientRepresentative”
    MissingAbnReasonCode
    string     		Reason why Provider’s ABN is missing. If SendPaymentTo is either Provider, PlanManager or SupportCoordinator, this field is EXCLS (ATO Excluded Supply) when Provider’s ABN is missing. If SendPaymentTo is either Client or ClientRepresentative, this field is always REIMB (Participant Reimbursement).
    CreationDate
    DateTime    		 The date the Claim record was created.
    ArchiveDate
    DateTime    		 Date when the Contact was archived, if they have been archived.
    ApprovedDate
    DateTime    		 The date when the Claim has been approved.
    ClientGuid
    Guid    		 Guid of the Client that Contact of the Claim belongs to. To view the client’s details, refer to Client endpoint.
    ContactGuid
    Guid    		 Guid of the Contact of the Claim. To view the contact’s details, refer to Contact endpoint.
    ProviderGuid
    Guid    		 Guid of the service provider of this Claim. To view the provider’s details, refer to Client endpoint.
    StaffGuid
    Guid    		 Guid of the staff who is in charge of the Claim. To view the staff’s details, refer to Staff endpoint.
    ProviderInvoiceGuid
    Guid    		 Guid of the provider invoice linked to the Claim. To view the provider invoice’s details, refer to ProviderInvoice endpoint.
    LineItems
    object    		 Breakdown of the Claim based on a product, called a LineItem object. To view the LineItem’s details, refer to the following LineItems table.
    LineItems
    Field Name Description
    LineItemGuid
    Guid (Identifier)     		The LineItem’s id.
    Notes
    string    		 Notes of the LineItem.
    Quantity
    decimal    		 Quantity of the product of LineItem.
    Price
    decimal    		 Price of the product of LineItem.
    Total
    decimal    		 Total amount of the LineItem.
    AmountPaid
    decimal    		 Amount paid for the LineItem in the past.
    TaxChoice
    string    		 Tax rate selected for the LineItem.
    Possible values are:
    “BasExcluded”
    “GstFreeExports”
    “GstFreeIncome”
    “GstOnIncome”
    null
    ClaimType
    string    		 Claim type that indicates what LineItem claims for.
    Possible values are:
    “None”
    “Cancellation”
    “NdiaRequiredReport”
    “ProviderTravel”
    “NonFaceToFaceServices”
    “DirectService”
    “IrregularSilSupports”
    “Telehealth”
    null
    CancellationReason
    string    		 Cancel reason of the service/product of the LineItem.
    Possible values are:
    “None”
    “HealthReason”
    “FamilyIssues”
    “UnavailabilityOfTransport”
    “Other”
    null
    CreationDate
    DateTime    		 The date the LineItem record was created.
    ModifyDate
    DateTime    		 The date the LineItem record was modified.
    ArchiveDate
    DateTime    		 The date the LineItem record was archived.
    PriceBook
    object    		 Price book that the product belongs to. To view the price book details, refer to PriceBook endpoint.
    Product
    object    		 Product/service of the LineItem. To view the product details, refer to PriceBook endpoint.

    Example JSON response:

    {
  "@odata.context": "https://api.mypcorp.com/$metadata#Claim(LineItems())",
  "value": [
    {
      "ClaimGuid": "1a2b3c4d-5e6f-7a8b-9c0d-1e2f3a4b5c6d",
      "ClaimNumber": "CORP-10001",
      "ProviderInvoiceReference": "INV-20001",
      "ExternalInvoiceNumber": null,
      "StartDate": "2021-05-05",
      "EndDate": "2021-05-06",
      "DueDate": "2021-05-31",
      "PaymentDate": null,
      "Total": 100.00,
      "Resubmitted": false,
      "GeniusStatus": "AwaitingStaffApproval",
      "SendPaymentTo": "Provider",
      "MissingAbnReasonCode": "EXCLS",
      "CreationDate": "2021-05-07T08:31:45.98+10:00",
      "ApprovedDate": null,
      "ArchiveDate": null,
      "ClientGuid": "63283ed7-1d2f-e911-810e-f36ca09d16f6",
      "ContactGuid": "66283ed7-1d2f-e911-810e-f36ca09d16f6",
      "StaffGuid": "1497e30c-6122-eb11-a824-000d3acb64f7",
      "ProviderGuid": "9ef14280-6442-ea11-811d-b21a1b4963a6",
      "ProviderInvoiceGuid": "a59fed52-6f66-eb11-a827-000d3aca5506",
      "LineItems": [
        {
          "LineItemGuid": "d6c5b4a3-f2e1-d0c9-b8a7-f6e5d4c3b2a1",
          "Notes": "Access Community Social And Rec Activities - Weekday Daytime",
          "Quantity": 1.00,
          "Price": 100.00,
          "Total": 100.00,
          "AmountPaid": null,
          "TaxChoice": "GstFreeIncome",
          "ClaimType": null,
          "CancellationReason": null,
          "CreationDate": "2021-05-07T08:31:45.98+10:00",
          "ModifyDate": "2021-05-07T08:31:45.98+10:00",
          "ArchiveDate": null,
          "PriceBook": {
            "PriceBookGuid": "b488c61d-38b1-4b8e-a28c-838e3e9fcd7f",
            "Name": "General NDIS Price Book"
          },
          "Product": {
            "ProductGuid": "f3cb6aec-63d8-4fb1-941b-4354116b6b7c",
            "Code": "04_104_0125_6_1",
            "Name": "Access Community Social And Rec Activities - Weekday Daytime-QLD",
            "LongDescription": "Access Community Social And Rec Activities - Weekday Daytime"
          }
        }
      ]
    }
  ]
}

    POST

    Parameter

    Parameter Name Description Required Default Value
    ignoreWarnings
    boolean    		 If set to true, warning messages in the response are ignored and the request is posted. Otherwise, the request will return warning messages with the response of 400 (Bad Request). Optional false

    Request Body

    The following table illustrates which fields can be included when sending a POST request. A number next to the data type (e.g. string (500)), is the maximum number of characters for this field. All required fields must be included in the request body to get a successful response. Dates must be set in the standard SQL datetime format, which is YYYY-MM-DD hh:mm:ss[.nnn].

    Claim
    Field Name Description Required
    ClaimNumber
    string (47)    		 Claim number of the Claim. This field must be unique. Automatically assigns ClaimNumber from ARM settings if not provided. Optional
    ProviderInvoiceReference
    string (100)    		 Reference number of the provider invoice the Claim is linked to. Required for POST requests when the provider invoice specified by ProviderInvoiceGuid does not have a value in ProviderInvoiceReference. This field must be unique. Required (conditional)
    StartDate
    Date    		 Start date of the Claim. Required
    EndDate
    Date    		 End date of the Claim. Required
    DueDate
    Date    		 Payment due date of the Claim. Optional
    SendPaymentTo
    string     		Entity that gets the payment of the claim. Automatically assigns “Provider” if not provided. SendPaymentTo feature applies only to LanternPay users.
    Possible values are:
    0 or “Provider”
    1 or “Client”
    2 or “PlanManager”
    3 or “SupportCoordinator”
    4 or “ClientRepresentative”     		Optional
    ContactGuid
    Guid    		 Guid of the Contact of the Claim. Required for POST requests when the provider invoice specified by ProviderInvoiceGuid does not have a value in ContactGuid. To view the contact’s details, refer to Contact endpoint. Required (conditional)
    ProviderGuid
    Guid    		 Guid of the business for this Claim. Required for POST requests when the provider invoice specified by ProviderInvoiceGuid does not have a value in ProviderGuid. To view the provider’s details, refer to Client endpoint. Required (conditional)
    StaffGuid
    Guid    		 Guid of the staff who is in charge of the Claim. View/Administer GENIUS invoice permissions required. To view the staff’s details, refer to Staff endpoint. Required
    ProviderInvoiceGuid
    Guid    		 Guid of the provider invoice linked to the Claim. This field must be either unique or a guid of reusable ProviderInvoice. To view the provider invoice’s details, refer to ProviderInvoice endpoint. Required
    LineItems
    object    		 Breakdown of the Claim based on a product, called a LineItem object. Required at least one item in the list for POST requests. To view the LineItem’s details, refer to the following LineItems table. Required
    LineItems
    Field Name Description Required
    Quantity
    decimal    		 Quantity of the product of LineItem. Required
    Price
    decimal    		 Price of the product of LineItem. Required for POST requests when the product price is not specified in the price book. Required (conditional)
    Notes
    string     		Notes of the LineItem. Automatically assigns LongDescription from Product if not provided. Optional
    TaxChoice
    string    		 Indicates the chosen tax rate for the LineItem. This field must be one of the follows if provided :
    34300 or “BasExcluded”
    34600 or “GstFreeExports”
    34700 or “GstFreeIncome”
    35200 or “GstOnIncome”    		 Optional
    ClaimType
    string    		 Claim type that indicates what LineItem claims for. This field must be one of the follows if provided:
    1 or “Cancellation”
    2 or “NdiaRequiredReport”
    3 or “ProviderTravel”
    4 or “NonFaceToFaceServices”
    5 or “DirectService”
    6 or “IrregularSilSupports”
    7 or “Telehealth”    		 Optional
    CancellationReason
    string    		 Cancel reason of the service/product of the LineItem. This field must be one of the follows if provided:
    1 or “HealthReason”
    2 or “FamilyIssues”
    3 or “UnavailabilityOfTransport”
    4 or “Other”    		 Optional
    PriceBook
    object    		 Price book that the product belongs to. To view the price book details, refer to PriceBook endpoint. Required
    Product
    object    		 Product/service of the LineItem. To view the product details, refer to PriceBook endpoint. Required

    Example request body:

    {
  "value": [
    {
      "ClaimNumber": "CORP-10001",
      "ProviderInvoiceReference": "INV-20001",
      "StartDate": "2021-05-05",
      "EndDate": "2021-05-06",
      "DueDate": "2021-05-31",
      "SendPaymentTo": "Provider",
      "ContactGuid": "66283ed7-1d2f-e911-810e-f36ca09d16f6",
      "StaffGuid": "1497e30c-6122-eb11-a824-000d3acb64f7",
      "ProviderGuid": "9ef14280-6442-ea11-811d-b21a1b4963a6",
      "ProviderInvoiceGuid": "a59fed52-6f66-eb11-a827-000d3aca5506",
      "LineItems": [
        {
          "Quantity": 1.00,
          "Price": 100.00,
          "Notes": "Provision of support to enable a participant to engage in community, social and/or recreational activities. Provided on 05/05/2021",
          "IsCreditItem": false,
          "TaxChoice": 34700,
          "ClaimType": null,
          "CancellationReason": null,
          "PriceBook": {
            "PriceBookGuid": "d34a7fe0-1546-4126-9c4c-b296403536ce"
          },
          "Product": {
            "ProductGuid": "01292657-4f56-473b-8451-e0bcbd7255ef"
        }
      ]
    }
  ]
}


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