Appointment Insurance

The Appointment Insurance feature allows the user to view and update the list of insurance packages of a patient for a given appointment. For more information, please refer Adding and updating Insurance Information.

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Endpoints

Get insurance package details for the appointment
GET
/v1/{practiceid}/appointments/{appointmentid}/insurances

Retrieves all insurances of the patient for a specific appointment Note: This endpoint may rely on specific settings to be enabled in athenaNet Production to function properly that are not required in other environments. Please see <a href="https://docs.athenahealth.com/api/resources/best-practices-and-troubles… Rollout of APIs</a> for more information if you are experiencing issues.

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Input Parameters

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❙ required

practiceid integer practiceid
appointmentid integer appointmentid
showcancelled string If set, include cancelled and expired insurances.
showfullssn string If set, will show full SSN instead of a masked number.
ignorerestrictions string Set to true to allow ability to show the insurance information of appointments of patients with record restrictions and/or blocked status.
limit integer Number of entries to return (default 100, max 5000)Please note that this endpoint has a different default than normal.
offset integer Starting point of entries; 0-indexed

Output Parameters

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adjusterfax string CASE POLICY FIELD - Fax for the adjuster on this case policy. Only available for auto insurance or worker's comp case policies.
adjusterfirstname string CASE POLICY FIELD - First name of the adjuster on this case policy. Only available for auto insurance or worker's comp case policies.
adjusterlastname string CASE POLICY FIELD - Last name of the adjuster on this case policy. Only available for auto insurance or worker's comp case policies.
adjusterphone string CASE POLICY FIELD - Phone number/other contact info for the adjuster on this case policy. Only available for auto insurance or worker's comp case policies.
anotherpartyresponsibleyn string CASE POLICY FIELD - Boolean field indicating if another party was responsible for this accident.
autoaccidentstate string CASE POLICY FIELD - Two-letter abbreviation for the state in which the auto accident took place. Only meaningful for auto insurance case policies.
cancelled string The date in which the insurance was marked cancelled.
caseinjurydate string CASE POLICY FIELD - Date of the injury. Required for auto insurance, legal, and worker's comp case policies.
casepolicytypename string CASE POLICY FIELD - The name of this type of case policy.
ccmstatusid integer Status ID of current CCM enrollment.
ccmstatusname string The name of current CCM enrollment status.
coinsurancepercent number The coinsurance percentage for this insurance. If you've just POSTed a new insurance you will have to wait for the auto eligbility check before this field populates.
copays array Details about the copays for this insurance package. If you've just POSTed a new insurance you will have to wait for the auto eligbility check before these populate.
descriptionofinjury string CASE POLICY FIELD - A description of the injury. Only available for auto insurance and worker's comp case policies.
eligibilitylastchecked string Date the eligibility was last checked.
eligibilitymessage string The message, usually from our engine, of the eligibility check.
eligibilityreason string The source of the current status. Athena is our eligibility engine.
eligibilitystatus string Current eligibility status of this insurance package.
employerid string The employer ID associated with the patient's insurance.
expirationdate string Date the insurance expires.
icd10codes array CASE POLICY FIELD - See documentation for ICD9CODES.
icd9codes array CASE POLICY FIELD - A list of ICD9 accepted diagnosis codes. Only available for worker's comp case policies.
injuredbodypart string CASE POLICY FIELD - Text field for describing the injured body part. Only available for auto insurance and worker's comp case policies.
insuranceclaimnumber string CASE POLICY FIELD - The auto insurance claim number or the worker's comp claim number.
insuranceid string The athena insurance policy ID.
insuranceidnumber string The insurance policy ID number (as presented on the insurance card itself).
insurancepackageaddress1 string Address 1 for the AthenaNet insurance Package.
insurancepackageaddress2 string Address 2 for the AthenaNet insurance Package.
insurancepackagecity string City for the AthenaNet insurance Package.
insurancepackageid integer The athenaNet insurance package ID.
insurancepackagestate string State of the AthenaNet insurance package
insurancepackagezip string Zip code of the AthenaNet insurance package
insurancephone string The phone number for the insurance company. Note: This defaults to the insurance package phone number. If this is set, it will override it. Likewise if blanked out, it will go back to default.
insuranceplandisplayname string Superpackagename of the specific insurance package.
insuranceplanname string Name of the specific insurance package.
insurancepolicyholder string The full name of the insurance policy holder.
insurancepolicyholderaddress1 string The first address line of the insurance policy holder.
insurancepolicyholderaddress2 string The second address line of the insurance policy holder.
insurancepolicyholdercity string The city of the insurance policy holder.
insurancepolicyholdercountrycode string The country code (3 letter) of the insurance policy holder.
insurancepolicyholdercountryiso3166 string The <a href="http://en.wikipedia.org/wiki/ISO_3166-1_alpha-2">ISO 3166</a> country code of the insurance policy holder.
insurancepolicyholderdob string The DOB of the insurance policy holder (mm/dd/yyyy).
insurancepolicyholderfirstname string The first name of the insurance policy holder. Except for self-pay, required for new policies.
insurancepolicyholderlastname string The last name of the insurance policy holder. Except for self-pay, required for new policies.
insurancepolicyholdermiddlename string The middle name of the insurance policy holder.
insurancepolicyholdersex string The sex of the insurance policy holder. Except for self-pay, required for new policies.
insurancepolicyholderssn string The SSN of the insurance policy holder.
insurancepolicyholderstate string The state of the insurance policy holder.
insurancepolicyholdersuffix string The suffix of the insurance policy holder.
insurancepolicyholderzip string The zip of the insurance policy holder.
insurancetype string Type of insurance. E.g., Medicare Part B, Group Policy, HMO, etc.
insuredentitytypeid integer The ID of the entity type for this insurance.
insuredpcp string
insuredpcpnpi integer The national provider id of the primary care physcian assicated with the insurance.
ircname string Insurance category / company. E.g., United Healthcare, BCBS-MA, etc.
issuedate string Date the insurance was issued.
policynumber string The insurance group number. This is sometimes present on an insurance card.
relatedtoautoaccidentyn string CASE POLICY FIELD - Boolean field indicating whether this case policy is related to an auto accident.
relatedtoemploymentyn string CASE POLICY FIELD - Boolean field indicating whether this case policy is related to the patient's employer.
relatedtootheraccidentyn string CASE POLICY FIELD - Boolean field indicating whether this case policy is related to another accident. Only available for worker's comp case policies.
relationshiptoinsured string This patient's relationship to the policy holder (text).
relationshiptoinsuredid integer This patient's relationship to the policy holder (as an ID). See <a href="/workflows/patient-relationship-mapping">the mapping</a>.
repricername string CASE POLICY FIELD - Name for the repricer. Only available for worker's comp case policies.
repricerphone string CASE POLICY FIELD - Phone number for the repricer. Only available for worker's comp case policies.
sequencenumber integer 1 = primary, 2 = secondary, 3 = tertiary, etc. Must have a primary before a secondary and a secondary before a tertiary, etc.
slidingfeeplanid integer If the patient is on a sliding fee plan, this is the ID of that plan. See /slidingfeeplans.
stateofreportedinjury string CASE POLICY FIELD - Two-letter state abbreviation for the state this injury was reported in. Only available for worker's comp case policies.
Example Code
Update insurance package details for the appointment
PUT
/v1/{practiceid}/appointments/{appointmentid}/insurances

Modifies the insurance package of the patient for a specific appointment

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Input Parameters

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❙ required

practiceid integer practiceid
appointmentid integer appointmentid
Content-Type string Content type of the payload

❙ Request Body

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primaryinsuranceid integer The athenaNet patient insurance ID for the policy you want to use as primary for this appointment.
secondaryinsuranceid integer The athenaNet patient insurance ID for the policy you want to use as secondary for this appointment.

Output Parameters

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errormessage string If the update was not successful, a string explaining why.
success string If update was successful, returns true.
Example Code