Import Claims

curl -X POST "https://api.refactorbilling.com/claims-import?tenant_id=1" \
  -H "x-api-key: your-api-key" \
  -H "Content-Type: application/json" \
  -d '{
    "claims": [
      {
        "patient_name": "John Doe",
        "patient_dob": "1985-04-12",
        "patient_gender": "M",
        "provider_name": "Dr. Smith",
        "provider_address": "123 Medical Dr, Suite 100, San Francisco, CA 94102",
        "provider_npi": "1234567890",
        "patient_member_id": "MEM987654",
        "payer_name": "Aetna",
        "claim_submitter_identifier": "CLM-2026-001",
        "facility_code_value": "11",
        "icd_codes": ["M54.5", "G89.29"],
        "visit_number": "V12345",
        "payer_phone_number": "+18005551234",
        "charge_lines": [
          {
            "hcpcs_code": "99213",
            "monetary_amount": 150.00,
            "units": 1,
            "diagnosis_code_pointers": ["1"],
            "service_date_from": "2026-03-01",
            "service_date_to": "2026-03-01",
            "modifiers": ["25"]
          },
          {
            "hcpcs_code": "20610",
            "monetary_amount": 250.00,
            "units": 1,
            "diagnosis_code_pointers": ["1", "2"],
            "service_date_from": "2026-03-01",
            "service_date_to": "2026-03-01"
          }
        ]
      }
    ]
  }'

{
  "success": true,
  "claim_ids": [101],
  "total_claims": 1
}

curl -X POST "https://api.refactorbilling.com/claims-import?tenant_id=1" \
  -H "x-api-key: your-api-key" \
  -H "Content-Type: application/json" \
  -d '{
    "claims": [
      {
        "patient_name": "John Doe",
        "patient_dob": "1985-04-12",
        "patient_gender": "M",
        "provider_name": "Dr. Smith",
        "provider_address": "123 Medical Dr, Suite 100, San Francisco, CA 94102",
        "provider_npi": "1234567890",
        "patient_member_id": "MEM987654",
        "payer_name": "Aetna",
        "claim_submitter_identifier": "CLM-2026-001",
        "facility_code_value": "11",
        "icd_codes": ["M54.5", "G89.29"],
        "visit_number": "V12345",
        "payer_phone_number": "+18005551234",
        "charge_lines": [
          {
            "hcpcs_code": "99213",
            "monetary_amount": 150.00,
            "units": 1,
            "diagnosis_code_pointers": ["1"],
            "service_date_from": "2026-03-01",
            "service_date_to": "2026-03-01",
            "modifiers": ["25"]
          },
          {
            "hcpcs_code": "20610",
            "monetary_amount": 250.00,
            "units": 1,
            "diagnosis_code_pointers": ["1", "2"],
            "service_date_from": "2026-03-01",
            "service_date_to": "2026-03-01"
          }
        ]
      }
    ]
  }'

{
  "success": true,
  "claim_ids": [101],
  "total_claims": 1
}

Authentication

All requests require an API key passed via the x-api-key header, along with a tenant_id query parameter.

string

required

Your tenant API key.

Query Parameters

integer

required

Your tenant ID.

Request Body

Submit an array of claims. Each claim contains claim-level fields and an array of charge lines. Claims are uniquely identified by the combination of provider_npi + claim_submitter_identifier.

Claim[]

required

Array of claims to import.

Show Claim

string

required

Patient full name.

string

required

Patient date of birth (YYYY-MM-DD).

string

required

Patient gender.

string

required

Rendering provider name.

string

required

Provider address.

string

required

Provider NPI. Used as part of the unique key for claim deduplication.

string

Provider tax ID.

string

required

Patient member/subscriber ID.

string

Payer name.

string

Payer identification code.

string

required

Claim submitter identifier. Used as part of the unique key for claim deduplication.

string

required

Place of service / facility code.

string[]

required

ICD diagnosis codes for the claim.

string

required

Your internal visit identifier. Used to look up results from other endpoints.

string

required

Payer phone number to call (E.164 format, e.g. +18005551234).

ChargeLine[]

required

Array of charge lines for this claim.

Show ChargeLine

string

required

HCPCS/CPT procedure code.

number

required

Charge amount in dollars.

number

Number of units billed.

string[]

Pointers to the ICD codes on the claim (e.g. ["1", "2"]).

string

Service start date (YYYY-MM-DD).

string

Service end date (YYYY-MM-DD).

string[]

Procedure modifiers (e.g. ["25", "59"]).

Response

boolean

Whether the import completed successfully.

integer[]

List of created or updated claim IDs.

integer

Number of claims processed.

curl -X POST "https://api.refactorbilling.com/claims-import?tenant_id=1" \
  -H "x-api-key: your-api-key" \
  -H "Content-Type: application/json" \
  -d '{
    "claims": [
      {
        "patient_name": "John Doe",
        "patient_dob": "1985-04-12",
        "patient_gender": "M",
        "provider_name": "Dr. Smith",
        "provider_address": "123 Medical Dr, Suite 100, San Francisco, CA 94102",
        "provider_npi": "1234567890",
        "patient_member_id": "MEM987654",
        "payer_name": "Aetna",
        "claim_submitter_identifier": "CLM-2026-001",
        "facility_code_value": "11",
        "icd_codes": ["M54.5", "G89.29"],
        "visit_number": "V12345",
        "payer_phone_number": "+18005551234",
        "charge_lines": [
          {
            "hcpcs_code": "99213",
            "monetary_amount": 150.00,
            "units": 1,
            "diagnosis_code_pointers": ["1"],
            "service_date_from": "2026-03-01",
            "service_date_to": "2026-03-01",
            "modifiers": ["25"]
          },
          {
            "hcpcs_code": "20610",
            "monetary_amount": 250.00,
            "units": 1,
            "diagnosis_code_pointers": ["1", "2"],
            "service_date_from": "2026-03-01",
            "service_date_to": "2026-03-01"
          }
        ]
      }
    ]
  }'

{
  "success": true,
  "claim_ids": [101],
  "total_claims": 1
}

Getting Started

Data Import

Pre-Service

Claim Follow-Up

Denial Management

Authentication

Query Parameters

Request Body

Response

​Authentication

​Query Parameters

​Request Body

​Response

Authentication

Query Parameters

Request Body

Response