{
  "accept_assignment": true,
  "billing_provider_id": "PROV123",
  "client_sig_on_file": true,
  "cms1500_policies": [
    {
      "benefits": [
        {
          "coinsurance": "15",
          "copay": "50",
          "deductible_calendar_year": "2000",
          "deductible_year_to_date": "1500"
        }
      ],
      "effective_end": "2024-07-04",
      "group_num": "331256",
      "id": "202402",
      "insurance_card_back_id": "123452",
      "insurance_card_front_id": "123451",
      "insurance_plan": {
        "id": "611231",
        "name_and_id": "Blue Cross Blue Shield - 629913",
        "payer_id": "629913",
        "payer_name": "Blue Cross Blue Shield"
      },
      "insurance_type": "Medicaid",
      "notes": "Policy is active",
      "num": "1912310",
      "patient_id": "100121",
      "priority_type": "Primary",
      "updated_at": "2024-07-01T11:29:19+00:00"
    }
  ],
  "cpt_codes_cms1500s": [
    {
      "cpt_code": "99215",
      "description": "New patient office visit, 45-60 minutes",
      "display_name": "New patient office visit",
      "mod1": "25",
      "mod2": "59",
      "mod3": "12",
      "mod4": "34",
      "pointers": "1",
      "service_date": "2025-09-22",
      "units": "1"
    }
  ],
  "dietician_organization_id": "123450",
  "dietitian_email_address": "drfleming@example.com",
  "dietitian_first_name": "Alexander",
  "dietitian_id": "100070",
  "dietitian_last_name": "Fleming",
  "dietitian_organization_id": "123450",
  "icd_codes_cms1500s": [
    {
      "active": true,
      "code": "F41.1",
      "created_at": "2024-01-15T10:30:00Z",
      "display_name": "Generalized anxiety disorder",
      "end_date": "2024-12-31",
      "first_symptom_date": "2024-01-10",
      "id": "789012",
      "updated_at": "2024-01-15T10:30:00Z"
    }
  ],
  "id": "57211",
  "insured_sig_on_file": true,
  "organization_info_id": "ORG789",
  "patient": {
    "date_of_birth": "1985-03-15",
    "location": {
      "city": "San Francisco",
      "country": "USA",
      "line1": "123 Main Street",
      "line2": "Suite 100",
      "state": "CA",
      "zip": "94117"
    },
    "sex": "Male"
  },
  "patient_id": "121250",
  "referral_info": {
    "case_qualifier": "431",
    "prior_auth_number": "AUTH123456",
    "ref_provider_first": "John",
    "ref_provider_last": "Smith",
    "ref_provider_qual": "MD"
  },
  "service_location_id": "LOC456"
}

{
  "accept_assignment": "The provider agrees to accept assignment",
  "billing_provider_id": "The ID of the Billing Provider",
  "client_sig_on_file": "True if the client's signature is on file",
  "cms1500_policies": {
    "benefits": {
      "coinsurance": "Coinsurance percentage due",
      "copay": "Copay amount due",
      "deductible_calendar_year": "Deductible amount for the calendar year",
      "deductible_year_to_date": "Deductible amount for the year to-date"
    },
    "effective_end": "Date the policy coverage expires",
    "group_num": "Group number",
    "id": "ID for the policy",
    "insurance_card_back_id": "ID of the insurance card back image object",
    "insurance_card_front_id": "ID of the insurance card front image object",
    "insurance_plan": {
      "id": "ID of the insurance plan",
      "name_and_id": "Name of the payer and id of payer",
      "payer_id": "ID of the insurance payer",
      "payer_name": "Name of the insurance payer"
    },
    "insurance_type": "The type of insurance: `type_string`",
    "notes": "Notes about the policy",
    "num": "Policy number",
    "patient_id": "ID of the patient associated with the policy",
    "priority_type": "The priority type of insurance: `priority_type`",
    "updated_at": "Last time the Policy was updated"
  },
  "cpt_codes_cms1500s": {
    "cpt_code": "The CPT code",
    "description": "The CPT code description",
    "display_name": "The CPT display name used in labels",
    "mod1": "First modification code",
    "mod2": "Second modification code",
    "mod3": "Third modification code",
    "mod4": "Fourth modification code",
    "pointers": "Diagnostic pointers. These are used to connect Diagnosis(ICD) with appropriate Billing Item(CPT) in CMS1500 form",
    "service_date": "The service date for the specific code",
    "units": "Units for the CPT code"
  },
  "dietician_organization_id": "Organization ID for the User's (Patient's) registered dietitian",
  "dietitian_email_address": "Email address of the User's (Patient's) registered dietitian",
  "dietitian_first_name": "First name of the User's (Patient's) registered dietitian",
  "dietitian_id": "ID of the User's (Patient's) registered dietitian",
  "dietitian_last_name": "Last name of the User's (Patient's) registered dietitian",
  "dietitian_organization_id": "Organization ID for the User's (Patient's) registered dietitian",
  "icd_codes_cms1500s": {
    "active": "Active IcdCodesCms1500",
    "code": "The ICD code",
    "created_at": "Date created",
    "display_name": "Display name for the ICD code",
    "end_date": "End date",
    "first_symptom_date": "ICD codes in use for this claim",
    "id": "The unique identifier of the CMS 1500 ICD code",
    "updated_at": "Date updated"
  },
  "id": "CMS1500 object ID",
  "insured_sig_on_file": "True if the insured's signature is on file",
  "organization_info_id": "The ID of the Organization Info",
  "patient": {
    "date_of_birth": "Date of birth of user",
    "location": {
      "city": "City",
      "country": "Country",
      "line1": "First line of the address",
      "line2": "Second line of the address",
      "state": "State",
      "zip": "Zip code"
    },
    "sex": "Sex of the user (Stated on ID card for insurance purposes)"
  },
  "patient_id": "Patient's ID",
  "referral_info": {
    "case_qualifier": "The qualifier for case_date",
    "prior_auth_number": "The prior authorization number",
    "ref_provider_first": "The first name of the referring provider",
    "ref_provider_last": "The last name of the referring provider",
    "ref_provider_qual": "The qualifications of the referring provider"
  },
  "service_location_id": "The ID of the service location"
}