POST api/OnlineForm/SaveClaimAppealFormRequest

Save Medical Claim Appeal

Request Information

URI Parameters

None.

Body Parameters

ClaimAppealFormRequestModel
NameDescriptionTypeAdditional information
CreatedBy

integer

None.
Id

integer

None.
Status

integer

None.
ClaimsAppealFormModel

ClaimsAppealFormModel

None.
FormDocumentModel

Collection of FormDocumentModel

None.

Request Formats

application/json, text/json

Sample: 
{
  "CreatedBy": 1,
  "Id": 2,
  "Status": 3,
  "ClaimsAppealFormModel": {
    "MemberInformationModel": {
      "GBGMemberName": "sample string 1",
      "MobileNumber": "sample string 2",
      "PolicyId": "sample string 3",
      "DOS": "sample string 4",
      "ClaimNumber": "sample string 5",
      "TypeOfService": "sample string 6",
      "AppealCorrespondence": "sample string 7",
      "RequestorName": "sample string 8",
      "RelatioShipWithPatients": "sample string 9",
      "AuthorizationRequired": "sample string 10",
      "AppealList": [
        "sample string 1",
        "sample string 2"
      ],
      "ReasonForReview": "sample string 11",
      "ContractedProvider": "sample string 12",
      "Title": "sample string 13",
      "FirstName": "sample string 14",
      "LastName": "sample string 15",
      "MiddleName": "sample string 16",
      "Email": "sample string 17",
      "Alias": "sample string 18",
      "DOB": "sample string 19",
      "GBGID": "sample string 20",
      "EmployerName": "sample string 21",
      "Address": "sample string 22",
      "City": "sample string 23",
      "Country": "sample string 24",
      "Phonenumber": "sample string 25",
      "Gender": "sample string 26",
      "State": "sample string 27",
      "AlternatePhone": "sample string 28",
      "ZipCode": "sample string 29"
    },
    "ConsentInformationModel": {
      "UKResident": true,
      "ICONSENT": true,
      "Date": "sample string 3",
      "Signature": "sample string 4",
      "DateSigned": "sample string 5",
      "NameSigned": "sample string 6",
      "Gaurdian": "sample string 7"
    }
  },
  "FormDocumentModel": [
    {
      "CreatedBy": 1,
      "CreatedDate": "2025-05-02T07:13:57.7490179-07:00",
      "DocumentExtension": "sample string 3",
      "DocumentFile": "QEA=",
      "DocumentFilePath": "sample string 4",
      "DocumentId": 5,
      "DocumentName": "sample string 6",
      "DocumentType": "sample string 7",
      "RequestId": 8,
      "SerialNumber": "sample string 9",
      "Status": 10,
      "UpdatedBy": 11,
      "UpdatedDate": "2025-05-02T07:13:57.7490179-07:00",
      "UploadedBy": 13,
      "UploadedDate": "2025-05-02T07:13:57.7490179-07:00"
    },
    {
      "CreatedBy": 1,
      "CreatedDate": "2025-05-02T07:13:57.7490179-07:00",
      "DocumentExtension": "sample string 3",
      "DocumentFile": "QEA=",
      "DocumentFilePath": "sample string 4",
      "DocumentId": 5,
      "DocumentName": "sample string 6",
      "DocumentType": "sample string 7",
      "RequestId": 8,
      "SerialNumber": "sample string 9",
      "Status": 10,
      "UpdatedBy": 11,
      "UpdatedDate": "2025-05-02T07:13:57.7490179-07:00",
      "UploadedBy": 13,
      "UploadedDate": "2025-05-02T07:13:57.7490179-07:00"
    }
  ]
}

application/xml, text/xml

Sample: 
<ClaimAppealFormRequestModel xmlns:i="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://schemas.datacontract.org/2004/07/GBG.MemberPortal.API.Models">
  <ClaimsAppealFormModel xmlns:d2p1="http://schemas.datacontract.org/2004/07/GBG.MemberPortal.Data.Models.OnlineForm">
    <d2p1:ConsentInformationModel>
      <d2p1:Date>sample string 3</d2p1:Date>
      <d2p1:DateSigned>sample string 5</d2p1:DateSigned>
      <d2p1:Gaurdian>sample string 7</d2p1:Gaurdian>
      <d2p1:ICONSENT>true</d2p1:ICONSENT>
      <d2p1:NameSigned>sample string 6</d2p1:NameSigned>
      <d2p1:Signature>sample string 4</d2p1:Signature>
      <d2p1:UKResident>true</d2p1:UKResident>
    </d2p1:ConsentInformationModel>
    <d2p1:MemberInformationModel>
      <d2p1:Address>sample string 22</d2p1:Address>
      <d2p1:Alias>sample string 18</d2p1:Alias>
      <d2p1:AlternatePhone>sample string 28</d2p1:AlternatePhone>
      <d2p1:City>sample string 23</d2p1:City>
      <d2p1:Country>sample string 24</d2p1:Country>
      <d2p1:DOB>sample string 19</d2p1:DOB>
      <d2p1:Email>sample string 17</d2p1:Email>
      <d2p1:EmployerName>sample string 21</d2p1:EmployerName>
      <d2p1:FirstName>sample string 14</d2p1:FirstName>
      <d2p1:GBGID>sample string 20</d2p1:GBGID>
      <d2p1:Gender>sample string 26</d2p1:Gender>
      <d2p1:LastName>sample string 15</d2p1:LastName>
      <d2p1:MiddleName>sample string 16</d2p1:MiddleName>
      <d2p1:MobileNumber i:nil="true" />
      <d2p1:Phonenumber>sample string 25</d2p1:Phonenumber>
      <d2p1:State>sample string 27</d2p1:State>
      <d2p1:Title>sample string 13</d2p1:Title>
      <d2p1:ZipCode>sample string 29</d2p1:ZipCode>
      <d2p1:AppealCorrespondence>sample string 7</d2p1:AppealCorrespondence>
      <d2p1:AppealList xmlns:d4p1="http://schemas.microsoft.com/2003/10/Serialization/Arrays">
        <d4p1:string>sample string 1</d4p1:string>
        <d4p1:string>sample string 2</d4p1:string>
      </d2p1:AppealList>
      <d2p1:AuthorizationRequired>sample string 10</d2p1:AuthorizationRequired>
      <d2p1:ClaimNumber>sample string 5</d2p1:ClaimNumber>
      <d2p1:ContractedProvider>sample string 12</d2p1:ContractedProvider>
      <d2p1:DOS>sample string 4</d2p1:DOS>
      <d2p1:GBGMemberName>sample string 1</d2p1:GBGMemberName>
      <d2p1:MobileNumber>sample string 2</d2p1:MobileNumber>
      <d2p1:PolicyId>sample string 3</d2p1:PolicyId>
      <d2p1:ReasonForReview>sample string 11</d2p1:ReasonForReview>
      <d2p1:RelatioShipWithPatients>sample string 9</d2p1:RelatioShipWithPatients>
      <d2p1:RequestorName>sample string 8</d2p1:RequestorName>
      <d2p1:TypeOfService>sample string 6</d2p1:TypeOfService>
    </d2p1:MemberInformationModel>
  </ClaimsAppealFormModel>
  <CreatedBy>1</CreatedBy>
  <FormDocumentModel xmlns:d2p1="http://schemas.datacontract.org/2004/07/GBG.MemberPortal.Data.Models.OnlineForm">
    <d2p1:FormDocumentModel>
      <d2p1:CreatedBy>1</d2p1:CreatedBy>
      <d2p1:CreatedDate>2025-05-02T07:13:57.7490179-07:00</d2p1:CreatedDate>
      <d2p1:DocumentExtension>sample string 3</d2p1:DocumentExtension>
      <d2p1:DocumentFile>QEA=</d2p1:DocumentFile>
      <d2p1:DocumentFilePath>sample string 4</d2p1:DocumentFilePath>
      <d2p1:DocumentId>5</d2p1:DocumentId>
      <d2p1:DocumentName>sample string 6</d2p1:DocumentName>
      <d2p1:DocumentType>sample string 7</d2p1:DocumentType>
      <d2p1:RequestId>8</d2p1:RequestId>
      <d2p1:SerialNumber>sample string 9</d2p1:SerialNumber>
      <d2p1:Status>10</d2p1:Status>
      <d2p1:UpdatedBy>11</d2p1:UpdatedBy>
      <d2p1:UpdatedDate>2025-05-02T07:13:57.7490179-07:00</d2p1:UpdatedDate>
      <d2p1:UploadedBy>13</d2p1:UploadedBy>
      <d2p1:UploadedDate>2025-05-02T07:13:57.7490179-07:00</d2p1:UploadedDate>
    </d2p1:FormDocumentModel>
    <d2p1:FormDocumentModel>
      <d2p1:CreatedBy>1</d2p1:CreatedBy>
      <d2p1:CreatedDate>2025-05-02T07:13:57.7490179-07:00</d2p1:CreatedDate>
      <d2p1:DocumentExtension>sample string 3</d2p1:DocumentExtension>
      <d2p1:DocumentFile>QEA=</d2p1:DocumentFile>
      <d2p1:DocumentFilePath>sample string 4</d2p1:DocumentFilePath>
      <d2p1:DocumentId>5</d2p1:DocumentId>
      <d2p1:DocumentName>sample string 6</d2p1:DocumentName>
      <d2p1:DocumentType>sample string 7</d2p1:DocumentType>
      <d2p1:RequestId>8</d2p1:RequestId>
      <d2p1:SerialNumber>sample string 9</d2p1:SerialNumber>
      <d2p1:Status>10</d2p1:Status>
      <d2p1:UpdatedBy>11</d2p1:UpdatedBy>
      <d2p1:UpdatedDate>2025-05-02T07:13:57.7490179-07:00</d2p1:UpdatedDate>
      <d2p1:UploadedBy>13</d2p1:UploadedBy>
      <d2p1:UploadedDate>2025-05-02T07:13:57.7490179-07:00</d2p1:UploadedDate>
    </d2p1:FormDocumentModel>
  </FormDocumentModel>
  <Id>2</Id>
  <Status>3</Status>
</ClaimAppealFormRequestModel>

application/x-www-form-urlencoded

Sample:

Sample not available.

Response Information

Resource Description

FormResponse
NameDescriptionTypeAdditional information
Id

integer

None.
SourceReferenceNumber

string

None.

Response Formats

application/json, text/json

Sample: 
{
  "Id": 1,
  "SourceReferenceNumber": "sample string 2"
}

application/xml, text/xml

Sample: 
<FormResponse xmlns:i="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://schemas.datacontract.org/2004/07/GBG.MemberPortal.Data.Models.OnlineForm">
  <Id>1</Id>
  <SourceReferenceNumber>sample string 2</SourceReferenceNumber>
</FormResponse>