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Claim Webhook

TPA Stream offers a claim webhook feature in which TPA Stream will post new claims to a customer-provided endpoint.

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Trigger

The claim webhook will fire whenever a new claim is processed in TPA Stream.

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Claim Webhook URL

To edit the claim webhook URL, click on “Account Settings” on the settings page. Note that you will only see this setting if the claim webhook feature is enabled. Once the webhook URL has been updated, all future posts will go to that URL.

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Replaying a Claim Post

To manually replay a claim post, find the appropriate claim on the claims page and click the “Replay webhook” button. If the button is not shown, please verify that the webhook feature is enabled and a URL is set as described above. This “replay” functionality is useful for testing, and can also be used to trigger a webhook for any pre-existing claims that are in the system, if desired.

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First Crawl Completion Webhook

TPA Stream also offers a crawl webhook feature that posts details about the first crawl of a policyholder to a customer-provided endpoint. Trigger The first crawl completion webhook will fire after all the claims for the first crawl of a policyholder have been processed. If this crawl is successful, that will be the last time the webhook fires for the policyholder. If the crawl fails, the trigger will fire again on the next crawl. This will occur until a crawl has successfully completed for the policyholder. For example, if the first two crawls fail and the next two ones succeed, 3 POST requests will be made. Two for the failures and a third, final POST for the first success. Note if you create a new member and associate it with an existing carrier login, the system will not fire the webhook if that existing carrier login has already had a successful first crawl. Even though the member is new, the system reuses the existing carrier login (policyholder).

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First Crawl Completion Webhook URL

To edit the first crawl completion webhook URL, click on “Account Settings” on the settings page similar to editing the claim webhook URL.

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Replaying a Crawl Completion Post

To manually replay a first completion webhook post, find the appropriate member on the member page. Under policy holders, there will be a button to replay the webhook request. If the button is not shown, please verify that the webhook feature is enabled and a URL is set as described above. This “replay” functionality is useful for testing. If a crawl for that policy holder has not happened yet, it will return a failure. Note that the replay will not have crawl_claim_ids and will not be retried upon failure.

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Request Retries

The request will be an HTTP POST with Content-Type header of application/json. An example of the JSON you can expect can be found at the end of this document. For Webhook POSTs, TPA Stream listens for the following codes from your server and reacts accordingly:
  • If TPA Stream receives a 200 or 2xx (Success) code it will determine the webhook POST is successful and not retry.
  • If TPA Stream receives a 406 (Not Acceptable) code, TPA Stream will determine the POST is rejected and not retry.
  • For any other code, TPA Stream will retry POSTing with an exponential backoff delay for up to 4 hours.

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Security

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TPAStream-Signature Verification

Also included in the request is a JWT signature that can be used to verify that the request has originated from TPA Stream, and not any other party. This header is passed in the TPAStream-Signature header of the request. The signature can be verified using our SSH RSA public key. The key can be obtained from TPA Stream Keys. The JWT hashing algorithm used is RS256. We strongly recommend that you verify our JWT signature as a part of your webhook. Examples of how to decode a JWT in several common programming languages can be found at JWT library. Note that the JWT library you choose must support RS256 (nearly all of them do), and should also support an exp check (although you could easily perform this simple expiration date check yourself using a UTC timestamp).

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Example Claim Webhook JSON Request

{
  "data": {
    "service_provider_billing_npi_number": null,
    "computed_coinsurance_patient": null,
    "group_name": null,
    "members": [
      {
        "id": 99999999,
        "email": "johnny@appleseed.com",
        "first_name": "Johnny",
        "last_name": "Appleseed",
        "employer": {
          "id": 999,
          "name": "Dunder Mifflin"
        }
      }
    ],
    "group_number": null,
    "eob_date": "2017-07-01T16:51:16.701956",
    "date_column": "2017-07-01T16:51:16.701956+00:00",
    "service_provider_number": "laMhYxXFh",
    "service_provider_billing_number": null,
    "coinsurance_patient": null,
    "modifieddate": "2017-06-01T04:14:29.348875+00:00",
    "service_provider_billing_address": null,
    "status": "Partially Approved",
    "amount_billed": 228,
    "reduction": null,
    "claim_medical_lines": [
      {
        "claim_medical_line_id": 10004,
        "procedure_code": "87254 - VIRUS INOCULATION SHELL VIA",
        "days_supply": null,
        "copayment": null,
        "date_of_service": {
          "bounds": "[]",
          "start": "2020-01-16",
          "end": "2020-01-17"
        },
        "vendor_system_id": "2b7e0936",
        "discount": null,
        "coinsurance_patient": null,
        "amount_allowed": null,
        "national_drug_code": null,
        "prescription_type_id": null,
        "patient_responsibility": 0,
        "procedure_name": "Preventive Visit-Ages 18-39 - see note E23",
        "prescription_type_str": null,
        "amount_billed": 228,
        "reduction": null,
        "amount_paid": null,
        "amount_not_covered": null,
        "diagnosis_code": "M19.172",
        "quantity": null,
        "amount_paid_other": null
      }
    ],
    "amount_paid_other": null,
    "computed_reduction": null,
    "vendor_system_id": "28284fbbaa164d02",
    "discount": null,
    "computed_amount_billed": null,
    "service_provider_npi_number": null,
    "patient_responsibility": 0,
    "dataobject_id": 104,
    "remarks": "leverage ubiquitous users",
    "service_provider_billing_name": null,
    "network": null,
    "amount_not_covered": null,
    "copayment": null,
    "computed_copayment": null,
    "policy_holder": {
      "id": 104,
      "first_name": "Parrish",
      "last_name": "Appleseed"
    },
    "patient_account_number": null,
    "tpafiles": [],
    "date_of_service": {
      "bounds": "[]",
      "start": "2020-01-28",
      "end": "2020-01-28"
    },
    "incurred_value": null,
    "is_incomplete": null,
    "id": 10004,
    "type": null,
    "amount_allowed": null,
    "service_provider_address": "1097 Dicha Garden",
    "claim_requests": [],
    "computed_amount_paid": null,
    "check_number": "8858906",
    "last_updated_status": "2020-02-11T13:56:45.249767+00:00",
    "processed_on": "2017-06-21T00:30:46.791615",
    "createddate": "2016-03-17T07:11:30.580677+00:00",
    "computed_amount_allowed": null,
    "dependents": [
      {
        "id": 999,
        "member_id": 9999,
        "first_name": "Sally",
        "last_name": "Appleseed",
        "email": "sally@appleseed.com",
        "ssn": "999999999",
        "relationship": "spouse",
        "createddate": "2017-07-01T16:51:16.701956",
        "modifieddate": "2017-07-01T16:51:16.701956"
      }
    ],
    "patient_payer_number": null,
    "service_provider_billing_phone": null,
    "claim_medical_id": 10004,
    "check_date": "2020-01-24T23:49:50+00:00",
    "computed_patient_responsibility": null,
    "amount_paid": null,
    "service_provider": "Salary.com",
    "patient_name": "Abram",
    "policy_holder_id": 104
  }
}