XML JSON   ( Small Full )

Job Class:

 

 Medical Only Claim (No Indemnity Costs Calculations)

Confounding Factors:

 Depression/PTSD/Psychosocial
 Diabetes
 Hypertension
 Legal Representation
 Obesity
 Smoker
 Opioids
 Substance Abuse
 Surgery or Hospital Stay
<15 Days 15-30 Days 30+ Days

Body Part Code:

Nature of Injury Code:

ICD Proc Codes:

CPT Proc Codes:

NDC Proc Codes:

HCPCS Proc Codes:


Input Request XML:

Output Response XML/JSON: