Supergood | ClaimLogiq API
Programmatically access claim review, documentation requests, audit determinations, and dispute workflows in ClaimLogiq with a stable REST API. Supergood builds and operates production-grade, unofficial ClaimLogiq integrations so your team can automate critical payment integrity and billing pipelines without heavy custom engineering.
In plain English: ClaimLogiq is software health plans and TPAs use to review medical claims before payment, apply coding and clinical rules, request documentation, and determine whether a claim is approved, adjusted, or denied. With an unofficial API, a healthcare tech startup focused on billing or practice management could see which claims are under review, what documents are requested, upload medical records, track determinations, and reconcile financial impacts—without manual portal work.
If you’re building integrations for providers, clinics, or revenue cycle teams, tying your stack into ClaimLogiq unlocks concrete data flows and features for both sides:
- Pull: Claim review queues, line-level reason codes, documentation requirements, due dates, audit notes, determinations, adjustments/savings
- Push: Medical records and supporting documents, query responses, disputes/appeals with narratives, provider contact updates
- Build: Workflow routing for document intake, authorization-aware claim editing, denial prevention dashboards, reconciliation views combining claim review outcomes with remit data
What is ClaimLogiq?
ClaimLogiq provides payment integrity and claim auditing solutions used by health plans, TPAs, and administrators to ensure claims are accurate, medically necessary, and compliant prior to payment. Their platform supports configurable pre-payment review rules, clinical and coding audits, provider communications for documentation, and dispute/appeal resolution with detailed audit trails and savings reporting.
Core product areas include:
- Pre-payment claim audits (coding, clinical, policy edits)
- Documentation request and intake workflows
- Provider communication and query management
- Determinations (approve, adjust, deny) with line-level granularity
- Savings and adjustment tracking with reporting
- Audit trails, compliance evidence, and case management
Common data entities:
- Claims and Claim Lines (CPT/HCPCS, modifiers, units, billed amounts)
- Providers (NPI, taxonomy, contact details)
- Members/Patients (identifiers, eligibility references)
- Audit Cases/Claim Reviews (status, reason codes, notes)
- Documentation Requests (required items, due dates)
- Determinations and Adjustments (final status, savings, line impacts)
- Disputes/Appeals (narratives, attachments, outcomes)
- Payers/Plans and programs
The ClaimLogiq Integration Challenge
Organizations rely on ClaimLogiq daily, but turning portal-based review workflows into automated pipelines is hard:
- Payer-specific configurations: Each plan enables unique rules, categories, and documentation standards
- Strong enterprise security: SSO/MFA and network controls complicate headless automation
- Portal-first delivery: Key review queues, requests, and determinations live in web apps or batch reports—not unified public APIs
- File interfaces and timing windows: Document intake often requires specific formats, naming conventions, and response windows
- Compliance and audit trails: Responses, edits, and appeals must carry appropriate rationale and be traceable for oversight
How Supergood Creates ClaimLogiq APIs
Supergood reverse-engineers authenticated browser flows, document intake, and network interactions to deliver a resilient API endpoint layer.
- Handles username/password, SSO/OAuth, and MFA (SMS, email, TOTP) securely
- Maintains session continuity with automated refresh and change detection
- Normalizes claim, review, and determination objects so you can integrate once across payers/plans
- Aligns with customer entitlements and licensing constraints to ensure compliant access
- Bridges portal and file/document workflows with signed URL retrieval and delivery
Use Cases
RCM-to-Review Synchronization
- Pull claim reviews into your RCM work queue with statuses, reason codes, and due dates
- Route documentation requests to staff automatically with templates and required items
- Maintain a source of truth for review outcomes and payment impacts
Document Intake Automation
- Upload medical records, itemized bills, and supporting letters directly from your EHR or document repository
- Track receipt acknowledgments and deficiencies in real time
- Reduce cycle time and avoid missed due dates
Dispute and Appeal Management
- Submit and track disputes/appeals programmatically with narratives and attachments
- Monitor outcomes at claim and line level with adjustment reasons
- Feed results back into denial prevention analytics
Pre-Payment Intelligence in Billing
- Surface pending review flags to billers before submission to reduce avoidable edits
- Align claim edits with payer rule categories and historical findings
- Forecast potential adjustments and savings to plan work efforts
Audit and Compliance
- Export complete case packets with requests, responses, notes, and determinations
- Maintain machine-readable audit trails aligned to payer documentation standards
- Prove timely responses and rationale during reviews
Available Endpoints
Authentication
POST /sessions: Establish a session using credentials. Supergood manages MFA (SMS, email, TOTP) and SSO/OAuth when enabled. Returns a short-lived auth token maintained by the platform.
curl --request POST \
--url https://api.supergood.ai/integrations/<integration_id>/sessions \
--header 'Authorization: Basic <Base64 encoded token>' \
--header 'Content-Type: application/json' \
--data '{
"username": "[email protected]",
"password": "<password>",
"mfa": {
"type": "totp",
"code": "123456"
}
}'
Example response
{
"authToken": "eyJhbGciOi...",
"expiresIn": 3600,
"user": {
"id": "u_7f19ac",
"name": "Claims Admin",
"entitlements": ["claim_reviews", "documents", "determinations", "disputes"]
}
}
Claim Reviews
GET /claim-reviews: Retrieve claims currently under payment integrity review with line-level reason codes, requested documentation, and due dates.
Query parameters
- claimId: string
- providerNpi: string
- status: string (pending_provider, in_review, adjusted, denied, approved)
- requestedBy: string (payer/plan identifier)
- activeOn: ISO 8601 date
Example response
{
"items": [
{
"reviewId": "rev_8c21b3",
"claimId": "clm_20250119_991231",
"payerId": "payer_acme-tpa",
"plan": "Commercial PPO",
"providerNpi": "1234567890",
"memberId": "mem_44902",
"dateOfServiceStart": "2026-01-10",
"dateOfServiceEnd": "2026-01-10",
"billedAmount": 1240.00,
"status": "pending_provider",
"reasonCodes": [
{"code": "MED_NECESSITY", "type": "clinical", "description": "Medical necessity validation required"},
{"code": "CODING_NCCI", "type": "coding", "description": "Possible NCCI edit on line 2"}
],
"documentationRequests": {
"dueDate": "2026-01-25",
"requiredItems": ["Progress Notes", "Operative Report", "Itemized Bill"],
"deliveryMethods": ["portal_upload", "sftp"],
"contact": {"email": "[email protected]", "phone": "+1-800-555-0199"}
},
"lineItems": [
{
"lineNumber": 1,
"procedureCode": "99213",
"modifiers": ["25"],
"units": 1,
"billedAmount": 140.00,
"flags": []
},
{
"lineNumber": 2,
"procedureCode": "11042",
"modifiers": [],
"units": 1,
"billedAmount": 1100.00,
"flags": ["CODING_NCCI"]
}
],
"savingsEstimate": 320.00,
"createdAt": "2026-01-19T15:02:02Z"
}
],
"page": 1,
"pageSize": 50,
"total": 1
}
Documentation Uploads
POST /claim-reviews/{reviewId}/documents: Upload medical records, itemized bills, and supporting documentation in response to requests. Supergood returns acknowledgments and tracks processing status.
curl --request POST \
--url https://api.supergood.ai/integrations/<integration_id>/claim-reviews/rev_8c21b3/documents \
--header 'Authorization: Bearer <authToken>' \
--header 'Content-Type: application/json' \
--data '{
"files": [
{
"filename": "progress-notes_2026-01-10.pdf",
"mimeType": "application/pdf",
"fileUrl": "https://your-s3-bucket.s3.amazonaws.com/progress-notes_2026-01-10.pdf",
"documentType": "Progress Notes"
},
{
"filename": "itemized-bill_2026-01-10.csv",
"mimeType": "text/csv",
"fileUrl": "https://your-s3-bucket.s3.amazonaws.com/itemized-bill_2026-01-10.csv",
"documentType": "Itemized Bill"
}
],
"referenceId": "ehr-doc-batch-42391"
}'
Example response
{
"reviewId": "rev_8c21b3",
"receipts": [
{"documentId": "doc_f91a2c", "filename": "progress-notes_2026-01-10.pdf", "status": "received"},
{"documentId": "doc_7bc481", "filename": "itemized-bill_2026-01-10.csv", "status": "received"}
],
"deficiencies": [],
"referenceId": "ehr-doc-batch-42391"
}
Disputes and Appeals
POST /disputes: Submit a dispute or appeal referencing a claim review or determination with narrative and attachments.
curl --request POST \
--url https://api.supergood.ai/integrations/<integration_id>/disputes \
--header 'Authorization: Bearer <authToken>' \
--header 'Content-Type: application/json' \
--data '{
"reviewId": "rev_8c21b3",
"claimId": "clm_20250119_991231",
"determinationId": "det_55af9e",
"reasonCode": "APPEAL_MED_NEC",
"narrative": "Supporting documentation demonstrates medical necessity per policy X.",
"attachments": ["doc_f91a2c", "doc_7bc481"],
"requestedAction": "overturn",
"referenceId": "appeal-jan-25-A1"
}'
Example response
{
"disputeId": "dsp_9e2101",
"status": "submitted",
"receivedAt": "2026-01-25T10:12:41Z",
"serviceLevel": {"type": "standard", "targetDays": 15},
"nextEventDue": "2026-02-09",
"referenceId": "appeal-jan-25-A1"
}
Determinations and Savings
GET /determinations: Retrieve audit outcomes and payment impacts at claim and line levels.
Query parameters
- claimId: string
- reviewId: string
- status: string (approved, adjusted, denied)
- since: ISO 8601 timestamp
Example response
{
"items": [
{
"determinationId": "det_55af9e",
"reviewId": "rev_8c21b3",
"claimId": "clm_20250119_991231",
"finalStatus": "adjusted",
"paymentImpact": {
"originalBilled": 1240.00,
"allowed": 920.00,
"savingsRealized": 320.00
},
"adjustments": [
{
"lineNumber": 2,
"procedureCode": "11042",
"originalAmount": 1100.00,
"allowedAmount": 780.00,
"adjustmentReason": {"ansiCode": "CO-97", "description": "Payment is adjusted; policy limitation"}
}
],
"notes": [
{"author": "ClaimLogiq Reviewer", "timestamp": "2026-01-26T14:05:00Z", "text": "Documentation reviewed; partial denial maintained per policy."}
],
"publishedAt": "2026-01-26T14:10:12Z"
}
],
"page": 1,
"pageSize": 50,
"total": 1
}
Technical Specifications
- Authentication: Username/password with MFA (SMS, email, TOTP) and SSO/OAuth where enabled; supports service accounts or customer-managed credentials
- Response format: JSON with consistent resource schemas and pagination
- Rate limits: Tuned for enterprise throughput while honoring licensing and usage controls
- Session management: Automatic reauth and cookie/session rotation with health checks
- Data freshness: Near real-time retrieval of claim reviews, documentation receipts, and determinations
- Security: Encrypted transport, scoped tokens, and audit logging; respects ClaimLogiq entitlements and compliance requirements
- Webhooks: Optional asynchronous delivery for documentation receipts, determinations, and dispute outcomes
Performance Characteristics
- Latency: Sub-second responses for list/detail queries under normal load
- Throughput: Designed for high-volume document intake and claim review synchronization
- Reliability: Retry logic, backoff, and idempotency keys minimize duplicate actions
- Adaptation: Continuous monitoring for UI/API changes with rapid adapter updates
Getting Started
- Schedule Integration Assessment
Book a 30-minute session to confirm your ClaimLogiq product mix, licensing, and authentication model.
- Supergood Builds and Validates Your API
We deliver a hardened ClaimLogiq adapter tailored to your workflows and entitlements.
- Deploy with Monitoring
Go live with continuous monitoring and automatic adjustments as ClaimLogiq evolves.
Frequently Asked Questions
Q: Which ClaimLogiq products can this integration cover?
Supergood supports workflows across commonly used ClaimLogiq payer/TPA-facing portals and case management tools, subject to your licensing and entitlements. We scope coverage (e.g., claim review queues, documentation intake, determinations, dispute submission) during integration assessment.
Q: How are MFA, SSO, and document/file interfaces handled for automation?
We support username/password + MFA (SMS, email, TOTP) and can operate behind SSO/OAuth when enabled. For document flows, we manage portal upload conventions, generate signed URLs, and return delivery confirmations programmatically.
Q: Can I manage disputes and track determinations programmatically?
Yes. You can submit disputes/appeals with narratives and attachments, and retrieve determinations and payment impacts at claim and line levels. We surface reason codes and notes to drive your RCM workflows.
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