Medical treatments

For Medical Details exposures, each workers' compensation claim can have one or more medical treatments. For example, lab work or an MRI. You can associate one or more ICD codes with each medical treatment. See Managing ICD codes. For more information on the business functionality of medical treatments for workers' compensation claims, refer to the Application Guide.

Querying for medical treatments

Use the following endpoint to retrieve all medical treatments for a claim assigned to the user you authenticated as:
  • GET /claims/{claimId}/medical-treatments

Use the following endpoint to retrieve a single medical treatment:

  • GET /claims/{claimId}/medical-treatments/{medicalTreatmentId}

For example, the following query returns information about medical treatment cc:S8KUjDftzeowY-mfjAnAF:

Command

GET claim/v1/claims/demo_sample:3001/medical-treatments/cc:S8KUjDftzeowY-mfjAnAF

Response

{
    "data": {
        "attributes": {
            "actionDate": "2025-02-18T00:00:00.000Z",
            "approvedTreatment": {
                "code": "LabXrayPath",
                "name": "Lab, x-ray, or path work"
            },
            "contact": {
                "displayName": "DoctorFrom Arcadia Medical Group",
                "id": "cc:S8THSfkC2CNMEBdQLNLho",
                "type": "ClaimContact",
                "uri": "/claim/v1/claims/demo_sample:3001/contacts/cc:S8THSfkC2CNMEBdQLNLho"
            },
            "icd1": "M25.831",
            "id": "cc:S8KUjDftzeowY-mfjAnAF",
            "treatmentQuantity": 1
        },

POSTing medical treatments

Use the following endpoint to POST a medical treatment:

  • POST /claims/{claimId}/medical-treatments

The minimum required fields are:

  • contact An id value representing the provider (Doctor contact).
  • actionDate A date representing the date the treatment was authorized.
  • approvedTreatment A typecode from the ApprovedTreatment typelist. This represents the approved treatment.
    Note: In the base application, the contact must have one of the following medical provider roles:
    • TC_DOCTOR
    • TC_FIRSTINTAKEDOCTOR
    • TC_PRIMARYDOCTOR
    • TC_OCCTHERAPIST
    • TC_PHYSTHERAPIST

      This is enforced by the ClaimCenter Gosu claim validation rule CLV17000, which you can configure with alternate logic. See the Gosu Rules Guide.

The following fields are optional:

  • icd1 A String of up to 8 characters representing the first ICD-10 code.
  • icd2 A String of up to 8 characters representing the second ICD-10 code.
  • icd3 A String of up to 8 characters representing the third ICD-10 code.
  • icd4 A String of up to 8 characters representing the fourth ICD-10 code.
  • treatmentQuantity An integer representing the quantity of treatments approved.

For example, the following request creates a new physical therapy medical treatment with 4 ICD codes (three of which represent the three types of typhoid fever):

Command

POST /claims/{claimId}/medical-treatments

Request

{
  "data": {
    "attributes": {
      "actionDate": "2025-02-14T00:00:00.000Z",
      "approvedTreatment": {
        "code": "PT"
      },
      "contact": {
        "id": "cc:S8THSfkC2CNMEBdQLNLho"
      },
      "icd1": "A01.01",
      "icd2": "A01.02",
      "icd3": "A01.03",
      "icd4": "S53.402A",
      "treatmentQuantity": 2
    }
  }
}

Response

{
    "data": {
        "attributes": {
            "actionDate": "2025-02-14T00:00:00.000Z",
            "approvedTreatment": {
                "code": "PT",
                "name": "Physical therapy"
            },
            "contact": {
                "displayName": "DoctorFrom Arcadia Medical Group",
                "id": "cc:S8THSfkC2CNMEBdQLNLho",
                "type": "ClaimContact",
                "uri": "/claim/v1/claims/demo_sample:3001/contacts/cc:S8THSfkC2CNMEBdQLNLho"
            },
            "icd1": "A01.01",
            "icd2": "A01.02",
            "icd3": "A01.03",
            "icd4": "S53.402A",
            "id": "cc:SPi_EZ_Ibyq_DvpKDO6Gr",
            "treatmentQuantity": 2
        },
        "checksum": "0",
        "links": {
            "self": {
                "href": "/claim/v1/claims/demo_sample:3001/medical-treatments/cc:SPi_EZ_Ibyq_DvpKDO6Gr",
                "methods": [
                    "delete",
                    "get",
                    "patch"
                ]
            }
        }
    }
}

PATCHing medical treatments

Use the following endpoint to PATCH a medical treatment:

  • PATCH /claims/{claimId}/medical-treatments/{medicalTreatmentId}

For example, the following request modifies the code for the third ICD Code created in the previous example to something less scary than typhoid (a paper cut - ICD-10 code W26.2).

Command

PATCH /claims/demo_sample:3001/medical-treatments/cc:SPi_EZ_Ibyq_DvpKDO6Gr

Request

{
  "data": {
    "attributes": {
      "icd3": "W26.2"
    }
  }
}

Response

{
    "data": {
        "attributes": {
            "actionDate": "2025-02-14T00:00:00.000Z",
            "approvedTreatment": {
                "code": "PT",
                "name": "Physical therapy"
            },
            "contact": {
                "displayName": "DoctorFrom Arcadia Medical Group",
                "id": "cc:S8THSfkC2CNMEBdQLNLho",
                "type": "ClaimContact",
                "uri": "/claim/v1/claims/demo_sample:3001/contacts/cc:S8THSfkC2CNMEBdQLNLho"
            },
            "icd1": "A01.01",
            "icd2": "A01.02",
            "icd3": "W26.2",
            "icd4": "S53.402A",
            "id": "cc:SPi_EZ_Ibyq_DvpKDO6Gr",
            "treatmentQuantity": 2
        },
        "checksum": "1",
        "links": {
            "self": {
                "href": "/claim/v1/claims/demo_sample:3001/medical-treatments/cc:SPi_EZ_Ibyq_DvpKDO6Gr",
                "methods": [
                    "delete",
                    "get",
                    "patch"
                ]
            }
        }
    }
}