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nextvisit/claim-md-php
======================

An unofficial PHP wrapper for the official Claim.MD API.

v2.0.0(2mo ago)22.4k—10%1MITPHPPHP >=8.3CI passing

Since Sep 25Pushed 2mo ago2 watchersCompare

[ Source](https://github.com/Nextvisit/claim-md-php)[ Packagist](https://packagist.org/packages/nextvisit/claim-md-php)[ Docs](https://github.com/Nextvisit/claim-md-php)[ RSS](/packages/nextvisit-claim-md-php/feed)WikiDiscussions main Synced 1mo ago

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Claim.MD PHP SDK
================

[](#claimmd-php-sdk)

[![CLAIM.md](https://camo.githubusercontent.com/75af6bc45000afb07a64fbfd36eb58863e34dd7d0728ed48b9dbf3a243ef4cbf/68747470733a2f2f63646e2e70726f642e776562736974652d66696c65732e636f6d2f3636313932353033353563336639653133343466383062352f3636313933303566626131616566386365353835386165375f636c61696d6d645f676c6f775f3132302e706e67)](https://camo.githubusercontent.com/75af6bc45000afb07a64fbfd36eb58863e34dd7d0728ed48b9dbf3a243ef4cbf/68747470733a2f2f63646e2e70726f642e776562736974652d66696c65732e636f6d2f3636313932353033353563336639653133343466383062352f3636313933303566626131616566386365353835386165375f636c61696d6d645f676c6f775f3132302e706e67)

Welcome to the unofficial PHP SDK for the [CLAIM.MD](https://www.claim.md/) API! 🎉 This library aims to simplify interactions with the official CLAIM.md API, providing a more developer-friendly way to integrate CLAIM.md services into your PHP applications.

⚠️ Disclaimer
-------------

[](#️-disclaimer)

**Nextvisit Inc. is not affiliated with CLAIM.MD in any way. This package is provided "as is", without warranty of any kind, express or implied, including but not limited to the warranties of merchantability, fitness for a particular purpose, and noninfringement. Use at your own risk.**

That being said, if you encounter any issues or have suggestions for improvement, feel free to open an issue or contribute to the package. 😊

🌟 Features
----------

[](#-features)

This library provides a range of features to interact with the CLAIM.MD API:

### [Electronic Remittance Advice (ERA) Management](#electronic-remittance-advice-era)

[](#electronic-remittance-advice-era-management)

- [**List Received ERAs**](#get-eras-list): Get a list of all ERAs that have been received.
- [**Get ERA 835**](#get-an-era-835): Get a specific ERA in the 835 format.
- [**Get ERA PDF**](#get-an-era-pdf): Get a specific ERA in the PDF format.
- [**Get ERA PDF**](#get-an-era-pdf): Get a specific ERA in the JSON format.

### [File Management](#file-management)

[](#file-management)

- [**Upload Files**](#upload-files): Upload batch files to the CLAIM.md service.
- [**Get Upload List**](#get-upload-list): Retrieve a list of uploaded files.

### [Provider Management](#provider-management)

[](#provider-management)

- [**Enroll Providers**](#enroll-providers): Enroll providers using detailed enrollment data.
- [**Fetch Provider Enrollment**](#enroll-providers): If a provider is already enrolled, that information will be received from the same `enroll()` method.

### [Claim Management](#claim-management)

[](#claim-management)

- [**Claim Appeal**](#claim-appeal): Submit and manage claim appeals.
- [**Fetch Claim Notes**](#fetch-claim-notes): Retrieve notes made on a specific claim.
- [**Archive Claim**](#archive-claim): Archive a Claim.MD claim.
- [**Claim Modifications**](#list-claim-modifications): Retrieve modifications for claims.

### [Response (Claim Status)](#response-claim-status)

[](#response-claim-status)

##### This refers to a claim status response, not an HTTP or protocol response.

[](#this-refers-to-a-claim-status-response-not-an-http-or-protocol-response)

- [**Fetch Responses**](#fetch-response): Retrieve claim statuses (referred to as "responses" in the Claim.MD API) from the Claim MD API.
- [**Fetch All Responses**](#fetch-all-responses): Automatically handle pagination to retrieve all claim statuses.

### [Eligibility](#eligibility)

[](#eligibility)

- [**Realtime Eligibility X12 270/271**](#realtime-x12-270271-eligibility-check): Validate and check the eligibility of X12 270/271 formatted claim. Receiving the response in the format as well.
- [**Realtime Eligibility JSON**](#realtime-parameter-eligibility-check): Validate and check the eligibility of a claim via parameters. Receiving the response in JSON format.

### [Webhook](#webhook)

[](#webhook)

- [**Parse Webhook Payload**](#parse-webhook-payload): Parse inbound webhook events for provider enrollment updates and appeal form creation/updates.

### [Payer](#payers)

[](#payer)

- [**Fetch Payers**](#list-payers): Retrieve a list of payers or a specific payer.

### [Data Transfer Objects (DTOs)](#data-transfer-objects-dtos)

[](#data-transfer-objects-dtos)

#### DTOs can make passing data to and from cleaner in your code. Consider using them over a traditional array.

[](#dtos-can-make-passing-data-to-and-from-cleaner-in-your-code-consider-using-them-over-a-traditional-array)

#### Note: All methods which use a DTO can instead take an array with correct [Claim.MD API](https://api.claim.md) mappings.

[](#note-all-methods-which-use-a-dto-can-instead-take-an-array-with-correct-claimmd-api-mappings)

- [**ClaimAppealDTO**](#claimappealdto)
- [**ProviderEnrollmentDTO**](#providerenrollmentdto)
- [**EligibilityDTO**](#eligibilitydto)
- [**ERADTO**](#eradto)
- [**WebhookPayloadDTO**](#webhookpayloaddto)

### Utility Features

[](#utility-features)

- **Configuration Handling**: Easily configure the client with account keys and other settings.
- **Validation**: Built-in validation for fields like dates, emails, phone numbers, state codes, etc.

📦 Installation
--------------

[](#-installation)

You can install the package via Composer:

```
composer require nextvisit/claim-md-php
```

🛠️ Usage
--------

[](#️-usage)

### Configuration

[](#configuration)

First, configure the `Client` with your account key:

```
use Nextvisit\ClaimMD\Client;
use Nextvisit\ClaimMD\Config;

$accountKey = 'your-account-key'; // Never hardcode your keys!
$config = new Config();

$client = new Client($accountKey, $config);
```

### Electronic Remittance Advice (ERA)

[](#electronic-remittance-advice-era)

### Get ERAs List

[](#get-eras-list)

```
use Nextvisit\ClaimMD\Requests\ERARequest;
use Nextvisit\ClaimMD\DTO\ERADTO;

$eraRequest = new ERARequest($client);

// optionally pass an array or ERADTO with at least the ERA ID to get remits since then.
$eraDto = new ERADTO(eraId: 'era-id');
$recentResponse = $eraRequest->getList($eraDto);

$allResponse = $eraRequest->getList();
```

### Get an ERA 835

[](#get-an-era-835)

```
use Nextvisit\ClaimMD\Requests\ERARequest;

$eraRequest = new ERARequest($client);
$response = $eraRequest->get835('era-id');
```

### Get an ERA PDF

[](#get-an-era-pdf)

```
use Nextvisit\ClaimMD\Requests\ERARequest;

$eraRequest = new ERARequest($client);

// optional PCN can be used after the era-id.
$pcnResponse = $eraRequest->getPDF('era-id', 'pcn');

$regularResponse = $eraRequest->getPDF('era-id');
```

### Get an ERA JSON

[](#get-an-era-json)

```
use Nextvisit\ClaimMD\Requests\ERARequest;

$eraRequest = new ERARequest($client);
$response = $eraRequest->getJson('era-id');
```

### File Management

[](#file-management-1)

#### Upload Files

[](#upload-files)

```
use Nextvisit\ClaimMD\Requests\FileRequest;

$fileRequest = new FileRequest($client);
$response = $fileRequest->upload(fopen('path/to/your/file.txt', 'r'));

print_r($response);
```

#### Get Upload List

[](#get-upload-list)

```
use Nextvisit\ClaimMD\Requests\FileRequest;

$fileRequest = new FileRequest($client);
$response = $fileRequest->getUploadList();
```

### Provider Management

[](#provider-management-1)

#### Enroll Providers

[](#enroll-providers)

```
use Nextvisit\ClaimMD\Requests\ProviderRequest;
use Nextvisit\ClaimMD\DTO\ProviderEnrollmentDTO;

// If this provider is already enrolled, the response will contain that information.
$providerEnrollment = new ProviderEnrollmentDTO(
    payerId: 'payer-id',
    enrollType: 'era',
    provTaxId: 'provider-tax-id',
    provNpi: 'provider-npi',
    provNameLast: 'Doe',
    provNameFirst: 'John',
    contactEmail: 'john.doe@example.com'
);

$providerRequest = new ProviderRequest($client);
$response = $providerRequest->enroll($providerEnrollment);
```

### Claim Management

[](#claim-management-1)

#### Claim Appeal

[](#claim-appeal)

```
use Nextvisit\ClaimMD\DTO\ClaimAppealDTO;
use Nextvisit\ClaimMD\Requests\ClaimRequest;

$appealDto = new ClaimAppealDTO(
    claimId: 'claim-id',
    remoteClaimId: 'remote-claim-id',
    contactName: 'Jane Doe',
    contactEmail: 'jane.doe@example.com',
    contactPhone: '+1234567890'
);
$claimRequest = new ClaimRequest($client);
$response = $claimRequest->appeal($appealDto);
```

#### Archive Claim

[](#archive-claim)

```
use Nextvisit\ClaimMD\Requests\ClaimRequest;

$claimRequest = new ClaimRequest($client);
$response = $claimRequest->archive('claim-id');
```

#### List Claim Modifications

[](#list-claim-modifications)

```
use Nextvisit\ClaimMD\Requests\ClaimRequest;

$claimRequest = new ClaimRequest($client);

$modId = 'mod-id'; // List modifications that have occurred after modId by specifying.
$claimMdId = 'claimmd-id'; // Get responses for a specific claim.
$field = 'some-field'; // Specify changes to a particular field.
$specifiedResponse = $claimRequest->listModifications($modId, $claimMdId, $field);

// list all modifications to all claims
$allResponse = $claimRequest->listModifications();
```

#### Fetch Claim Notes

[](#fetch-claim-notes)

```
use Nextvisit\ClaimMD\Requests\ClaimRequest;

$claimRequest = new ClaimRequest($client);

// specify notesId to get notes since that note.
$noteId = 'note-id';
// specify claimId to get notes on just that claim.
$claimId = 'claim-id';
$specifiedResponse = $claimRequest->notes($noteId, $claimId);

// list all notes on all claims
$allResponse = $claimRequest->notes();
```

### Response (Claim Status)

[](#response-claim-status-1)

#### Fetch Response

[](#fetch-response)

```
use Nextvisit\ClaimMD\Requests\ResponseRequest;

$responseRequest = new ResponseRequest($client);

// Get responses since responseId
$responseId = 'response-id';
$recentResponse = $responseRequest->fetchResponses($responseId);
```

#### Fetch All Responses

[](#fetch-all-responses)

```
use Nextvisit\ClaimMD\Requests\ResponseRequest;

$responseRequest = new ResponseRequest($client);

// optionally pass the claimmd-id to get responses for that id
// Note per the ClaimMD API "Do not use this option for periodic status updates".
foreach ($responseRequest->fetchAllResponses() as $response) {
    // do something with the response
    print_r($response);
}
```

### Eligibility

[](#eligibility-1)

#### Realtime X12 270/271 Eligibility Check

[](#realtime-x12-270271-eligibility-check)

```
use Nextvisit\ClaimMD\Requests\EligibilityRequest;

$eligibilityRequest = new EligibilityRequest($client);

$eligibility270 = fopen('path/to/your/file.270', 'r');

// the response will contain a 270 file
$realtimeResponse = $eligibilityRequest->checkEligibility270271($eligibility270);
```

#### Realtime Parameter Eligibility Check

[](#realtime-parameter-eligibility-check)

```
use Nextvisit\ClaimMD\Requests\EligibilityRequest;
use Nextvisit\ClaimMD\DTO\EligibilityDTO;

$eligibilityRequest = new EligibilityRequest($client);

// build an EligibilityDTO or pass an existing array
$eligDto = new EligibilityDTO(
    insLastName: 'Doe',
    insFirstName: 'Jane',
    payerId: 'payer-id',
    // 18 or G8 are the only valid codes
    patientRelationship: '18',
    serviceDate: '20220203',
    providerNpi: 'provider-npi',
    providerTaxId: 'provider-tax-id'
);

// response will be in the response array
$response = $eligibilityRequest->checkEligibilityJSON($eligDto);
```

### Webhook

[](#webhook-1)

#### Parse Webhook Payload

[](#parse-webhook-payload)

```
use Nextvisit\ClaimMD\DTO\WebhookPayloadDTO;

// Parse directly from the raw JSON request body
$json = file_get_contents('php://input');
$webhook = WebhookPayloadDTO::fromJsonString($json);

// Or from a decoded array
$webhook = WebhookPayloadDTO::fromArray($decodedData);

// Access top-level fields
$webhook->utcTime;          // UTC current time
$webhook->acctNumber;       // Claim.MD Account Number
$webhook->remoteAcctNumber; // Customer assigned account number

// Iterate over events
foreach ($webhook->events as $event) {
    $event->eventId;   // Unique event identifier
    $event->eventType; // "enroll" or "appeal"
    $event->eventTime; // UTC time of event

    if ($event->eventType === 'enroll') {
        $event->enroll->enrollId;   // Enrollment ID
        $event->enroll->event;      // "enrolled", "received", "completed", "rejected"
        $event->enroll->enrollType; // "era", "1500", "ub", "elig", "attach"
        $event->enroll->provNpi;    // Provider NPI
        $event->enroll->payerId;    // Payer ID
    }

    if ($event->eventType === 'appeal') {
        $event->appeal->appealId;      // Appeal ID
        $event->appeal->event;         // "created", "mailed", "update", "faxed", "transmitted", "failure"
        $event->appeal->appealType;    // "electronic", "mail", "fax", "download"
        $event->appeal->claimId;       // Associated Claim.MD claim ID
        $event->appeal->remoteClaimId; // User-assigned claim ID
        $event->appeal->serviceFee;    // Service fees
        $event->appeal->pages;         // Number of pages
    }
}
```

### Payers

[](#payers)

#### List Payers

[](#list-payers)

```
use Nextvisit\ClaimMD\Requests\PayerRequest;

$payerRequest = new PayerRequest($client);

// specify a specific payer
$payerId = 'payer-id';
$specifiedPayerResponse = $payerRequest->listPayer(payerId: $payerId);

// specify a general payer name search
$payerName = 'payer-name';
$searchResponse = $payerRequest->listPayer($payerName: $payerName);

// get all payers
$allResponse = $payerRequest->listPayer();
```

### Data Transfer Objects (DTOs)

[](#data-transfer-objects-dtos-1)

#### ClaimAppealDTO

[](#claimappealdto)

```
use Nextvisit\ClaimMD\DTO\ClaimAppealDTO;

$claimAppealDto = new ClaimAppealDTO(
    claimId: '12345',
    remoteClaimId: 'remote-claim-123',
    contactName: 'John Doe',
    contactTitle: 'Claims Manager',
    contactEmail: 'john.doe@example.com',
    contactPhone: '+1-555-123-4567',
    contactFax: '+1-555-765-4321',
    contactAddr1: '123 Main St',
    contactAddr2: 'Suite 456',
    contactCity: 'Los Angeles',
    contactState: 'CA',
    contactZip: '90001'
);

// or construct from an array
$data = [
    'claimid'        => '12345',
    'remote_claimid' => 'remote-claim-123',
    'contact_name'   => 'John Doe',
    'contact_title'  => 'Claims Manager',
    'contact_email'  => 'john.doe@example.com',
    'contact_phone'  => '+1-555-123-4567',
    'contact_fax'    => '+1-555-765-4321',
    'contact_addr_1' => '123 Main St',
    'contact_addr_2' => 'Suite 456',
    'contact_city'   => 'Los Angeles',
    'contact_state'  => 'CA',
    'contact_zip'    => '90001',
];

$claimAppealDto = ClaimAppealDTO::fromArray($data);
```

#### ProviderEnrollmentDTO

[](#providerenrollmentdto)

```
use Nextvisit\ClaimMD\DTO\ProviderEnrollmentDTO;

$providerEnrollmentDto = new ProviderEnrollmentDTO(
    payerId: 'payer-123',
    enrollType: 'era',
    provTaxId: '123456789',
    provNpi: '9876543210',
    provNameLast: 'Doe',
    provNameFirst: 'John',
    provNameMiddle: 'M',
    contact: 'Jane Smith',
    contactTitle: 'Billing Manager',
    contactEmail: 'jane.smith@example.com',
    contactPhone: '+1-555-123-4567',
    contactFax: '+1-555-765-4321',
    provId: 'provider-id-123',
    provAddr1: '123 Main St',
    provAddr2: 'Suite 100',
    provCity: 'Los Angeles',
    provState: 'CA',
    provZip: '90001'
);

// or generate from an array
$data = [
    'payerid'        => 'payer-123',
    'enroll_type'    => 'era',
    'prov_taxid'     => '123456789',
    'prov_npi'       => '9876543210',
    'prov_name_l'    => 'Doe',
    'prov_name_f'    => 'John',
    'prov_name_m'    => 'M',
    'contact'        => 'Jane Smith',
    'contact_title'  => 'Billing Manager',
    'contact_email'  => 'jane.smith@example.com',
    'contact_phone'  => '+1-555-123-4567',
    'contact_fax'    => '+1-555-765-4321',
    'prov_id'        => 'provider-id-123',
    'prov_addr_1'    => '123 Main St',
    'prov_addr_2'    => 'Suite 100',
    'prov_city'      => 'Los Angeles',
    'prov_state'     => 'CA',
    'prov_zip'       => '90001',
];

$providerEnrollmentDto = ProviderEnrollmentDTO::fromArray($data);
```

#### EligibilityDTO

[](#eligibilitydto)

```
use Nextvisit\ClaimMD\DTO\EligibilityDTO;

$eligibilityDto = new EligibilityDTO(
    insLastName: 'Doe',
    insFirstName: 'John',
    payerId: 'payer-123',
    patientRelationship: '18',
    serviceDate: '20230920',
    providerNpi: '9876543210',
    providerTaxId: '123456789',
    insMiddleName: 'M',
    serviceCode: 'SC123',
    procCode: 'PC456',
    insNumber: 'INS987654',
    insDob: '19800101',
    insSex: 'M',
    patLastName: 'Smith',
    patFirstName: 'Jane',
    patMiddleName: 'K',
    patDob: '20100101',
    patSex: 'F',
    provNameLast: 'Doe',
    provNameFirst: 'Jane',
    provTaxonomy: '207Q00000X',
    provTaxIdType: 'E',
    provAddr1: '123 Main St',
    provCity: 'Los Angeles',
    provState: 'CA',
    provZip: '90001'
);

// or convert an array to DTO
$data = [
    'ins_name_l' => 'Doe',
    'ins_name_f' => 'John',
    'payerid' => 'payer-123',
    'pat_rel' => '18',
    'fdos' => '20230920',
    'prov_npi' => '9876543210',
    'prov_taxid' => '123456789',
    'ins_name_m' => 'M',
    'service_code' => 'SC123',
    'proc_code' => 'PC456',
    'ins_number' => 'INS987654',
    'ins_dob' => '19800101',
    'ins_sex' => 'M',
    'pat_name_l' => 'Smith',
    'pat_name_f' => 'Jane',
    'pat_name_m' => 'K',
    'pat_dob' => '20100101',
    'pat_sex' => 'F',
    'prov_name_l' => 'Doe',
    'prov_name_f' => 'Jane',
    'prov_taxonomy' => '207Q00000X',
    'prov_taxid_type' => 'E',
    'prov_addr_1' => '123 Main St',
    'prov_city' => 'Los Angeles',
    'prov_state' => 'CA',
    'prov_zip' => '90001',
];

$eligibilityDto = EligibilityDTO::fromArray($data);
```

#### ERADTO

[](#eradto)

```
use Nextvisit\ClaimMD\DTO\ERADTO;

$eraDto = new ERADTO(
    checkDate: '09-01-2023',
    receivedDate: 'today',
    receivedAfterDate: '08-01-2023',
    checkNumber: '123456',
    checkAmount: '1000.00',
    payerId: 'payer-123',
    npi: '9876543210',
    taxId: '123456789',
    newOnly: '1',
    eraId: 'ERA12345',
    page: '1'
);

// or convert an array to DTO
$data = [
    'CheckDate' => '09-01-2023',
    'ReceivedDate' => 'today',
    'ReceivedAfterDate' => '08-01-2023',
    'CheckNumber' => '123456',
    'CheckAmount' => '1000.00',
    'PayerID' => 'payer-123',
    'NPI' => '9876543210',
    'TaxID' => '123456789',
    'NewOnly' => '1',
    'ERAID' => 'ERA12345',
    'Page' => '1',
];

$eraDto = ERADTO::fromArray($data);
```

#### WebhookPayloadDTO

[](#webhookpayloaddto)

```
use Nextvisit\ClaimMD\DTO\WebhookPayloadDTO;

// Parse from a raw JSON string (e.g., webhook request body)
$json = file_get_contents('php://input');
$webhookPayload = WebhookPayloadDTO::fromJsonString($json);

// Or from a decoded array
$data = [
    'UTCTime'            => '2026-03-13T12:00:00Z',
    'acct_number'        => 'ACCT-001',
    'remote_acct_number' => 'REMOTE-001',
    'events'             => [
        [
            'eventid'    => 'EVT-001',
            'event_type' => 'enroll',
            'event_time' => '2026-03-13T11:00:00Z',
            'event_data' => [
                'enroll' => [
                    'enrollid'    => 'ENR-001',
                    'event'       => 'enrolled',
                    'enroll_type' => 'era',
                    'prov_npi'    => '1234567890',
                    'payerid'     => 'PAYER-001',
                ],
            ],
        ],
    ],
];

$webhookPayload = WebhookPayloadDTO::fromArray($data);
```

🤝 Contributing
--------------

[](#-contributing)

Contributions are welcome! If you find any issues or have suggestions for improvements, feel free to open an issue or submit a pull request.

📄 License
---------

[](#-license)

This package is licensed under the MIT License. See the [LICENSE](LICENSE) file for more information.

Credits
-------

[](#credits)

- [Nextvisit AI](https://nextvisit.ai)
- [Ryan Yannelli](https://ryanyannelli.com)
- [Kyle Yannelli](https://github.com/kyleyannelli)

###  Health Score

48

—

FairBetter than 95% of packages

Maintenance87

Actively maintained with recent releases

Popularity25

Limited adoption so far

Community11

Small or concentrated contributor base

Maturity56

Maturing project, gaining track record

 Bus Factor1

Top contributor holds 92.5% of commits — single point of failure

How is this calculated?**Maintenance (25%)** — Last commit recency, latest release date, and issue-to-star ratio. Uses a 2-year decay window.

**Popularity (30%)** — Total and monthly downloads, GitHub stars, and forks. Logarithmic scaling prevents top-heavy scores.

**Community (15%)** — Contributors, dependents, forks, watchers, and maintainers. Measures real ecosystem engagement.

**Maturity (30%)** — Project age, version count, PHP version support, and release stability.

###  Release Activity

Cadence

Every ~267 days

Total

3

Last Release

66d ago

Major Versions

v1.1.0 → v2.0.02026-03-13

PHP version history (2 changes)1.0.0PHP >=8.2

v2.0.0PHP >=8.3

### Community

Maintainers

![](https://www.gravatar.com/avatar/53b64331d4de8c9cef47bc20707ed728c0e900cd2bda4ed7d95359ced8b9adf1?d=identicon)[yannelli](/maintainers/yannelli)

---

Top Contributors

[![yannelli](https://avatars.githubusercontent.com/u/59575788?v=4)](https://github.com/yannelli "yannelli (49 commits)")[![kyleyannelli](https://avatars.githubusercontent.com/u/32677784?v=4)](https://github.com/kyleyannelli "kyleyannelli (4 commits)")

---

Tags

insurance-claimsx12apiphp-wrapperx12claimmdinsurance-claims

###  Code Quality

TestsPest

### Embed Badge

![Health badge](/badges/nextvisit-claim-md-php/health.svg)

```
[![Health](https://phpackages.com/badges/nextvisit-claim-md-php/health.svg)](https://phpackages.com/packages/nextvisit-claim-md-php)
```

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