Health Insurance Claim Packets API reference

PostalForm uses the same workflow definition for this API reference and its guided browser form. Fetch the live schema, collect the active required fields and attachments, and validate the completed request. Review the generated PDF, resolved recipient, mailing service and price with the owner before authorizing payment.

Send a top-level form instead of pdf or letter; those three document sources are mutually exclusive. Workflow forms are letters, not postcards. The machine envelope requires buyer, sender and recipient fields. For predefined or computed recipients, the server binds the final recipient to the workflow rules. Inspect the resolved recipient returned by validation; do not substitute a convenient office address.

The template below is structural, not ready to submit: replace every placeholder, complete the active fields, omit unused optional attachments, and use the field options and visibility rules in the schema. Empty strings and unchecked checkboxes are not user answers. Never infer a signature, legal eligibility, factual declaration or consent from a default value.

{
  "request_id": "<new UUID; preserve on retry>",
  "buyer_name": "<buyer name>",
  "buyer_email": "<buyer email>",
  "sender_name": "<sender name>",
  "sender_address_type": "Manual",
  "sender_address_manual": {
    "line1": "<street address>",
    "city": "<city>",
    "state": "<state or region>",
    "zip": "<postal code>",
    "countryCode": "US"
  },
  "recipient_name": "<confirmed recipient name>",
  "recipient_address_type": "Manual",
  "recipient_address_manual": {
    "line1": "<street address>",
    "city": "<city>",
    "state": "<state or region>",
    "zip": "<postal code>",
    "countryCode": "US"
  },
  "mail_class": "standard",
  "double_sided": true,
  "color": false,
  "certified": false,
  "form": {
    "slug": "health-insurance-claim-packets",
    "fields": {
      "lane_initial_claim": false,
      "lane_supporting_documents": false,
      "lane_reprocessing_request": false,
      "lane_accident_or_cob_follow_up": false,
      "patient_name": "",
      "member_id": "",
      "patient_date_of_birth": "",
      "plan_name": "",
      "claim_number": "",
      "request_reference": "",
      "provider_name": "",
      "amount_claimed": "",
      "service_from_date": "",
      "service_to_date": "",
      "submission_deadline": "",
      "request_summary": "",
      "requested_action": "",
      "requested_by_date": "",
      "previous_submission_details": "",
      "reprocessing_context": "",
      "accident_or_other_insurance_details": "",
      "sender_name": "",
      "sender_role": "",
      "sender_email": "",
      "sender_phone": "",
      "sender_address": "",
      "payer_name": "",
      "recipient_name": "",
      "recipient_address": "",
      "payer_instructions_acknowledged": false,
      "appeal_process_acknowledged": false,
      "acceptance_acknowledged": false
    },
    "attachments": [
      {
        "id": "claim_forms",
        "file_name": "<filename>",
        "base64": "<base64 file content>"
      },
      {
        "id": "itemized_bills",
        "file_name": "<filename>",
        "base64": "<base64 file content>"
      },
      {
        "id": "eobs_or_denial_letters",
        "file_name": "<filename>",
        "base64": "<base64 file content>"
      },
      {
        "id": "medical_records",
        "file_name": "<filename>",
        "base64": "<base64 file content>"
      },
      {
        "id": "payer_correspondence",
        "file_name": "<filename>",
        "base64": "<base64 file content>"
      },
      {
        "id": "other_supporting_documents",
        "file_name": "<filename>",
        "base64": "<base64 file content>"
      }
    ]
  }
}

Compound fields use nested objects keyed by subfield ID. Evaluate group and field visibility before deciding which fields are active. Conditional requirements, validation rules, recipient rules, attachment formats and compliance policies are preserved in the complete schema below.

{
  "schema_version": 1,
  "workflow_version": 1,
  "slug": "health-insurance-claim-packets",
  "name": "Health Insurance Claim Packets",
  "description": "Build a health insurance claim packet online, review the generated PDF, and mail it to the payer or claims department with tracking.",
  "agent_summary": "Collect the patient, payer, claim, sender, deadline, and attachment details needed to prepare a mailed claim submission, requested-document response, or informal reprocessing packet. Require the user to verify the plan's current procedure, destination, and deadline, and do not represent this workflow as a formal appeal.",
  "form_summary": "Use this workflow to organize a mailed health insurance claim, requested-document response, or informal reprocessing packet with a cover page, claim letter, summary, exhibit index, and supporting documents. It is not a substitute for the plan's formal appeal or external-review process.",
  "data_collected": [
    "Patient or member details, plan details, and service dates",
    "Health insurer, claims department, and mailing destination",
    "Claim or reimbursement summary, claim number, and requested action",
    "Claim forms, bills, EOBs or denial letters, medical records, and supporting correspondence"
  ],
  "topics": [
    "health insurance",
    "insurance",
    "claims",
    "medical"
  ],
  "category": "health_insurance_claim_packets",
  "publish_state": "published",
  "aliases": [
    "health-insurance-claim-packet",
    "medical-claim-packets"
  ],
  "llms": true,
  "indexable": true,
  "certified_mail": "optional",
  "recipient": {
    "mode": "user"
  },
  "checkout_flow": "forms_order",
  "published_at": "2026-04-24",
  "updated_at": "2026-07-11",
  "groups": [
    {
      "id": "packet_type",
      "label": "Claim packet type",
      "description": "What are you mailing? Pick the option that matches the letter or claim you have — we'll tailor the packet to it.",
      "depends_on": []
    },
    {
      "id": "patient",
      "label": "Patient and member details",
      "description": "Identify the patient, member, and plan details that should appear in the packet.",
      "depends_on": []
    },
    {
      "id": "claim",
      "label": "Claim details",
      "description": "Explain the services, claim context, and the action you want the payer to take.",
      "depends_on": []
    },
    {
      "id": "sender",
      "label": "Your details",
      "description": "Provide the sender information that should appear in the packet and return address.",
      "depends_on": []
    },
    {
      "id": "recipient",
      "label": "Payer mailing address",
      "description": "Enter the claims department or payer mailing address you want the packet mailed to.",
      "depends_on": []
    },
    {
      "id": "review",
      "label": "Submission review",
      "description": "Confirm the payer's current claim procedure, destination, documents, and deadline before building the packet.",
      "depends_on": []
    }
  ],
  "fields": [
    {
      "id": "lane_initial_claim",
      "label": "New claim or reimbursement packet",
      "type": "checkbox",
      "required": true,
      "meta_class": "radio",
      "ui_width": null,
      "group_id": "packet_type",
      "choice_group": "packet_type_selection",
      "choice_label": "Which packet type best matches what you need?",
      "depends_on": [],
      "compound": null
    },
    {
      "id": "lane_supporting_documents",
      "label": "Requested supporting documents",
      "type": "checkbox",
      "required": true,
      "meta_class": "radio",
      "ui_width": null,
      "group_id": "packet_type",
      "choice_group": "packet_type_selection",
      "choice_label": "Which packet type best matches what you need?",
      "depends_on": [],
      "compound": null
    },
    {
      "id": "lane_reprocessing_request",
      "label": "Claim reprocessing or follow-up",
      "type": "checkbox",
      "required": true,
      "meta_class": "radio",
      "ui_width": null,
      "group_id": "packet_type",
      "choice_group": "packet_type_selection",
      "choice_label": "Which packet type best matches what you need?",
      "depends_on": [],
      "compound": null
    },
    {
      "id": "lane_accident_or_cob_follow_up",
      "label": "Accident or coordination-of-benefits follow-up",
      "type": "checkbox",
      "required": true,
      "meta_class": "radio",
      "ui_width": null,
      "group_id": "packet_type",
      "choice_group": "packet_type_selection",
      "choice_label": "Which packet type best matches what you need?",
      "depends_on": [],
      "compound": null
    },
    {
      "id": "patient_name",
      "label": "Patient or member full name",
      "type": "text",
      "required": true,
      "meta_class": null,
      "ui_width": "half",
      "group_id": "patient",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "member_id",
      "label": "Member ID or subscriber number",
      "type": "text",
      "required": true,
      "meta_class": null,
      "ui_width": "half",
      "group_id": "patient",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "patient_date_of_birth",
      "label": "Patient date of birth (optional)",
      "type": "date",
      "required": false,
      "meta_class": "date",
      "ui_width": "half",
      "group_id": "patient",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "plan_name",
      "label": "Plan or insurer name (optional)",
      "type": "text",
      "required": false,
      "meta_class": null,
      "ui_width": "half",
      "group_id": "patient",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "claim_number",
      "label": "Claim number (if you have one)",
      "type": "text",
      "required": false,
      "meta_class": null,
      "ui_width": "half",
      "group_id": "claim",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "request_reference",
      "label": "Payer letter date or request reference (optional)",
      "type": "text",
      "required": false,
      "meta_class": null,
      "ui_width": "half",
      "group_id": "claim",
      "choice_group": null,
      "choice_label": null,
      "visibility": {
        "fieldId": "lane_initial_claim",
        "operator": "falsy"
      },
      "depends_on": [
        "lane_initial_claim"
      ],
      "compound": null
    },
    {
      "id": "provider_name",
      "label": "Provider or facility name",
      "type": "text",
      "required": true,
      "meta_class": null,
      "ui_width": "half",
      "group_id": "claim",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "amount_claimed",
      "label": "Claim amount or reimbursement amount (optional)",
      "type": "text",
      "required": false,
      "meta_class": "currency",
      "ui_width": "half",
      "group_id": "claim",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "service_from_date",
      "label": "Service from date (optional)",
      "type": "date",
      "required": false,
      "meta_class": "date",
      "ui_width": "half",
      "group_id": "claim",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "service_to_date",
      "label": "Service to date (optional)",
      "type": "date",
      "required": false,
      "meta_class": "date",
      "ui_width": "half",
      "group_id": "claim",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "submission_deadline",
      "label": "Payer filing or response deadline (optional)",
      "type": "date",
      "required": false,
      "meta_class": "date",
      "ui_width": "half",
      "group_id": "claim",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "request_summary",
      "label": "In 1-2 sentences, what should the payer know first?",
      "type": "textarea",
      "required": true,
      "placeholder": "e.g., Requesting reimbursement for out-of-network visits on 3/2 and 3/9; claim form and itemized bills enclosed.",
      "meta_class": null,
      "ui_width": null,
      "group_id": "claim",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "requested_action",
      "label": "What do you want the payer to do? (optional)",
      "type": "textarea",
      "required": false,
      "meta_class": null,
      "ui_width": null,
      "group_id": "claim",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "requested_by_date",
      "label": "Requested response or review date (optional)",
      "type": "date",
      "required": false,
      "meta_class": "date",
      "ui_width": "half",
      "group_id": "claim",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "previous_submission_details",
      "label": "What was previously submitted or requested? (optional)",
      "type": "textarea",
      "required": false,
      "meta_class": null,
      "ui_width": null,
      "group_id": "claim",
      "choice_group": null,
      "choice_label": null,
      "visibility": {
        "fieldId": "lane_supporting_documents",
        "operator": "truthy"
      },
      "depends_on": [
        "lane_supporting_documents"
      ],
      "compound": null
    },
    {
      "id": "reprocessing_context",
      "label": "Why does the claim need review or reprocessing? (optional)",
      "type": "textarea",
      "required": false,
      "meta_class": null,
      "ui_width": null,
      "group_id": "claim",
      "choice_group": null,
      "choice_label": null,
      "visibility": {
        "fieldId": "lane_reprocessing_request",
        "operator": "truthy"
      },
      "depends_on": [
        "lane_reprocessing_request"
      ],
      "compound": null
    },
    {
      "id": "accident_or_other_insurance_details",
      "label": "Accident, COB, or other insurance details (optional)",
      "type": "textarea",
      "required": false,
      "meta_class": null,
      "ui_width": null,
      "group_id": "claim",
      "choice_group": null,
      "choice_label": null,
      "visibility": {
        "fieldId": "lane_accident_or_cob_follow_up",
        "operator": "truthy"
      },
      "depends_on": [
        "lane_accident_or_cob_follow_up"
      ],
      "compound": null
    },
    {
      "id": "sender_name",
      "label": "Sender name",
      "type": "text",
      "required": true,
      "meta_class": null,
      "ui_width": "half",
      "group_id": "sender",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "sender_role",
      "label": "Sender role (optional)",
      "type": "select",
      "required": false,
      "meta_class": null,
      "ui_width": "half",
      "group_id": "sender",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "options": [
        "Patient or member",
        "Parent or guardian",
        "Authorized representative",
        "Provider billing office",
        "Attorney or advocate"
      ],
      "compound": null
    },
    {
      "id": "sender_email",
      "label": "Reply email",
      "type": "text",
      "required": true,
      "meta_class": "email",
      "ui_width": null,
      "group_id": "sender",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "sender_phone",
      "label": "Reply phone (optional)",
      "type": "text",
      "required": false,
      "meta_class": "phone",
      "ui_width": null,
      "group_id": "sender",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "sender_address",
      "label": "Your mailing address",
      "type": "address",
      "required": true,
      "meta_class": null,
      "ui_width": null,
      "group_id": "sender",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "payer_name",
      "label": "Payer or insurer name",
      "type": "text",
      "required": true,
      "meta_class": null,
      "ui_width": "half",
      "group_id": "recipient",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "recipient_name",
      "label": "Claims department or attention line",
      "type": "text",
      "required": true,
      "meta_class": null,
      "ui_width": "half",
      "group_id": "recipient",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "recipient_address",
      "label": "Payer mailing address",
      "type": "address",
      "required": true,
      "meta_class": null,
      "ui_width": null,
      "group_id": "recipient",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "payer_instructions_acknowledged",
      "label": "I verified the payer's current claim form, required documents, exact mailing destination, and filing or response deadline.",
      "type": "checkbox",
      "required": true,
      "meta_class": null,
      "ui_width": null,
      "group_id": "review",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "appeal_process_acknowledged",
      "label": "I understand this packet is not a substitute for a formal internal appeal or external review, and I will follow the appeal instructions in any denial notice or plan document.",
      "type": "checkbox",
      "required": true,
      "meta_class": null,
      "ui_width": null,
      "group_id": "review",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    },
    {
      "id": "acceptance_acknowledged",
      "label": "I understand proof of mailing or delivery does not prove that the payer accepted, processed, or timely received the claim under its rules.",
      "type": "checkbox",
      "required": true,
      "meta_class": null,
      "ui_width": null,
      "group_id": "review",
      "choice_group": null,
      "choice_label": null,
      "depends_on": [],
      "compound": null
    }
  ],
  "attachments": [
    {
      "id": "claim_forms",
      "label": "Claim form or insurer packet",
      "required": true,
      "instructions": "Attach the payer's current completed claim or reimbursement form, signed anywhere the payer requires a signature.",
      "allowed_types": [
        "pdf",
        "jpg",
        "jpeg",
        "png"
      ],
      "max_files": 6,
      "max_size_mb": 12
    },
    {
      "id": "itemized_bills",
      "label": "Itemized bills or receipts",
      "required": false,
      "instructions": "Attach itemized provider bills, receipts, or statements that support the claim amount.",
      "allowed_types": [
        "pdf",
        "jpg",
        "jpeg",
        "png"
      ],
      "max_files": 10,
      "max_size_mb": 12
    },
    {
      "id": "eobs_or_denial_letters",
      "label": "EOBs or denial letters",
      "required": false,
      "instructions": "Attach any explanation of benefits, denial notice, or request-for-information letter that explains the follow-up.",
      "allowed_types": [
        "pdf",
        "jpg",
        "jpeg",
        "png"
      ],
      "max_files": 10,
      "max_size_mb": 12
    },
    {
      "id": "medical_records",
      "label": "Medical records or referrals",
      "required": false,
      "instructions": "Attach chart notes, referrals, prescriptions, or other records the payer asked you to provide.",
      "allowed_types": [
        "pdf",
        "jpg",
        "jpeg",
        "png"
      ],
      "max_files": 12,
      "max_size_mb": 12
    },
    {
      "id": "payer_correspondence",
      "label": "Payer instructions or correspondence",
      "required": false,
      "instructions": "Attach letters, portal printouts, or instructions showing where the claim packet should go and what it should include.",
      "allowed_types": [
        "pdf",
        "jpg",
        "jpeg",
        "png"
      ],
      "max_files": 10,
      "max_size_mb": 12
    },
    {
      "id": "other_supporting_documents",
      "label": "Other supporting documents",
      "required": false,
      "instructions": "Any other record you want appended behind the packet.",
      "allowed_types": [
        "pdf",
        "jpg",
        "jpeg",
        "png"
      ],
      "max_files": 10,
      "max_size_mb": 12
    }
  ],
  "attachments_max_total_size_mb": 12,
  "machine_submission": {
    "payload_property": "form",
    "create_paths": {
      "x402": "/api/machine/orders",
      "mpp": "/api/machine/mpp/orders"
    }
  }
}

Validation does not mail the document. For a human checkout, use MCP postalform.create_form_order_draft and present the returned preview, total and checkout URL. Machine API clients must handle the returned MPP or x402 challenge only within owner-approved spending authority. Preserve request_id and the exact payload for retries; changing the content requires a new request ID. After an uncertain payment, retrieve order status before creating another order. Provider handoff is not USPS delivery.