Resources

Claims

Submit claims with structured intake, track status, and receive AI scoring inline.

Pierflow handles claim submission and status tracking. Full auto-adjudication is on the roadmap (Phase 2); for MVP, you submit and observe.

Submit a claim#

POST/v1/claims

request

json

{
  "policy_id": "pf_pol_01HX...",
  "provider_id": "pf_prov_reddington",
  "encounter": {
    "type": "outpatient",
    "diagnosis_codes": ["A01.0"],
    "service_date": "2026-06-05"
  },
  "amount_ngn": 45000
}

202 Accepted

json

{
  "claim_id": "pf_clm_01HX...",
  "status": "SUBMITTED",
  "fraud_score": 12,
  "eligibility_confidence": 0.99
}

Status codes#

Status	Description	Suggested action
SUBMITTED	Received by Pierflow	None
PENDING_HMO	Sent to HMO, awaiting acknowledgement	None
UNDER_REVIEW	HMO is reviewing	None
APPROVED	Approved for payment	Notify member
REJECTED	Rejected with reason code	Surface reason to member
PAID	Disbursed to provider/member	Notify member