| Name | Description | Type | Additional information |
|---|---|---|---|
| ClaimReferenceNumber | string |
Required |
|
| BeneficiaryEntityId | integer |
Required |
|
| AgentEntityId | integer |
None. |
|
| AgentName | string |
None. |
|
| PolicyNumber | string |
None. |
|
| PolicyHolderName | string |
Required |
|
| BenefciaryFirstName | string |
Required |
|
| BeneficiaryLastName | string |
Required |
|
| SourcePortal | string |
Required |
|
| ClaimType | string |
Required |
|
| ClaimDocuments | Collection of claimDocumentList |
Required |
|
| MembershipNumber | string |
Required |
|
| Language | integer |
Required |