What it is

An unofficial PHP SDK for the CLAIM.MD API, the clearinghouse that handles claim submission, eligibility verification, and remittance for a large slice of US healthcare providers. The SDK wraps four core flows behind typed PHP interfaces:

Claims management. Submit X12 837P (professional) and 837I (institutional) claims, check acknowledgment status, retrieve scrubber feedback, and resubmit corrected claims.
Eligibility verification. X12 270 requests against payers, normalized 271 responses parsed into structured PHP objects with coverage details, copay, deductible, and remaining benefit data.
Electronic remittance advice. X12 835 ERA retrieval, with payer adjustment codes and CARC/RARC reason codes surfaced as enums instead of raw strings.
Provider enrollment. EFT/ERA enrollment workflows, payer roster sync, and provider credential management.

Why it exists

Healthcare claims processing is one of those domains where the standards are technically open (X12 EDI is decades old) but the practical integration work is the opposite of fun. Every payer interprets the spec slightly differently, the failure modes are subtle, and the cost of a malformed claim is real money sitting in accounts receivable for weeks.

This SDK started as the integration layer behind Nextvisit’s billing pipeline. We wanted same-day claim submission from clinical notes, which meant tight coupling between the LLM-drafted note, ICD-10 / CPT code suggestions, eligibility lookups, and the actual claim send. Doing that against a raw HTTP client was a recipe for production bugs at the worst possible time.

Why it’s open-source

There was no maintained PHP SDK for CLAIM.MD. Releasing this saves any other PHP shop building healthcare billing the same six weeks of EDI normalization we paid for. It’s distributed under the MIT license on Packagist as nextvisit/claim-md-php. Issues and PRs are welcome.