claim responses

Create Claim Response

post

/organizations/{organizationId}/fhir/3/ClaimResponse

This resource provides the adjudication details from the processing of a Claim resource.

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Params


organizationId*	string\|string		id\|slug

Body


resourceType*	string	ClaimResponse	This is a ClaimResponse resource
identifier	array(Identifier)		The Response business identifier.
status	string		The status of the resource instance.
patient	Reference		Patient Resource.
created	string		The date when the enclosed suite of services were performed or completed.
insurer	Reference		The Insurer who produced this adjudicated response.
requestProvider	Reference		The practitioner who is responsible for the services rendered to the patient.
requestOrganization	Reference		The organization which is responsible for the services rendered to the patient.
request	Reference		Original request resource referrence.
outcome	CodeableConcept		Processing outcome errror, partial or complete processing.
disposition	string		A description of the status of the adjudication.
payeeType	CodeableConcept		Party to be reimbursed: Subscriber, provider, other.
item	array(ClaimResponse_Item)		The first tier service adjudications for submitted services.
addItem	array(ClaimResponse_AddItem)		The first tier service adjudications for payor added services.
error	array(ClaimResponse_Error)		Mutually exclusive with Services Provided (Item).
totalCost	Money		The total cost of the services reported.
unallocDeductable	Money		The amount of deductible applied which was not allocated to any particular service line.
totalBenefit	Money		Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible).
payment	ClaimResponse_Payment		Payment details for the claim if the claim has been paid.
reserved	Coding		Status of funds reservation (For provider, for Patient, None).
form	CodeableConcept		The form to be used for printing the content.
processNote	array(ClaimResponse_ProcessNote)		Note text.
communicationRequest	array(Reference)		Request for additional supporting or authorizing information, such as: documents, images or resources.
insurance	array(ClaimResponse_Insurance)		Financial instrument by which payment information for health care.

Response

201 400 401 404

Patch Claim Response

patch

/organizations/{organizationId}/fhir/3/ClaimResponse/{resourceId}

This resource provides the adjudication details from the processing of a Claim resource.

Request

Headers


content-type*	string	application/json-patch+json	application/json-patch+json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Params


organizationId*	string\|string		id\|slug
resourceId*

Body


resourceType*	string	ClaimResponse	This is a ClaimResponse resource
identifier	array(Identifier)		The Response business identifier.
status	string		The status of the resource instance.
patient	Reference		Patient Resource.
created	string		The date when the enclosed suite of services were performed or completed.
insurer	Reference		The Insurer who produced this adjudicated response.
requestProvider	Reference		The practitioner who is responsible for the services rendered to the patient.
requestOrganization	Reference		The organization which is responsible for the services rendered to the patient.
request	Reference		Original request resource referrence.
outcome	CodeableConcept		Processing outcome errror, partial or complete processing.
disposition	string		A description of the status of the adjudication.
payeeType	CodeableConcept		Party to be reimbursed: Subscriber, provider, other.
item	array(ClaimResponse_Item)		The first tier service adjudications for submitted services.
addItem	array(ClaimResponse_AddItem)		The first tier service adjudications for payor added services.
error	array(ClaimResponse_Error)		Mutually exclusive with Services Provided (Item).
totalCost	Money		The total cost of the services reported.
unallocDeductable	Money		The amount of deductible applied which was not allocated to any particular service line.
totalBenefit	Money		Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible).
payment	ClaimResponse_Payment		Payment details for the claim if the claim has been paid.
reserved	Coding		Status of funds reservation (For provider, for Patient, None).
form	CodeableConcept		The form to be used for printing the content.
processNote	array(ClaimResponse_ProcessNote)		Note text.
communicationRequest	array(Reference)		Request for additional supporting or authorizing information, such as: documents, images or resources.
insurance	array(ClaimResponse_Insurance)		Financial instrument by which payment information for health care.

Response

200 201 400 401 404 409

Read Claim Response

get

/organizations/{organizationId}/fhir/3/ClaimResponse/{resourceId}

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Params


organizationId*	string\|string		id\|slug
resourceId*

Response

200 401 404

Read History Claim Response

get

/organizations/{organizationId}/fhir/3/ClaimResponse/{resourceId}/_history

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Query params


_count	string
_since	string

Params


organizationId*	string\|string		id\|slug
resourceId*

Response

200 401 404

Read Version Claim Response

get

/organizations/{organizationId}/fhir/3/ClaimResponse/{resourceId}/_history/{versionId}

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Params


organizationId*	string\|string	id\|slug
resourceId*
versionId*

Response

200 400 401 404

Remove Claim Response

delete

/organizations/{organizationId}/fhir/3/ClaimResponse/{resourceId}

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Params


organizationId*	string\|string		id\|slug
resourceId*

Response

200 204 400 401 404 409

Search Get Claim Response

get

/organizations/{organizationId}/fhir/3/ClaimResponse

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Query params


_id	string
_language	string
created	string
disposition	string
identifier	string
insurer	string
outcome	string
patient	string
payment-date	string
request	string
request-provider	string

Params


organizationId*	string\|string		id\|slug

Response

200 401 404

Search History Claim Response

get

/organizations/{organizationId}/fhir/3/ClaimResponse/_history

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Query params


_count	string
_since	string

Params


organizationId*	string\|string		id\|slug

Response

200 401 404

Search Post Claim Response

post

/organizations/{organizationId}/fhir/3/ClaimResponse/_search

This resource provides the adjudication details from the processing of a Claim resource.

Request

Headers


content-type*	string	application/json\|application/x-www-form-urlencoded	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Query params


_id	string
_language	string
created	string
disposition	string
identifier	string
insurer	string
outcome	string
patient	string
payment-date	string
request	string
request-provider	string

Params


organizationId*	string\|string		id\|slug

Body


resourceType*	string	ClaimResponse	This is a ClaimResponse resource
identifier	array(Identifier)		The Response business identifier.
status	string		The status of the resource instance.
patient	Reference		Patient Resource.
created	string		The date when the enclosed suite of services were performed or completed.
insurer	Reference		The Insurer who produced this adjudicated response.
requestProvider	Reference		The practitioner who is responsible for the services rendered to the patient.
requestOrganization	Reference		The organization which is responsible for the services rendered to the patient.
request	Reference		Original request resource referrence.
outcome	CodeableConcept		Processing outcome errror, partial or complete processing.
disposition	string		A description of the status of the adjudication.
payeeType	CodeableConcept		Party to be reimbursed: Subscriber, provider, other.
item	array(ClaimResponse_Item)		The first tier service adjudications for submitted services.
addItem	array(ClaimResponse_AddItem)		The first tier service adjudications for payor added services.
error	array(ClaimResponse_Error)		Mutually exclusive with Services Provided (Item).
totalCost	Money		The total cost of the services reported.
unallocDeductable	Money		The amount of deductible applied which was not allocated to any particular service line.
totalBenefit	Money		Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible).
payment	ClaimResponse_Payment		Payment details for the claim if the claim has been paid.
reserved	Coding		Status of funds reservation (For provider, for Patient, None).
form	CodeableConcept		The form to be used for printing the content.
processNote	array(ClaimResponse_ProcessNote)		Note text.
communicationRequest	array(Reference)		Request for additional supporting or authorizing information, such as: documents, images or resources.
insurance	array(ClaimResponse_Insurance)		Financial instrument by which payment information for health care.

Response

200 401 404

Update Claim Response

put

/organizations/{organizationId}/fhir/3/ClaimResponse/{resourceId}

This resource provides the adjudication details from the processing of a Claim resource.

Request

Headers


content-type*	string	application/json\|application/json+fhir	application/json
log-cdata	string
log-cdata-format	string	kv\|json	kv
Authorization	string	Bearer <token>

Params


organizationId*	string\|string		id\|slug
resourceId*

Body


resourceType*	string	ClaimResponse	This is a ClaimResponse resource
identifier	array(Identifier)		The Response business identifier.
status	string		The status of the resource instance.
patient	Reference		Patient Resource.
created	string		The date when the enclosed suite of services were performed or completed.
insurer	Reference		The Insurer who produced this adjudicated response.
requestProvider	Reference		The practitioner who is responsible for the services rendered to the patient.
requestOrganization	Reference		The organization which is responsible for the services rendered to the patient.
request	Reference		Original request resource referrence.
outcome	CodeableConcept		Processing outcome errror, partial or complete processing.
disposition	string		A description of the status of the adjudication.
payeeType	CodeableConcept		Party to be reimbursed: Subscriber, provider, other.
item	array(ClaimResponse_Item)		The first tier service adjudications for submitted services.
addItem	array(ClaimResponse_AddItem)		The first tier service adjudications for payor added services.
error	array(ClaimResponse_Error)		Mutually exclusive with Services Provided (Item).
totalCost	Money		The total cost of the services reported.
unallocDeductable	Money		The amount of deductible applied which was not allocated to any particular service line.
totalBenefit	Money		Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible).
payment	ClaimResponse_Payment		Payment details for the claim if the claim has been paid.
reserved	Coding		Status of funds reservation (For provider, for Patient, None).
form	CodeableConcept		The form to be used for printing the content.
processNote	array(ClaimResponse_ProcessNote)		Note text.
communicationRequest	array(Reference)		Request for additional supporting or authorizing information, such as: documents, images or resources.
insurance	array(ClaimResponse_Insurance)		Financial instrument by which payment information for health care.

Response

200 201 400 401 404 409