claims

Create Claim

post
/organizations/{organizationId}/fhir/4/Claim

A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Params

organizationId*string|stringid|slug

Body

resourceType*This is a Claim resource
ididThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
metaMetaThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRulesuriA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
languagecodeThe base language in which the resource is written.
textNarrativeA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
containedarray(ResourceList)These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
extensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
modifierExtensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
identifierarray(Identifier)A unique identifier assigned to this claim.
statuscodeThe status of the resource instance.
type*CodeableConceptThe category of claim, e.g. oral, pharmacy, vision, institutional, professional.
subTypeCodeableConceptA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
useclaim|preauthorization|predeterminationA code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
patient*ReferenceThe party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.
billablePeriodPeriodThe period for which charges are being submitted.
createddateTimeThe date this resource was created.
entererReferenceIndividual who created the claim, predetermination or preauthorization.
insurerReferenceThe Insurer who is target of the request.
provider*ReferenceThe provider which is responsible for the claim, predetermination or preauthorization.
priority*CodeableConceptThe provider-required urgency of processing the request. Typical values include: stat, routine deferred.
fundsReserveCodeableConceptA code to indicate whether and for whom funds are to be reserved for future claims.
relatedarray(Claim_Related)Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
prescriptionReferencePrescription to support the dispensing of pharmacy, device or vision products.
originalPrescriptionReferenceOriginal prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
payeeClaim_PayeeThe party to be reimbursed for cost of the products and services according to the terms of the policy.
referralReferenceA reference to a referral resource.
facilityReferenceFacility where the services were provided.
careTeamarray(Claim_CareTeam)The members of the team who provided the products and services.
supportingInfoarray(Claim_SupportingInfo)Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
diagnosisarray(Claim_Diagnosis)Information about diagnoses relevant to the claim items.
procedurearray(Claim_Procedure)Procedures performed on the patient relevant to the billing items with the claim.
insurance*array(Claim_Insurance)Financial instruments for reimbursement for the health care products and services specified on the claim.
accidentClaim_AccidentDetails of an accident which resulted in injuries which required the products and services listed in the claim.
itemarray(Claim_Item)A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
totalMoneyThe total value of the all the items in the claim.

Response

Patch Claim

patch
/organizations/{organizationId}/fhir/4/Claim/{resourceId}

A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

Request

Headers

content-type*stringapplication/json-patch+jsonapplication/json-patch+json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Params

organizationId*string|stringid|slug
resourceId*

Body

resourceType*This is a Claim resource
ididThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
metaMetaThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRulesuriA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
languagecodeThe base language in which the resource is written.
textNarrativeA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
containedarray(ResourceList)These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
extensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
modifierExtensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
identifierarray(Identifier)A unique identifier assigned to this claim.
statuscodeThe status of the resource instance.
type*CodeableConceptThe category of claim, e.g. oral, pharmacy, vision, institutional, professional.
subTypeCodeableConceptA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
useclaim|preauthorization|predeterminationA code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
patient*ReferenceThe party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.
billablePeriodPeriodThe period for which charges are being submitted.
createddateTimeThe date this resource was created.
entererReferenceIndividual who created the claim, predetermination or preauthorization.
insurerReferenceThe Insurer who is target of the request.
provider*ReferenceThe provider which is responsible for the claim, predetermination or preauthorization.
priority*CodeableConceptThe provider-required urgency of processing the request. Typical values include: stat, routine deferred.
fundsReserveCodeableConceptA code to indicate whether and for whom funds are to be reserved for future claims.
relatedarray(Claim_Related)Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
prescriptionReferencePrescription to support the dispensing of pharmacy, device or vision products.
originalPrescriptionReferenceOriginal prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
payeeClaim_PayeeThe party to be reimbursed for cost of the products and services according to the terms of the policy.
referralReferenceA reference to a referral resource.
facilityReferenceFacility where the services were provided.
careTeamarray(Claim_CareTeam)The members of the team who provided the products and services.
supportingInfoarray(Claim_SupportingInfo)Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
diagnosisarray(Claim_Diagnosis)Information about diagnoses relevant to the claim items.
procedurearray(Claim_Procedure)Procedures performed on the patient relevant to the billing items with the claim.
insurance*array(Claim_Insurance)Financial instruments for reimbursement for the health care products and services specified on the claim.
accidentClaim_AccidentDetails of an accident which resulted in injuries which required the products and services listed in the claim.
itemarray(Claim_Item)A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
totalMoneyThe total value of the all the items in the claim.

Response

Read Claim

get
/organizations/{organizationId}/fhir/4/Claim/{resourceId}

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Params

organizationId*string|stringid|slug
resourceId*

Response

Read History Claim

get
/organizations/{organizationId}/fhir/4/Claim/{resourceId}/_history

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Query params

_countstring
_sincestring

Params

organizationId*string|stringid|slug
resourceId*

Response

Read Version Claim

get
/organizations/{organizationId}/fhir/4/Claim/{resourceId}/_history/{versionId}

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Params

organizationId*string|stringid|slug
resourceId*
versionId*

Response

Remove Claim

delete
/organizations/{organizationId}/fhir/4/Claim/{resourceId}

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Params

organizationId*string|stringid|slug
resourceId*

Response

Search Get Claim

get
/organizations/{organizationId}/fhir/4/Claim

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Query params

_idstring
_languagestring
care-teamstring
createdstring
detail-udistring
encounterstring
entererstring
facilitystring
identifierstring
insurerstring
item-udistring
patientstring
payeestring
prioritystring
procedure-udistring
providerstring
statusstring
subdetail-udistring
usestring

Params

organizationId*string|stringid|slug

Response

Search History Claim

get
/organizations/{organizationId}/fhir/4/Claim/_history

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Query params

_countstring
_sincestring

Params

organizationId*string|stringid|slug

Response

Search Post Claim

post
/organizations/{organizationId}/fhir/4/Claim/_search

A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

Request

Headers

content-type*stringapplication/json|application/x-www-form-urlencodedapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Query params

_idstring
_languagestring
care-teamstring
createdstring
detail-udistring
encounterstring
entererstring
facilitystring
identifierstring
insurerstring
item-udistring
patientstring
payeestring
prioritystring
procedure-udistring
providerstring
statusstring
subdetail-udistring
usestring

Params

organizationId*string|stringid|slug

Body

resourceType*This is a Claim resource
ididThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
metaMetaThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRulesuriA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
languagecodeThe base language in which the resource is written.
textNarrativeA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
containedarray(ResourceList)These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
extensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
modifierExtensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
identifierarray(Identifier)A unique identifier assigned to this claim.
statuscodeThe status of the resource instance.
type*CodeableConceptThe category of claim, e.g. oral, pharmacy, vision, institutional, professional.
subTypeCodeableConceptA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
useclaim|preauthorization|predeterminationA code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
patient*ReferenceThe party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.
billablePeriodPeriodThe period for which charges are being submitted.
createddateTimeThe date this resource was created.
entererReferenceIndividual who created the claim, predetermination or preauthorization.
insurerReferenceThe Insurer who is target of the request.
provider*ReferenceThe provider which is responsible for the claim, predetermination or preauthorization.
priority*CodeableConceptThe provider-required urgency of processing the request. Typical values include: stat, routine deferred.
fundsReserveCodeableConceptA code to indicate whether and for whom funds are to be reserved for future claims.
relatedarray(Claim_Related)Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
prescriptionReferencePrescription to support the dispensing of pharmacy, device or vision products.
originalPrescriptionReferenceOriginal prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
payeeClaim_PayeeThe party to be reimbursed for cost of the products and services according to the terms of the policy.
referralReferenceA reference to a referral resource.
facilityReferenceFacility where the services were provided.
careTeamarray(Claim_CareTeam)The members of the team who provided the products and services.
supportingInfoarray(Claim_SupportingInfo)Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
diagnosisarray(Claim_Diagnosis)Information about diagnoses relevant to the claim items.
procedurearray(Claim_Procedure)Procedures performed on the patient relevant to the billing items with the claim.
insurance*array(Claim_Insurance)Financial instruments for reimbursement for the health care products and services specified on the claim.
accidentClaim_AccidentDetails of an accident which resulted in injuries which required the products and services listed in the claim.
itemarray(Claim_Item)A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
totalMoneyThe total value of the all the items in the claim.

Response

Update Claim

put
/organizations/{organizationId}/fhir/4/Claim/{resourceId}

A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

Request

Headers

content-type*stringapplication/json|application/json+fhirapplication/json
log-cdatastring
log-cdata-formatstringkv|jsonkv
AuthorizationstringBearer <token>

Params

organizationId*string|stringid|slug
resourceId*

Body

resourceType*This is a Claim resource
ididThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
metaMetaThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRulesuriA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
languagecodeThe base language in which the resource is written.
textNarrativeA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
containedarray(ResourceList)These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
extensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
modifierExtensionarray(Extension)May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
identifierarray(Identifier)A unique identifier assigned to this claim.
statuscodeThe status of the resource instance.
type*CodeableConceptThe category of claim, e.g. oral, pharmacy, vision, institutional, professional.
subTypeCodeableConceptA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
useclaim|preauthorization|predeterminationA code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
patient*ReferenceThe party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.
billablePeriodPeriodThe period for which charges are being submitted.
createddateTimeThe date this resource was created.
entererReferenceIndividual who created the claim, predetermination or preauthorization.
insurerReferenceThe Insurer who is target of the request.
provider*ReferenceThe provider which is responsible for the claim, predetermination or preauthorization.
priority*CodeableConceptThe provider-required urgency of processing the request. Typical values include: stat, routine deferred.
fundsReserveCodeableConceptA code to indicate whether and for whom funds are to be reserved for future claims.
relatedarray(Claim_Related)Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
prescriptionReferencePrescription to support the dispensing of pharmacy, device or vision products.
originalPrescriptionReferenceOriginal prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
payeeClaim_PayeeThe party to be reimbursed for cost of the products and services according to the terms of the policy.
referralReferenceA reference to a referral resource.
facilityReferenceFacility where the services were provided.
careTeamarray(Claim_CareTeam)The members of the team who provided the products and services.
supportingInfoarray(Claim_SupportingInfo)Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
diagnosisarray(Claim_Diagnosis)Information about diagnoses relevant to the claim items.
procedurearray(Claim_Procedure)Procedures performed on the patient relevant to the billing items with the claim.
insurance*array(Claim_Insurance)Financial instruments for reimbursement for the health care products and services specified on the claim.
accidentClaim_AccidentDetails of an accident which resulted in injuries which required the products and services listed in the claim.
itemarray(Claim_Item)A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
totalMoneyThe total value of the all the items in the claim.

Response