claim responses

Create Claim Response

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

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

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 ClaimResponse 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 response.
statuscodeThe status of the resource instance.
type*CodeableConceptA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
subTypeCodeableConceptA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
usecodeA 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 for facast reimbursement is sought.
createddateTimeThe date this resource was created.
insurer*ReferenceThe party responsible for authorization, adjudication and reimbursement.
requestorReferenceThe provider which is responsible for the claim, predetermination or preauthorization.
requestReferenceOriginal request resource reference.
outcomecodeThe outcome of the claim, predetermination, or preauthorization processing.
dispositionstringA human readable description of the status of the adjudication.
preAuthRefstringReference from the Insurer which is used in later communications which refers to this adjudication.
preAuthPeriodPeriodThe time frame during which this authorization is effective.
payeeTypeCodeableConceptType of Party to be reimbursed: subscriber, provider, other.
itemarray(ClaimResponse_Item)A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.
addItemarray(ClaimResponse_AddItem)The first-tier service adjudications for payor added product or service lines.
adjudicationarray(ClaimResponse_Adjudication)The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
totalarray(ClaimResponse_Total)Categorized monetary totals for the adjudication.
paymentClaimResponse_PaymentPayment details for the adjudication of the claim.
fundsReserveCodeableConceptA code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
formCodeCodeableConceptA code for the form to be used for printing the content.
formAttachmentThe actual form, by reference or inclusion, for printing the content or an EOB.
processNotearray(ClaimResponse_ProcessNote)A note that describes or explains adjudication results in a human readable form.
communicationRequestarray(Reference)Request for additional supporting or authorizing information.
insurancearray(ClaimResponse_Insurance)Financial instruments for reimbursement for the health care products and services specified on the claim.
errorarray(ClaimResponse_Error)Errors encountered during the processing of the adjudication.

Response

Patch Claim Response

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

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

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 ClaimResponse 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 response.
statuscodeThe status of the resource instance.
type*CodeableConceptA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
subTypeCodeableConceptA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
usecodeA 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 for facast reimbursement is sought.
createddateTimeThe date this resource was created.
insurer*ReferenceThe party responsible for authorization, adjudication and reimbursement.
requestorReferenceThe provider which is responsible for the claim, predetermination or preauthorization.
requestReferenceOriginal request resource reference.
outcomecodeThe outcome of the claim, predetermination, or preauthorization processing.
dispositionstringA human readable description of the status of the adjudication.
preAuthRefstringReference from the Insurer which is used in later communications which refers to this adjudication.
preAuthPeriodPeriodThe time frame during which this authorization is effective.
payeeTypeCodeableConceptType of Party to be reimbursed: subscriber, provider, other.
itemarray(ClaimResponse_Item)A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.
addItemarray(ClaimResponse_AddItem)The first-tier service adjudications for payor added product or service lines.
adjudicationarray(ClaimResponse_Adjudication)The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
totalarray(ClaimResponse_Total)Categorized monetary totals for the adjudication.
paymentClaimResponse_PaymentPayment details for the adjudication of the claim.
fundsReserveCodeableConceptA code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
formCodeCodeableConceptA code for the form to be used for printing the content.
formAttachmentThe actual form, by reference or inclusion, for printing the content or an EOB.
processNotearray(ClaimResponse_ProcessNote)A note that describes or explains adjudication results in a human readable form.
communicationRequestarray(Reference)Request for additional supporting or authorizing information.
insurancearray(ClaimResponse_Insurance)Financial instruments for reimbursement for the health care products and services specified on the claim.
errorarray(ClaimResponse_Error)Errors encountered during the processing of the adjudication.

Response

Read Claim Response

get
/organizations/{organizationId}/fhir/4/ClaimResponse/{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 Response

get
/organizations/{organizationId}/fhir/4/ClaimResponse/{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 Response

get
/organizations/{organizationId}/fhir/4/ClaimResponse/{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 Response

delete
/organizations/{organizationId}/fhir/4/ClaimResponse/{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 Response

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

Request

Headers

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

Query params

_idstring
_languagestring
createdstring
dispositionstring
identifierstring
insurerstring
outcomestring
patientstring
payment-datestring
requeststring
requestorstring
statusstring
usestring

Params

organizationId*string|stringid|slug

Response

Search History Claim Response

get
/organizations/{organizationId}/fhir/4/ClaimResponse/_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 Response

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

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

Request

Headers

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

Query params

_idstring
_languagestring
createdstring
dispositionstring
identifierstring
insurerstring
outcomestring
patientstring
payment-datestring
requeststring
requestorstring
statusstring
usestring

Params

organizationId*string|stringid|slug

Body

resourceType*This is a ClaimResponse 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 response.
statuscodeThe status of the resource instance.
type*CodeableConceptA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
subTypeCodeableConceptA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
usecodeA 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 for facast reimbursement is sought.
createddateTimeThe date this resource was created.
insurer*ReferenceThe party responsible for authorization, adjudication and reimbursement.
requestorReferenceThe provider which is responsible for the claim, predetermination or preauthorization.
requestReferenceOriginal request resource reference.
outcomecodeThe outcome of the claim, predetermination, or preauthorization processing.
dispositionstringA human readable description of the status of the adjudication.
preAuthRefstringReference from the Insurer which is used in later communications which refers to this adjudication.
preAuthPeriodPeriodThe time frame during which this authorization is effective.
payeeTypeCodeableConceptType of Party to be reimbursed: subscriber, provider, other.
itemarray(ClaimResponse_Item)A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.
addItemarray(ClaimResponse_AddItem)The first-tier service adjudications for payor added product or service lines.
adjudicationarray(ClaimResponse_Adjudication)The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
totalarray(ClaimResponse_Total)Categorized monetary totals for the adjudication.
paymentClaimResponse_PaymentPayment details for the adjudication of the claim.
fundsReserveCodeableConceptA code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
formCodeCodeableConceptA code for the form to be used for printing the content.
formAttachmentThe actual form, by reference or inclusion, for printing the content or an EOB.
processNotearray(ClaimResponse_ProcessNote)A note that describes or explains adjudication results in a human readable form.
communicationRequestarray(Reference)Request for additional supporting or authorizing information.
insurancearray(ClaimResponse_Insurance)Financial instruments for reimbursement for the health care products and services specified on the claim.
errorarray(ClaimResponse_Error)Errors encountered during the processing of the adjudication.

Response

Update Claim Response

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

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

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 ClaimResponse 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 response.
statuscodeThe status of the resource instance.
type*CodeableConceptA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
subTypeCodeableConceptA finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
usecodeA 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 for facast reimbursement is sought.
createddateTimeThe date this resource was created.
insurer*ReferenceThe party responsible for authorization, adjudication and reimbursement.
requestorReferenceThe provider which is responsible for the claim, predetermination or preauthorization.
requestReferenceOriginal request resource reference.
outcomecodeThe outcome of the claim, predetermination, or preauthorization processing.
dispositionstringA human readable description of the status of the adjudication.
preAuthRefstringReference from the Insurer which is used in later communications which refers to this adjudication.
preAuthPeriodPeriodThe time frame during which this authorization is effective.
payeeTypeCodeableConceptType of Party to be reimbursed: subscriber, provider, other.
itemarray(ClaimResponse_Item)A claim line. Either a simple (a product or service) or a 'group' of details which can also be a simple items or groups of sub-details.
addItemarray(ClaimResponse_AddItem)The first-tier service adjudications for payor added product or service lines.
adjudicationarray(ClaimResponse_Adjudication)The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
totalarray(ClaimResponse_Total)Categorized monetary totals for the adjudication.
paymentClaimResponse_PaymentPayment details for the adjudication of the claim.
fundsReserveCodeableConceptA code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.
formCodeCodeableConceptA code for the form to be used for printing the content.
formAttachmentThe actual form, by reference or inclusion, for printing the content or an EOB.
processNotearray(ClaimResponse_ProcessNote)A note that describes or explains adjudication results in a human readable form.
communicationRequestarray(Reference)Request for additional supporting or authorizing information.
insurancearray(ClaimResponse_Insurance)Financial instruments for reimbursement for the health care products and services specified on the claim.
errorarray(ClaimResponse_Error)Errors encountered during the processing of the adjudication.

Response