claims

Create Claim

post
/organizations/{organizationId}/fhir/3/Claim

A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery.

Request

Headers

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

Params

organizationId*string|stringid|slug

Body

resourceType*stringClaimThis is a Claim resource
identifierarray(Identifier)The business identifier for the instance: claim number, pre-determination or pre-authorization number.
statusstringThe status of the resource instance.
typeCodeableConceptThe category of claim, eg, oral, pharmacy, vision, insitutional, professional.
subTypearray(CodeableConcept)A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.
usestringcomplete|proposed|exploratory|otherComplete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).
patientReferencePatient Resource.
billablePeriodPeriodThe billable period for which charges are being submitted.
createdstringThe date when the enclosed suite of services were performed or completed.
entererReferencePerson who created the invoice/claim/pre-determination or pre-authorization.
insurerReferenceThe Insurer who is target of the request.
providerReferenceThe provider which is responsible for the bill, claim pre-determination, pre-authorization.
organizationReferenceThe organization which is responsible for the bill, claim pre-determination, pre-authorization.
priorityCodeableConceptImmediate (STAT), best effort (NORMAL), deferred (DEFER).
fundsReserveCodeableConceptIn the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.
relatedarray(Claim_Related)Other claims which are related to this claim such as prior claim versions or for related services.
prescriptionReferencePrescription to support the dispensing of Pharmacy or Vision products.
originalPrescriptionReferenceOriginal prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.
payeeClaim_PayeeThe party to be reimbursed for the services.
referralReferenceThe referral resource which lists the date, practitioner, reason and other supporting information.
facilityReferenceFacility where the services were provided.
careTeamarray(Claim_CareTeam)The members of the team who provided the overall service as well as their role and whether responsible and qualifications.
informationarray(Claim_Information)Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.
diagnosisarray(Claim_Diagnosis)List of patient diagnosis for which care is sought.
procedurearray(Claim_Procedure)Ordered list of patient procedures performed to support the adjudication.
insurancearray(Claim_Insurance)Financial instrument by which payment information for health care.
accidentClaim_AccidentAn accident which resulted in the need for healthcare services.
employmentImpactedPeriodThe start and optional end dates of when the patient was precluded from working due to the treatable condition(s).
hospitalizationPeriodThe start and optional end dates of when the patient was confined to a treatment center.
itemarray(Claim_Item)First tier of goods and services.
totalMoneyThe total value of the claim.

Response

Patch Claim

patch
/organizations/{organizationId}/fhir/3/Claim/{resourceId}

A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery.

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*stringClaimThis is a Claim resource
identifierarray(Identifier)The business identifier for the instance: claim number, pre-determination or pre-authorization number.
statusstringThe status of the resource instance.
typeCodeableConceptThe category of claim, eg, oral, pharmacy, vision, insitutional, professional.
subTypearray(CodeableConcept)A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.
usestringcomplete|proposed|exploratory|otherComplete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).
patientReferencePatient Resource.
billablePeriodPeriodThe billable period for which charges are being submitted.
createdstringThe date when the enclosed suite of services were performed or completed.
entererReferencePerson who created the invoice/claim/pre-determination or pre-authorization.
insurerReferenceThe Insurer who is target of the request.
providerReferenceThe provider which is responsible for the bill, claim pre-determination, pre-authorization.
organizationReferenceThe organization which is responsible for the bill, claim pre-determination, pre-authorization.
priorityCodeableConceptImmediate (STAT), best effort (NORMAL), deferred (DEFER).
fundsReserveCodeableConceptIn the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.
relatedarray(Claim_Related)Other claims which are related to this claim such as prior claim versions or for related services.
prescriptionReferencePrescription to support the dispensing of Pharmacy or Vision products.
originalPrescriptionReferenceOriginal prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.
payeeClaim_PayeeThe party to be reimbursed for the services.
referralReferenceThe referral resource which lists the date, practitioner, reason and other supporting information.
facilityReferenceFacility where the services were provided.
careTeamarray(Claim_CareTeam)The members of the team who provided the overall service as well as their role and whether responsible and qualifications.
informationarray(Claim_Information)Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.
diagnosisarray(Claim_Diagnosis)List of patient diagnosis for which care is sought.
procedurearray(Claim_Procedure)Ordered list of patient procedures performed to support the adjudication.
insurancearray(Claim_Insurance)Financial instrument by which payment information for health care.
accidentClaim_AccidentAn accident which resulted in the need for healthcare services.
employmentImpactedPeriodThe start and optional end dates of when the patient was precluded from working due to the treatable condition(s).
hospitalizationPeriodThe start and optional end dates of when the patient was confined to a treatment center.
itemarray(Claim_Item)First tier of goods and services.
totalMoneyThe total value of the claim.

Response

Read Claim

get
/organizations/{organizationId}/fhir/3/Claim/{resourceId}

Request

Headers

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

Params

organizationId*string|stringid|slug
resourceId*

Response

Read History Claim

get
/organizations/{organizationId}/fhir/3/Claim/{resourceId}/_history

Request

Headers

content-type*stringapplication/jsonapplication/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/3/Claim/{resourceId}/_history/{versionId}

Request

Headers

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

Params

organizationId*string|stringid|slug
resourceId*
versionId*

Response

Remove Claim

delete
/organizations/{organizationId}/fhir/3/Claim/{resourceId}

Request

Headers

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

Params

organizationId*string|stringid|slug
resourceId*

Response

Search Get Claim

get
/organizations/{organizationId}/fhir/3/Claim

Request

Headers

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

Query params

_idstring
_languagestring
care-teamstring
createdstring
encounterstring
entererstring
facilitystring
identifierstring
insurerstring
organizationstring
patientstring
payeestring
prioritystring
providerstring
usestring

Params

organizationId*string|stringid|slug

Response

Search History Claim

get
/organizations/{organizationId}/fhir/3/Claim/_history

Request

Headers

content-type*stringapplication/jsonapplication/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/3/Claim/_search

A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery.

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
encounterstring
entererstring
facilitystring
identifierstring
insurerstring
organizationstring
patientstring
payeestring
prioritystring
providerstring
usestring

Params

organizationId*string|stringid|slug

Body

resourceType*stringClaimThis is a Claim resource
identifierarray(Identifier)The business identifier for the instance: claim number, pre-determination or pre-authorization number.
statusstringThe status of the resource instance.
typeCodeableConceptThe category of claim, eg, oral, pharmacy, vision, insitutional, professional.
subTypearray(CodeableConcept)A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.
usestringcomplete|proposed|exploratory|otherComplete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).
patientReferencePatient Resource.
billablePeriodPeriodThe billable period for which charges are being submitted.
createdstringThe date when the enclosed suite of services were performed or completed.
entererReferencePerson who created the invoice/claim/pre-determination or pre-authorization.
insurerReferenceThe Insurer who is target of the request.
providerReferenceThe provider which is responsible for the bill, claim pre-determination, pre-authorization.
organizationReferenceThe organization which is responsible for the bill, claim pre-determination, pre-authorization.
priorityCodeableConceptImmediate (STAT), best effort (NORMAL), deferred (DEFER).
fundsReserveCodeableConceptIn the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.
relatedarray(Claim_Related)Other claims which are related to this claim such as prior claim versions or for related services.
prescriptionReferencePrescription to support the dispensing of Pharmacy or Vision products.
originalPrescriptionReferenceOriginal prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.
payeeClaim_PayeeThe party to be reimbursed for the services.
referralReferenceThe referral resource which lists the date, practitioner, reason and other supporting information.
facilityReferenceFacility where the services were provided.
careTeamarray(Claim_CareTeam)The members of the team who provided the overall service as well as their role and whether responsible and qualifications.
informationarray(Claim_Information)Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.
diagnosisarray(Claim_Diagnosis)List of patient diagnosis for which care is sought.
procedurearray(Claim_Procedure)Ordered list of patient procedures performed to support the adjudication.
insurancearray(Claim_Insurance)Financial instrument by which payment information for health care.
accidentClaim_AccidentAn accident which resulted in the need for healthcare services.
employmentImpactedPeriodThe start and optional end dates of when the patient was precluded from working due to the treatable condition(s).
hospitalizationPeriodThe start and optional end dates of when the patient was confined to a treatment center.
itemarray(Claim_Item)First tier of goods and services.
totalMoneyThe total value of the claim.

Response

Update Claim

put
/organizations/{organizationId}/fhir/3/Claim/{resourceId}

A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery.

Request

Headers

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

Params

organizationId*string|stringid|slug
resourceId*

Body

resourceType*stringClaimThis is a Claim resource
identifierarray(Identifier)The business identifier for the instance: claim number, pre-determination or pre-authorization number.
statusstringThe status of the resource instance.
typeCodeableConceptThe category of claim, eg, oral, pharmacy, vision, insitutional, professional.
subTypearray(CodeableConcept)A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType.
usestringcomplete|proposed|exploratory|otherComplete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).
patientReferencePatient Resource.
billablePeriodPeriodThe billable period for which charges are being submitted.
createdstringThe date when the enclosed suite of services were performed or completed.
entererReferencePerson who created the invoice/claim/pre-determination or pre-authorization.
insurerReferenceThe Insurer who is target of the request.
providerReferenceThe provider which is responsible for the bill, claim pre-determination, pre-authorization.
organizationReferenceThe organization which is responsible for the bill, claim pre-determination, pre-authorization.
priorityCodeableConceptImmediate (STAT), best effort (NORMAL), deferred (DEFER).
fundsReserveCodeableConceptIn the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.
relatedarray(Claim_Related)Other claims which are related to this claim such as prior claim versions or for related services.
prescriptionReferencePrescription to support the dispensing of Pharmacy or Vision products.
originalPrescriptionReferenceOriginal prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'.
payeeClaim_PayeeThe party to be reimbursed for the services.
referralReferenceThe referral resource which lists the date, practitioner, reason and other supporting information.
facilityReferenceFacility where the services were provided.
careTeamarray(Claim_CareTeam)The members of the team who provided the overall service as well as their role and whether responsible and qualifications.
informationarray(Claim_Information)Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.
diagnosisarray(Claim_Diagnosis)List of patient diagnosis for which care is sought.
procedurearray(Claim_Procedure)Ordered list of patient procedures performed to support the adjudication.
insurancearray(Claim_Insurance)Financial instrument by which payment information for health care.
accidentClaim_AccidentAn accident which resulted in the need for healthcare services.
employmentImpactedPeriodThe start and optional end dates of when the patient was precluded from working due to the treatable condition(s).
hospitalizationPeriodThe start and optional end dates of when the patient was confined to a treatment center.
itemarray(Claim_Item)First tier of goods and services.
totalMoneyThe total value of the claim.

Response