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

Params

organizationId*string|stringid|slug

Body

resourceType*stringClaimResponseThis is a ClaimResponse resource
identifierarray(Identifier)The Response business identifier.
statusstringThe status of the resource instance.
patientReferencePatient Resource.
createdstringThe date when the enclosed suite of services were performed or completed.
insurerReferenceThe Insurer who produced this adjudicated response.
requestProviderReferenceThe practitioner who is responsible for the services rendered to the patient.
requestOrganizationReferenceThe organization which is responsible for the services rendered to the patient.
requestReferenceOriginal request resource referrence.
outcomeCodeableConceptProcessing outcome errror, partial or complete processing.
dispositionstringA description of the status of the adjudication.
payeeTypeCodeableConceptParty to be reimbursed: Subscriber, provider, other.
itemarray(ClaimResponse_Item)The first tier service adjudications for submitted services.
addItemarray(ClaimResponse_AddItem)The first tier service adjudications for payor added services.
errorarray(ClaimResponse_Error)Mutually exclusive with Services Provided (Item).
totalCostMoneyThe total cost of the services reported.
unallocDeductableMoneyThe amount of deductible applied which was not allocated to any particular service line.
totalBenefitMoneyTotal amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible).
paymentClaimResponse_PaymentPayment details for the claim if the claim has been paid.
reservedCodingStatus of funds reservation (For provider, for Patient, None).
formCodeableConceptThe form to be used for printing the content.
processNotearray(ClaimResponse_ProcessNote)Note text.
communicationRequestarray(Reference)Request for additional supporting or authorizing information, such as: documents, images or resources.
insurancearray(ClaimResponse_Insurance)Financial instrument by which payment information for health care.

Response

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

Params

organizationId*string|stringid|slug
resourceId*

Body

resourceType*stringClaimResponseThis is a ClaimResponse resource
identifierarray(Identifier)The Response business identifier.
statusstringThe status of the resource instance.
patientReferencePatient Resource.
createdstringThe date when the enclosed suite of services were performed or completed.
insurerReferenceThe Insurer who produced this adjudicated response.
requestProviderReferenceThe practitioner who is responsible for the services rendered to the patient.
requestOrganizationReferenceThe organization which is responsible for the services rendered to the patient.
requestReferenceOriginal request resource referrence.
outcomeCodeableConceptProcessing outcome errror, partial or complete processing.
dispositionstringA description of the status of the adjudication.
payeeTypeCodeableConceptParty to be reimbursed: Subscriber, provider, other.
itemarray(ClaimResponse_Item)The first tier service adjudications for submitted services.
addItemarray(ClaimResponse_AddItem)The first tier service adjudications for payor added services.
errorarray(ClaimResponse_Error)Mutually exclusive with Services Provided (Item).
totalCostMoneyThe total cost of the services reported.
unallocDeductableMoneyThe amount of deductible applied which was not allocated to any particular service line.
totalBenefitMoneyTotal amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible).
paymentClaimResponse_PaymentPayment details for the claim if the claim has been paid.
reservedCodingStatus of funds reservation (For provider, for Patient, None).
formCodeableConceptThe form to be used for printing the content.
processNotearray(ClaimResponse_ProcessNote)Note text.
communicationRequestarray(Reference)Request for additional supporting or authorizing information, such as: documents, images or resources.
insurancearray(ClaimResponse_Insurance)Financial instrument by which payment information for health care.

Response

Read Claim Response

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

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

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

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

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

Request

Headers

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

Query params

_idstring
_languagestring
createdstring
dispositionstring
identifierstring
insurerstring
outcomestring
patientstring
payment-datestring
requeststring
request-providerstring

Params

organizationId*string|stringid|slug

Response

Search History Claim Response

get
/organizations/{organizationId}/fhir/3/ClaimResponse/_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 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*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
request-providerstring

Params

organizationId*string|stringid|slug

Body

resourceType*stringClaimResponseThis is a ClaimResponse resource
identifierarray(Identifier)The Response business identifier.
statusstringThe status of the resource instance.
patientReferencePatient Resource.
createdstringThe date when the enclosed suite of services were performed or completed.
insurerReferenceThe Insurer who produced this adjudicated response.
requestProviderReferenceThe practitioner who is responsible for the services rendered to the patient.
requestOrganizationReferenceThe organization which is responsible for the services rendered to the patient.
requestReferenceOriginal request resource referrence.
outcomeCodeableConceptProcessing outcome errror, partial or complete processing.
dispositionstringA description of the status of the adjudication.
payeeTypeCodeableConceptParty to be reimbursed: Subscriber, provider, other.
itemarray(ClaimResponse_Item)The first tier service adjudications for submitted services.
addItemarray(ClaimResponse_AddItem)The first tier service adjudications for payor added services.
errorarray(ClaimResponse_Error)Mutually exclusive with Services Provided (Item).
totalCostMoneyThe total cost of the services reported.
unallocDeductableMoneyThe amount of deductible applied which was not allocated to any particular service line.
totalBenefitMoneyTotal amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible).
paymentClaimResponse_PaymentPayment details for the claim if the claim has been paid.
reservedCodingStatus of funds reservation (For provider, for Patient, None).
formCodeableConceptThe form to be used for printing the content.
processNotearray(ClaimResponse_ProcessNote)Note text.
communicationRequestarray(Reference)Request for additional supporting or authorizing information, such as: documents, images or resources.
insurancearray(ClaimResponse_Insurance)Financial instrument by which payment information for health care.

Response

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

Params

organizationId*string|stringid|slug
resourceId*

Body

resourceType*stringClaimResponseThis is a ClaimResponse resource
identifierarray(Identifier)The Response business identifier.
statusstringThe status of the resource instance.
patientReferencePatient Resource.
createdstringThe date when the enclosed suite of services were performed or completed.
insurerReferenceThe Insurer who produced this adjudicated response.
requestProviderReferenceThe practitioner who is responsible for the services rendered to the patient.
requestOrganizationReferenceThe organization which is responsible for the services rendered to the patient.
requestReferenceOriginal request resource referrence.
outcomeCodeableConceptProcessing outcome errror, partial or complete processing.
dispositionstringA description of the status of the adjudication.
payeeTypeCodeableConceptParty to be reimbursed: Subscriber, provider, other.
itemarray(ClaimResponse_Item)The first tier service adjudications for submitted services.
addItemarray(ClaimResponse_AddItem)The first tier service adjudications for payor added services.
errorarray(ClaimResponse_Error)Mutually exclusive with Services Provided (Item).
totalCostMoneyThe total cost of the services reported.
unallocDeductableMoneyThe amount of deductible applied which was not allocated to any particular service line.
totalBenefitMoneyTotal amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductible).
paymentClaimResponse_PaymentPayment details for the claim if the claim has been paid.
reservedCodingStatus of funds reservation (For provider, for Patient, None).
formCodeableConceptThe form to be used for printing the content.
processNotearray(ClaimResponse_ProcessNote)Note text.
communicationRequestarray(Reference)Request for additional supporting or authorizing information, such as: documents, images or resources.
insurancearray(ClaimResponse_Insurance)Financial instrument by which payment information for health care.

Response