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*	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*			This is a Claim resource
id	id		The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	Meta		The 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.
implicitRules	uri		A 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.
language	code		The base language in which the resource is written.
text	Narrative		A 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.
contained	array(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.
extension	array(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.
modifierExtension	array(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).
identifier	array(Identifier)		A unique identifier assigned to this claim.
status	code		The status of the resource instance.
type*	CodeableConcept		The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
subType	CodeableConcept		A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
use		claim\|preauthorization\|predetermination	A 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*	Reference		The 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.
billablePeriod	Period		The period for which charges are being submitted.
created	dateTime		The date this resource was created.
enterer	Reference		Individual who created the claim, predetermination or preauthorization.
insurer	Reference		The Insurer who is target of the request.
provider*	Reference		The provider which is responsible for the claim, predetermination or preauthorization.
priority*	CodeableConcept		The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
fundsReserve	CodeableConcept		A code to indicate whether and for whom funds are to be reserved for future claims.
related	array(Claim_Related)		Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
prescription	Reference		Prescription to support the dispensing of pharmacy, device or vision products.
originalPrescription	Reference		Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
payee	Claim_Payee		The party to be reimbursed for cost of the products and services according to the terms of the policy.
referral	Reference		A reference to a referral resource.
facility	Reference		Facility where the services were provided.
careTeam	array(Claim_CareTeam)		The members of the team who provided the products and services.
supportingInfo	array(Claim_SupportingInfo)		Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
diagnosis	array(Claim_Diagnosis)		Information about diagnoses relevant to the claim items.
procedure	array(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.
accident	Claim_Accident		Details of an accident which resulted in injuries which required the products and services listed in the claim.
item	array(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.
total	Money		The total value of the all the items in the claim.

Response

201 400 401 404

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*	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*			This is a Claim resource
id	id		The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	Meta		The 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.
implicitRules	uri		A 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.
language	code		The base language in which the resource is written.
text	Narrative		A 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.
contained	array(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.
extension	array(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.
modifierExtension	array(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).
identifier	array(Identifier)		A unique identifier assigned to this claim.
status	code		The status of the resource instance.
type*	CodeableConcept		The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
subType	CodeableConcept		A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
use		claim\|preauthorization\|predetermination	A 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*	Reference		The 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.
billablePeriod	Period		The period for which charges are being submitted.
created	dateTime		The date this resource was created.
enterer	Reference		Individual who created the claim, predetermination or preauthorization.
insurer	Reference		The Insurer who is target of the request.
provider*	Reference		The provider which is responsible for the claim, predetermination or preauthorization.
priority*	CodeableConcept		The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
fundsReserve	CodeableConcept		A code to indicate whether and for whom funds are to be reserved for future claims.
related	array(Claim_Related)		Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
prescription	Reference		Prescription to support the dispensing of pharmacy, device or vision products.
originalPrescription	Reference		Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
payee	Claim_Payee		The party to be reimbursed for cost of the products and services according to the terms of the policy.
referral	Reference		A reference to a referral resource.
facility	Reference		Facility where the services were provided.
careTeam	array(Claim_CareTeam)		The members of the team who provided the products and services.
supportingInfo	array(Claim_SupportingInfo)		Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
diagnosis	array(Claim_Diagnosis)		Information about diagnoses relevant to the claim items.
procedure	array(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.
accident	Claim_Accident		Details of an accident which resulted in injuries which required the products and services listed in the claim.
item	array(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.
total	Money		The total value of the all the items in the claim.

Response

200 201 400 401 404 409

Read Claim

get

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

get

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

get

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

delete

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

get

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

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
care-team	string
created	string
detail-udi	string
encounter	string
enterer	string
facility	string
identifier	string
insurer	string
item-udi	string
patient	string
payee	string
priority	string
procedure-udi	string
provider	string
status	string
subdetail-udi	string
use	string

Params


organizationId*	string\|string		id\|slug

Response

200 401 404

Search History Claim

get

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

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*	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
care-team	string
created	string
detail-udi	string
encounter	string
enterer	string
facility	string
identifier	string
insurer	string
item-udi	string
patient	string
payee	string
priority	string
procedure-udi	string
provider	string
status	string
subdetail-udi	string
use	string

Params


organizationId*	string\|string		id\|slug

Body


resourceType*			This is a Claim resource
id	id		The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	Meta		The 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.
implicitRules	uri		A 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.
language	code		The base language in which the resource is written.
text	Narrative		A 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.
contained	array(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.
extension	array(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.
modifierExtension	array(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).
identifier	array(Identifier)		A unique identifier assigned to this claim.
status	code		The status of the resource instance.
type*	CodeableConcept		The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
subType	CodeableConcept		A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
use		claim\|preauthorization\|predetermination	A 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*	Reference		The 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.
billablePeriod	Period		The period for which charges are being submitted.
created	dateTime		The date this resource was created.
enterer	Reference		Individual who created the claim, predetermination or preauthorization.
insurer	Reference		The Insurer who is target of the request.
provider*	Reference		The provider which is responsible for the claim, predetermination or preauthorization.
priority*	CodeableConcept		The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
fundsReserve	CodeableConcept		A code to indicate whether and for whom funds are to be reserved for future claims.
related	array(Claim_Related)		Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
prescription	Reference		Prescription to support the dispensing of pharmacy, device or vision products.
originalPrescription	Reference		Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
payee	Claim_Payee		The party to be reimbursed for cost of the products and services according to the terms of the policy.
referral	Reference		A reference to a referral resource.
facility	Reference		Facility where the services were provided.
careTeam	array(Claim_CareTeam)		The members of the team who provided the products and services.
supportingInfo	array(Claim_SupportingInfo)		Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
diagnosis	array(Claim_Diagnosis)		Information about diagnoses relevant to the claim items.
procedure	array(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.
accident	Claim_Accident		Details of an accident which resulted in injuries which required the products and services listed in the claim.
item	array(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.
total	Money		The total value of the all the items in the claim.

Response

200 401 404

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*	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*			This is a Claim resource
id	id		The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
meta	Meta		The 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.
implicitRules	uri		A 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.
language	code		The base language in which the resource is written.
text	Narrative		A 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.
contained	array(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.
extension	array(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.
modifierExtension	array(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).
identifier	array(Identifier)		A unique identifier assigned to this claim.
status	code		The status of the resource instance.
type*	CodeableConcept		The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
subType	CodeableConcept		A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
use		claim\|preauthorization\|predetermination	A 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*	Reference		The 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.
billablePeriod	Period		The period for which charges are being submitted.
created	dateTime		The date this resource was created.
enterer	Reference		Individual who created the claim, predetermination or preauthorization.
insurer	Reference		The Insurer who is target of the request.
provider*	Reference		The provider which is responsible for the claim, predetermination or preauthorization.
priority*	CodeableConcept		The provider-required urgency of processing the request. Typical values include: stat, routine deferred.
fundsReserve	CodeableConcept		A code to indicate whether and for whom funds are to be reserved for future claims.
related	array(Claim_Related)		Other claims which are related to this claim such as prior submissions or claims for related services or for the same event.
prescription	Reference		Prescription to support the dispensing of pharmacy, device or vision products.
originalPrescription	Reference		Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
payee	Claim_Payee		The party to be reimbursed for cost of the products and services according to the terms of the policy.
referral	Reference		A reference to a referral resource.
facility	Reference		Facility where the services were provided.
careTeam	array(Claim_CareTeam)		The members of the team who provided the products and services.
supportingInfo	array(Claim_SupportingInfo)		Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
diagnosis	array(Claim_Diagnosis)		Information about diagnoses relevant to the claim items.
procedure	array(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.
accident	Claim_Accident		Details of an accident which resulted in injuries which required the products and services listed in the claim.
item	array(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.
total	Money		The total value of the all the items in the claim.

Response

200 201 400 401 404 409