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
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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
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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
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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
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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
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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
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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
keyboard_arrow_down
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
keyboard_arrow_down
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
keyboard_arrow_down
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
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