ClaimResponse

Trial Use 2 Financial

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

Endpoints

alphahttps://api.dev.ovok.com/fhir/R4/ClaimResponse

Interaction	Method	Path
Read	GET	/fhir/R4/ClaimResponse/[id]
Vread	GET	/fhir/R4/ClaimResponse/[id]/_history/[vid]
Update	PUT	/fhir/R4/ClaimResponse/[id]
Patch	PATCH	/fhir/R4/ClaimResponse/[id]
Delete	DELETE	/fhir/R4/ClaimResponse/[id]
Create	POST	/fhir/R4/ClaimResponse
Search	GET	/fhir/R4/ClaimResponse
History	GET	/fhir/R4/ClaimResponse/[id]/_history

Top-level elements

Element	Type(s)	Cardinality	Description
identifier	Identifier	0..*	Business Identifier for a claim response
status	code	1..1	active | cancelled | draft | entered-in-error modifier
type	CodeableConcept	1..1	More granular claim type
subType	CodeableConcept	0..1	More granular claim type
use	code	1..1	claim | preauthorization | predetermination
patient	Reference	1..1	The recipient of the products and services
created	dateTime	1..1	Response creation date
insurer	Reference	1..1	Party responsible for reimbursement
requestor	Reference	0..1	Party responsible for the claim
request	Reference	0..1	Id of resource triggering adjudication
outcome	code	1..1	queued | complete | error | partial
disposition	string	0..1	Disposition Message
preAuthRef	string	0..1	Preauthorization reference
preAuthPeriod	Period	0..1	Preauthorization reference effective period
payeeType	CodeableConcept	0..1	Party to be paid any benefits payable
item	BackboneElement	0..*	Adjudication for claim line items
addItem	BackboneElement	0..*	Insurer added line items
adjudication	—	0..*	Header-level adjudication
total	BackboneElement	0..*	Adjudication totals
payment	BackboneElement	0..1	Payment Details
fundsReserve	CodeableConcept	0..1	Funds reserved status
formCode	CodeableConcept	0..1	Printed form identifier
form	Attachment	0..1	Printed reference or actual form
processNote	BackboneElement	0..*	Note concerning adjudication
communicationRequest	Reference	0..*	Request for additional information
insurance	BackboneElement	0..*	Patient insurance information
error	BackboneElement	0..*	Processing errors

Resource-specific search parameters

Parameter	Type	Description
_compartment	string
_count	string	https://www.hl7.org/fhir/search.html#_count
_elements	string	https://www.hl7.org/fhir/search.html#_elements
_id	string
_lastUpdated	string
_profile	string
_security	string
_sort	string	https://www.hl7.org/fhir/search.html#_sort
_source	string
_summary	string	https://www.hl7.org/fhir/search.html#_summary
_tag	string
_total	string	https://www.hl7.org/fhir/search.html#_total
created	string	http://hl7.org/fhir/SearchParameter/ClaimResponse-created
disposition	string	http://hl7.org/fhir/SearchParameter/ClaimResponse-disposition
identifier	string	http://hl7.org/fhir/SearchParameter/ClaimResponse-identifier
insurer	string	http://hl7.org/fhir/SearchParameter/ClaimResponse-insurer
outcome	string	http://hl7.org/fhir/SearchParameter/ClaimResponse-outcome
patient	string	http://hl7.org/fhir/SearchParameter/ClaimResponse-patient
payment-date	string	http://hl7.org/fhir/SearchParameter/ClaimResponse-payment-date
request	string	http://hl7.org/fhir/SearchParameter/ClaimResponse-request
requestor	string	http://hl7.org/fhir/SearchParameter/ClaimResponse-requestor
status	string	http://hl7.org/fhir/SearchParameter/ClaimResponse-status
use	string	http://hl7.org/fhir/SearchParameter/ClaimResponse-use

Reference

• Official FHIR R4 spec: ClaimResponse
• Maturity: Trial Use 2 (FMM 2).