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.

These interaction paths describe standard FHIR R4 patterns. Availability can depend on the API capabilities enabled for your Ovok project.

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

Top-level elements

Element	Type	Cardinality	Description
id	string	0..1	Logical id of this artifact
meta	Meta	0..1	Metadata about the resource
implicitRules	uri	0..1	A set of rules under which this content was created
language	code	0..1	Language of the resource content
text	Narrative	0..1	Text summary of the resource, for human interpretation
contained	Resource	0..*	Contained, inline Resources
extension	Extension	0..*	Additional content defined by implementations
modifierExtension	Extension	0..*	Extensions that cannot be ignored
identifier	Identifier	0..*	Business Identifier for claim
status	code	1..1	active | cancelled | draft | entered-in-error
type	CodeableConcept	1..1	Category or discipline
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
billablePeriod	Period	0..1	Relevant time frame for the claim
created	dateTime	1..1	Resource creation date
enterer	Reference	0..1	Author of the claim
insurer	Reference	0..1	Target
provider	Reference	1..1	Party responsible for the claim
priority	CodeableConcept	1..1	Desired processing ugency
fundsReserve	CodeableConcept	0..1	For whom to reserve funds
related	BackboneElement	0..*	Prior or corollary claims
prescription	Reference	0..1	Prescription authorizing services and products
originalPrescription	Reference	0..1	Original prescription if superseded by fulfiller
payee	BackboneElement	0..1	Recipient of benefits payable
referral	Reference	0..1	Treatment referral
facility	Reference	0..1	Servicing facility
careTeam	BackboneElement	0..*	Members of the care team
supportingInfo	BackboneElement	0..*	Supporting information
diagnosis	BackboneElement	0..*	Pertinent diagnosis information
procedure	BackboneElement	0..*	Clinical procedures performed
insurance	BackboneElement	1..*	Patient insurance information
accident	BackboneElement	0..1	Details of the event
item	BackboneElement	0..*	Product or service provided
total	Money	0..1	Total claim cost

Resource-specific search parameters

Parameter	Type	Description
care-team	reference	Member of the CareTeam
created	date	The creation date for the Claim
detail-udi	reference	UDI associated with a line item, detail product or service
encounter	reference	Encounters associated with a billed line item
enterer	reference	The party responsible for the entry of the Claim
facility	reference	Facility where the products or services have been or will be provided
identifier	token	The primary identifier of the financial resource
insurer	reference	The target payor/insurer for the Claim
item-udi	reference	UDI associated with a line item product or service
patient	reference	Patient receiving the products or services
payee	reference	The party receiving any payment for the Claim
priority	token	Processing priority requested
procedure-udi	reference	UDI associated with a procedure
provider	reference	Provider responsible for the Claim
status	token	The status of the Claim instance.
subdetail-udi	reference	UDI associated with a line item, detail, subdetail product or service
use	token	The kind of financial resource

Reference

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