ClaimResponse
This resource provides the adjudication details from the processing of a Claim resource.
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/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 | 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 a claim response |
status | code | 1..1 | active | cancelled | draft | entered-in-error |
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 | BackboneElement | 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 |
|---|---|---|
created | date | The creation date |
disposition | string | The contents of the disposition message |
identifier | token | The identity of the ClaimResponse |
insurer | reference | The organization which generated this resource |
outcome | token | The processing outcome |
patient | reference | The subject of care |
payment-date | date | The expected payment date |
request | reference | The claim reference |
requestor | reference | The Provider of the claim |
status | token | The status of the ClaimResponse |
use | token | The type of claim |
Reference
Official FHIR R4 spec: ClaimResponse.
Maturity: Trial Use 2 (FMM 2).