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.
Endpoints
dev
https://api.sandbox.ovok.com/fhir/R5/Claim| Interaction | Method | Path |
|---|---|---|
| Read | GET | /fhir/R5/Claim/[id] |
| Vread | GET | /fhir/R5/Claim/[id]/_history/[vid] |
| Update | PUT | /fhir/R5/Claim/[id] |
| Patch | PATCH | /fhir/R5/Claim/[id] |
| Delete | DELETE | /fhir/R5/Claim/[id] |
| Create | POST | /fhir/R5/Claim |
| Search | GET | /fhir/R5/Claim?... |
| History | GET | /fhir/R5/Claim/[id]/_history |
| Type-history | GET | /fhir/R5/Claim/_history |
Top-level elements
| Element | Type(s) | Cardinality | Description |
|---|---|---|---|
identifier | Identifier | 0..* | Business Identifier for claim |
traceNumber | Identifier | 0..* | Number for tracking |
status | code | 1..1 | active |
type | CodeableConcept | 1..1 | Category or discipline |
subType | CodeableConcept | 0..1 | More granular claim type |
use | code | 1..1 | claim |
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 | 0..1 | Party responsible for the claim |
priority | CodeableConcept | 0..1 | Desired processing urgency |
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originalPrescription | Reference | 0..1 | Original prescription if superseded by fulfiller |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 |
encounter | Reference | 0..* | Encounters associated with the listed treatments |
facility | Reference | 0..1 | Servicing facility |
diagnosisRelatedGroup | CodeableConcept | 0..1 | Package billing code |
event | BackboneElement | 0..* | Event information |
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 | 0..* | Patient insurance information |
accident | BackboneElement | 0..1 | Details of the event |
patientPaid | Money | 0..1 | Paid by the patient |
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 | Encounter related to the activity recorded in the AuditEvent |
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 | Account number |
insurer | reference | The target payor/insurer for the Claim |
item-udi | reference | UDI associated with a line item product or service |
patient | reference | The entity that caused the expenses |
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 R5 spec:
Claim - Maturity: Trial Use 2 (FMM 2).