Claim - FHIR Resource (dstu2)
This Claim Resource uses the
FHIR API standard for access and structure.
Validate an Claim FHIR Resource (dstu2)
Resource Attributes
Attribute | Field is list | Type | Description |
---|
accident | false | date | # Accident Date
|
accidentType | false | Coding | # Accident Type
|
additionalMaterials | true | Coding | # Additional materials, documents, etc.
|
condition | true | Coding | # List of presenting Conditions
|
coverage | true | Data Type | # Insurance or medical plan
|
created | false | dateTime | # Creation date
|
diagnosis | true | Data Type | # Diagnosis
|
enterer | false | Reference | # Author
|
exception | true | Coding | # Eligibility exceptions
|
facility | false | Reference | # Servicing Facility
|
fundsReserve | false | Coding | # Funds requested to be reserved
|
identifier | true | Identifier | # Claim number
|
interventionException | true | Coding | # Intervention and exception code (Pharma)
|
item | true | Data Type | # Goods and Services
|
missingTeeth | true | Data Type | # Only if type = oral
|
organization | false | Reference | # Responsible organization
|
originalPrescription | false | Reference | # Original Prescription
|
originalRuleset | false | Coding | # Original specification followed
|
patient | false | Reference | # The subject of the Products and Services
|
payee | false | Data Type | # Payee
|
prescription | false | Reference | # Prescription
|
priority | false | Coding | # Desired processing priority
|
provider | false | Reference | # Responsible provider
|
referral | false | Reference | # Treatment Referral
|
ruleset | false | Coding | # Current specification followed
|
school | false | string | # Name of School
|
target | false | Reference | # Insurer
|
type | false | code | # institutional | oral | pharmacy | professional | vision
|
use | false | code | # complete | proposed | exploratory | other
|
Claim Structure
{
"resourceType" : "Claim",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"type" : "<code>", // R! institutional | oral | pharmacy | professional | vision
"identifier" : [{ Identifier }], // Claim number
"ruleset" : { Coding }, // Current specification followed
"originalRuleset" : { Coding }, // Original specification followed
"created" : "<dateTime>", // Creation date
"target" : { Reference(Organization) }, // Insurer
"provider" : { Reference(Practitioner) }, // Responsible provider
"organization" : { Reference(Organization) }, // Responsible organization
"use" : "<code>", // complete | proposed | exploratory | other
"priority" : { Coding }, // Desired processing priority
"fundsReserve" : { Coding }, // Funds requested to be reserved
"enterer" : { Reference(Practitioner) }, // Author
"facility" : { Reference(Location) }, // Servicing Facility
"prescription" : { Reference(MedicationOrder|VisionPrescription) }, // Prescription
"originalPrescription" : { Reference(MedicationOrder) }, // Original Prescription
"payee" : { // Payee
"type" : { Coding }, // Party to be paid any benefits payable
"provider" : { Reference(Practitioner) }, // Provider who is the payee
"organization" : { Reference(Organization) }, // Organization who is the payee
"person" : { Reference(Patient) } // Other person who is the payee
},
"referral" : { Reference(ReferralRequest) }, // Treatment Referral
"diagnosis" : [{ // Diagnosis
"sequence" : "<positiveInt>", // R! Sequence of diagnosis
"diagnosis" : { Coding } // R! Patient's list of diagnosis
}],
"condition" : [{ Coding }], // List of presenting Conditions
"patient" : { Reference(Patient) }, // R! The subject of the Products and Services
"coverage" : [{ // Insurance or medical plan
"sequence" : "<positiveInt>", // R! Service instance identifier
"focal" : <boolean>, // R! The focal Coverage
"coverage" : { Reference(Coverage) }, // R! Insurance information
"businessArrangement" : "<string>", // Business agreement
"relationship" : { Coding }, // R! Patient relationship to subscriber
"preAuthRef" : ["<string>"], // Pre-Authorization/Determination Reference
"claimResponse" : { Reference(ClaimResponse) }, // Adjudication results
"originalRuleset" : { Coding } // Original version
}],
"exception" : [{ Coding }], // Eligibility exceptions
"school" : "<string>", // Name of School
"accident" : "<date>", // Accident Date
"accidentType" : { Coding }, // Accident Type
"interventionException" : [{ Coding }], // Intervention and exception code (Pharma)
"item" : [{ // Goods and Services
"sequence" : "<positiveInt>", // R! Service instance
"type" : { Coding }, // R! Group or type of product or service
"provider" : { Reference(Practitioner) }, // Responsible practitioner
"diagnosisLinkId" : ["<positiveInt>"], // Diagnosis Link
"service" : { Coding }, // R! Item Code
"serviceDate" : "<date>", // Date of Service
"quantity" : { Quantity(SimpleQuantity) }, // Count of Products or Services
"unitPrice" : { Quantity(Money) }, // Fee, charge or cost per point
"factor" : <decimal>, // Price scaling factor
"points" : <decimal>, // Difficulty scaling factor
"net" : { Quantity(Money) }, // Total item cost
"udi" : { Coding }, // Unique Device Identifier
"bodySite" : { Coding }, // Service Location
"subSite" : [{ Coding }], // Service Sub-location
"modifier" : [{ Coding }], // Service/Product billing modifiers
"detail" : [{ // Additional items
"sequence" : "<positiveInt>", // R! Service instance
"type" : { Coding }, // R! Group or type of product or service
"service" : { Coding }, // R! Additional item codes
"quantity" : { Quantity(SimpleQuantity) }, // Count of Products or Services
"unitPrice" : { Quantity(Money) }, // Fee, charge or cost per point
"factor" : <decimal>, // Price scaling factor
"points" : <decimal>, // Difficulty scaling factor
"net" : { Quantity(Money) }, // Total additional item cost
"udi" : { Coding }, // Unique Device Identifier
"subDetail" : [{ // Additional items
"sequence" : "<positiveInt>", // R! Service instance
"type" : { Coding }, // R! Type of product or service
"service" : { Coding }, // R! Additional item codes
"quantity" : { Quantity(SimpleQuantity) }, // Count of Products or Services
"unitPrice" : { Quantity(Money) }, // Fee, charge or cost per point
"factor" : <decimal>, // Price scaling factor
"points" : <decimal>, // Difficulty scaling factor
"net" : { Quantity(Money) }, // Net additional item cost
"udi" : { Coding } // Unique Device Identifier
}]
}],
"prosthesis" : { // Prosthetic details
"initial" : <boolean>, // Is this the initial service
"priorDate" : "<date>", // Initial service Date
"priorMaterial" : { Coding } // Prosthetic Material
}
}],
"additionalMaterials" : [{ Coding }], // Additional materials, documents, etc.
"missingTeeth" : [{ // Only if type = oral
"tooth" : { Coding }, // R! Tooth Code
"reason" : { Coding }, // Reason for missing
"extractionDate" : "<date>" // Date of Extraction
}]
}
Claim Search Parameters
The following search parameters can be used to query Claim resources. Just submit them like so:
https://api.1up.health/fhir/dstu2/Claim?query-param=queryvalue
Search Parameter | Field Type | Resource Fields Searched |
---|
identifier | text | identifier |
patient | reference | patient |
priority | text | priority |
provider | reference | provider |
use | text | use |