"facility":
"accidentType":
"fundsReserve":
"originalPrescription":
"missingTeeth":
"use":
"payee":
"additionalMaterials":
"enterer":
"exception":
"priority":
"ruleset":
"provider":
"type":
"patient":
"interventionException":
"originalRuleset":
"coverage":
"condition":
"school":
"accident":
"prescription":
"target":
"referral":
"created":
"item":
"diagnosis":
"organization":
"identifier":
{
"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
}]
}
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 |