Check the status claim and associated line items.
Identifies the type of the resource
Indicates the purpose of this bundle - how it is intended to be used.
An array of FHIR resources. At a minimum, a the claim status request should include the following entries:
The Resource for the entry. The purpose/meaning of the resource is determined by the Bundle.type.
Identifies the type of the resource
A global unique identifier for the Claim - this should correspond to the initial Claim.id sent.
The status of the resource instance.
Type of claim. Example Codes
The recommended system is http://terminology.hl7.org/CodeSystem/claim-type. Typical values include
pharmacy - Pharmacy claims for goods and servicesprofessional - Typically outpatient claims such as Psychological, Chiropractor, rehabilitative, consultinginstitutional - Hospital, clinic and other inpatient claimsA reference to a code defined by a terminology system.
The identification of the code system that defines the meaning of the symbol in the code.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
A code to indicate whether the nature of the request is: to request adjudication of products and services previously rendered; or requesting authorization and adjudication for provision in the future; or requesting the non-binding adjudication of the listed products and services which could be provided in the future.
The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.
Must be a resource of type Patient.
A reference to a Patient resource
The date this resource was created.
The provider which is responsible for the claim, predetermination or preauthorization.
Must reference one of the following types of resources:
PractitionerOrganizationA reference to either an Organization or Provider.
The provider-required urgency of processing the request. Typical values include: stat, routine, and deferred.
If sending one of these statuses, use the system http://terminology.hl7.org/CodeSystem/processpriority
A reference to a code defined by a terminology system.
The identification of the code system that defines the meaning of the symbol in the code.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Financial instruments for reimbursement for the health care products and services specified on the claim.
A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.
A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.
Reference to Coverage resource for patient.
Must be a resource of type Coverage.
A reference to another resource. This is typically either a relative reference which includes the resource type and ID, or an internal reference which starts with # and refers to a contained resource.
A business agreement number established between the provider and the insurer for special business processing purposes.
The Insurer who is target of the request.
Must be a resource of type Organization.
A reference to an Organization resource
A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
A number to uniquely identify item entries.
For prior auth, the requestedService extension carries more information than this field, and this field should just duplicate the product or service code found in that resource.
A reference to a code defined by a terminology system.
The identification of the code system that defines the meaning of the symbol in the code.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
A unique id for the line item. This can be used on subsequent status checks to get-line-level status information.
The number of repetitions of a service or product.
The value of the measured amount. The value includes an implicit precision in the presentation of the value.
This element contains extensions for value. Depending on the extensions present it could be used in place of value or contain additional information about value. See the extension element for more details on the possible extensions being sent.
A Precision extension allows the communication of values more precise than a JSON number, for example, 3.10 as opposed to just 3.1.
Explicit precision of the number. If the actual value is 3.10, the value field will contain the number 3.1 while the precision extension will contain 2.
See http://hl7.org/fhir/StructureDefinition/quantity-precision for more information
Source of the definition for the extension code - a logical name or a URL.
Number of significant decimal places after the decimal.
A human-readable form of the unit.
The date or dates when the service or product was supplied, performed or completed.
The start of the period. The boundary is inclusive.
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
Where the product or service was provided.
A reference to a code defined by a terminology system.
The identification of the code system that defines the meaning of the symbol in the code.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
The total value of the all the items in the claim.
Numerical value (with implicit precision).
ISO 4217 Currency Code (e.g. USD for US Dollar)
A claim for one patient receiving inpatient services for blood work and an EKG. Attending Provider was Pat Granite, and Referring provider was Joan Fishman.
Identifies the type of the resource
A structured respresentation of the error that occurred
Generally error or fatal
A FHIR category code that describes the general type of issue. See http://hl7.org/fhir/ValueSet/issue-type for details
If the error occurs in the RedoxEngine, this corresponds to an Error record in the organization.
Additional details about the error. This may be a text description of the error or a system code that identifies the error.
A more granular FHIR code for the specific error. Typically from http://hl7.org/fhir/ValueSet/operation-outcome
The identification of the code system that defines the meaning of the symbol in the code.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
A human-readable interpretation of the issue code
Additional diagnostic information about the issue.