Claim $status

Check the status claim and associated line items.

Request Fields and Example
resourceType
required, string

Identifies the type of the resource

Value: Bundle
type
required, string

Indicates the purpose of this bundle - how it is intended to be used.

Value: collection
entry
required, [Claim, Patient, Coverage, Location, Practitioner, RelatedPerson, Other]

An array of FHIR resources. At a minimum, a the claim status request should include the following entries:

  • Claim - the most important part of the request - contains references to all other resources, details adjudication at the appropriate levels.
  • Patient - the patient the claim is for.
  • Organization - at least one resource representing the party responsible for making the claim. Additional organization resources may carry information such as pharmacy, payor, or policy holder.
  • Practitioner - for professional claims the provider submitting the claim
  • Coverage - the patient's insurance
Any of:
resource
required, object

The Resource for the entry. The purpose/meaning of the resource is determined by the Bundle.type.

resourceType
required, string

Identifies the type of the resource

Value: Claim
id
required, string

A global unique identifier for the Claim - this should correspond to the initial Claim.id sent.

status
required, string

The status of the resource instance.

Value: fm-status-active
type
required, object

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 services
  • professional - Typically outpatient claims such as Psychological, Chiropractor, rehabilitative, consulting
  • institutional - Hospital, clinic and other inpatient claims
coding
[object]

A reference to a code defined by a terminology system.

system
string

The identification of the code system that defines the meaning of the symbol in the code.

code
string

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).

text
string

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.

use
required, string

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.

Value: claim
patient
required, object

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.

reference
string

A reference to a Patient resource

created
required, string

The date this resource was created.

provider
required, object

The provider which is responsible for the claim, predetermination or preauthorization.

Must reference one of the following types of resources:

  • Practitioner
  • Organization
reference
string

A reference to either an Organization or Provider.

priority
required, object

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

coding
[object]

A reference to a code defined by a terminology system.

system
string

The identification of the code system that defines the meaning of the symbol in the code.

code
string

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).

text
string

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.

insurance
required, [object]

Financial instruments for reimbursement for the health care products and services specified on the claim.

sequence
required, number

A number to uniquely identify insurance entries and provide a sequence of coverages to convey coordination of benefit order.

focal
required, boolean

A flag to indicate that this Coverage is to be used for adjudication of this claim when set to true.

coverage
required, object

Reference to Coverage resource for patient.

Must be a resource of type Coverage.

reference
string

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.

businessArrangement
string

A business agreement number established between the provider and the insurer for special business processing purposes.

insurer
object

The Insurer who is target of the request.

Must be a resource of type Organization.

reference
string

A reference to an Organization resource

item
[object]

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.

sequence
required, number

A number to uniquely identify item entries.

productOrService
required, object

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.

coding
[object]

A reference to a code defined by a terminology system.

system
string

The identification of the code system that defines the meaning of the symbol in the code.

code
string

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).

text
string

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.

id
string

A unique id for the line item. This can be used on subsequent status checks to get-line-level status information.

quantity
object

The number of repetitions of a service or product.

value
number

The value of the measured amount. The value includes an implicit precision in the presentation of the value.

_value
object

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.

extension
[Precision, Other]

A Precision extension allows the communication of values more precise than a JSON number, for example, 3.10 as opposed to just 3.1.

Any of:

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

url
required, string

Source of the definition for the extension code - a logical name or a URL.

Value: http://hl7.org/fhir/StructureDefinition/quantity-precision
valueInteger
required, number

Number of significant decimal places after the decimal.

unit
string

A human-readable form of the unit.

servicedPeriod
object

The date or dates when the service or product was supplied, performed or completed.

start
string

The start of the period. The boundary is inclusive.

end
string

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.

locationCodeableConcept
object

Where the product or service was provided.

coding
[object]

A reference to a code defined by a terminology system.

system
string

The identification of the code system that defines the meaning of the symbol in the code.

code
string

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).

text
string

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.

total
object

The total value of the all the items in the claim.

value
number

Numerical value (with implicit precision).

currency
string

ISO 4217 Currency Code (e.g. USD for US Dollar)

post/Claim/$status
Open dropdown

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.

Response Fields and Example
resourceType
required, string

Identifies the type of the resource

Value: OperationOutcome
issue
required, [object]

A structured respresentation of the error that occurred

severity
required, string

Generally error or fatal

Possible Values: fatal, error, warning, information
code
required, string

A FHIR category code that describes the general type of issue. See http://hl7.org/fhir/ValueSet/issue-type for details

id
string

If the error occurs in the RedoxEngine, this corresponds to an Error record in the organization.

details
object

Additional details about the error. This may be a text description of the error or a system code that identifies the error.

coding
[object]

A more granular FHIR code for the specific error. Typically from http://hl7.org/fhir/ValueSet/operation-outcome

system
string

The identification of the code system that defines the meaning of the symbol in the code.

code
string

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).

text
string

A human-readable interpretation of the issue code

diagnostics
string

Additional diagnostic information about the issue.