This resource contains the financial details for provider services for a patient visit or treatment. Healthcare organizations can use this resource to request reimbursement, while payers can review this resource to process claims and respond with the ClaimResponse resource.
You can submit, check, or add to claim information using one of the supported operations.
$attach
Attach additional patient information (i.e., X12 275) to a claim.
Providing extra context for a claim often helps it process more successfully.
cURL request example
Request Body Schema
- resourceTyperequired, string
Identifies the type of the resource
Value:Bundle
- typerequired, string
Indicates the purpose of this bundle - how it is intended to be used.
Value:collection
- entryrequired, Array of DocumentReference, Patient, Organization, PractitionerRole
An array of FHIR resources. Only a DocumentReference resource is required, but additional resources associated with the document or prior auth (such as the patient) may also be included.
In certain async workflows, some or all of the claim-related resources may also be included.
- resourcerequired, object
A binary document relating to a claim or response. The claim identifier is communicated in
context.related
.- resourceTyperequired, string
Identifies the type of the resource
Value:DocumentReference
- statusrequired, string
The status of this document reference.
Possible Values:current
,superseded
,entered-in-error
- contentrequired, Array of object
The contents of the document. If the size is small enough (<7mb), the data can be base64-encoded and sent in the
attachment.data
field. Otherwise, a binary resource must be uploaded independently and its identifier sent inattachment.url
.- attachmentrequired, object
The document or URL of the document along with critical metadata to prove content has integrity.
- contentTypestring
Identifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriate.
- datastring
The actual data of the attachment - a sequence of bytes, base64 encoded.
- urlstring
A location where the data can be accessed.
- contextrequired, object
The clinical context in which the document was prepared.
If the FHIR Claim or ClaimResponse resource is known or included in the bundle,
reference
can point to its internal FHIR id. Otherwise,identifier
communicates the value ofClaim.identifier
Must be a resource of type
Resource
.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.An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Source of the definition for the extension code - a logical name or a URL.
A single value for the extension.
The purpose of this identifier.
Possible Values:usual
,official
,temp
,secondary
,old (If known)
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
- subjectobject
Who or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).
Must reference one of the following types of resources:
Patient
Practitioner
Group
Device
- referencestring
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. - identifierobject
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
- extensionArray of Boolean, String, CodeableConcept, Coding
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
- urlrequired, string
Source of the definition for the extension code - a logical name or a URL.
- valueBooleanboolean
A single value for the extension.
- usestring
The purpose of this identifier.
Possible Values:usual
,official
,temp
,secondary
,old (If known)
- systemstring
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
- valuestring
The portion of the identifier typically relevant to the user and which is unique within the context of the system.