Claim

This data model facilitates transactions between providers and payers. We support submitting claims and sending payment notifications in batches.

Typically, the claims workflow kicks off with providers grouping (i.e., batching) and sending claims to payers with details about services rendered to a patient and a request for payment. After processing the claims, payers send batched payment notifications to the provider with a status of whether the payment request was accepted or denied. In some cases, the status may indicate that a third party transferred funds to the provider.

This data model has event types that allow you to:

• submit a batch of claims; or
• sent a batch of payment notifications.

Events in Claim