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Claim

A provider issued list of professional services and products which have been provided, or are to be provided, to a patient which is sent to an insurer for reimbursement.

Properties

NameCardTypeDescription
id0..1stringLogical id of this artifact
meta0..1MetaMetadata about the resource
implicitRules0..1uriA set of rules under which this content was created
language0..1codeLanguage of the resource content
text0..1NarrativeText summary of the resource, for human interpretation
contained0..*ResourceContained, inline Resources
extension0..*ExtensionAdditional content defined by implementations
modifierExtension0..*ExtensionExtensions that cannot be ignored
identifier0..*IdentifierBusiness Identifier for claim
status1..1codeactive | cancelled | draft | entered-in-error
type1..1CodeableConceptCategory or discipline
subType0..1CodeableConceptMore granular claim type
use1..1codeclaim | preauthorization | predetermination
patient1..1ReferenceThe recipient of the products and services
billablePeriod0..1PeriodRelevant time frame for the claim
created1..1dateTimeResource creation date
enterer0..1ReferenceAuthor of the claim
insurer0..1ReferenceTarget
provider1..1ReferenceParty responsible for the claim
priority1..1CodeableConceptDesired processing ugency
fundsReserve0..1CodeableConceptFor whom to reserve funds
related0..*BackboneElementPrior or corollary claims
prescription0..1ReferencePrescription authorizing services and products
originalPrescription0..1ReferenceOriginal prescription if superseded by fulfiller
payee0..1BackboneElementRecipient of benefits payable
referral0..1ReferenceTreatment referral
facility0..1ReferenceServicing facility
careTeam0..*BackboneElementMembers of the care team
supportingInfo0..*BackboneElementSupporting information
diagnosis0..*BackboneElementPertinent diagnosis information
procedure0..*BackboneElementClinical procedures performed
insurance1..*BackboneElementPatient insurance information
accident0..1BackboneElementDetails of the event
item0..*BackboneElementProduct or service provided
total0..1MoneyTotal claim cost

Search Parameters

NameTypeDescriptionExpression
care-teamreferenceMember of the CareTeamClaim.careTeam.provider
createddateThe creation date for the ClaimClaim.created
detail-udireferenceUDI associated with a line item, detail product or serviceClaim.item.detail.udi
encounterreferenceEncounters associated with a billed line itemClaim.item.encounter
entererreferenceThe party responsible for the entry of the ClaimClaim.enterer
facilityreferenceFacility where the products or services have been or will be providedClaim.facility
identifiertokenThe primary identifier of the financial resourceClaim.identifier
insurerreferenceThe target payor/insurer for the ClaimClaim.insurer
item-udireferenceUDI associated with a line item product or serviceClaim.item.udi
patientreferencePatient receiving the products or servicesClaim.patient
payeereferenceThe party receiving any payment for the ClaimClaim.payee.party
prioritytokenProcessing priority requestedClaim.priority
procedure-udireferenceUDI associated with a procedureClaim.procedure.udi
providerreferenceProvider responsible for the ClaimClaim.provider
statustokenThe status of the Claim instance.Claim.status
subdetail-udireferenceUDI associated with a line item, detail, subdetail product or serviceClaim.item.detail.subDetail.udi
usetokenThe kind of financial resourceClaim.use