Release 4

This page is part of the FHIR Specification (v4.0.1: R4 - Mixed Normative and STU) in it's permanent home (it will always be available at this URL). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4

Operation-claim-submit.xml

Financial Management Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Device, Encounter, Patient, Practitioner, RelatedPerson

Raw XML (canonical form + also see XML Format Specification)

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Operation Definition

<?xml version="1.0" encoding="UTF-8"?>

<OperationDefinition xmlns="http://hl7.org/fhir">
  <id value="Claim-submit"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
      <h2> Submit a Claim resource for adjudication</h2> 
      <p> OPERATION: Submit a Claim resource for adjudication</p> 
      <p> The official URL for this operation definition is: </p> 
      <pre> http://hl7.org/fhir/OperationDefinition/Claim-submit</pre> 
      <div> 
        <p> This operation is used to submit a Claim, Pre-Authorization or Pre-Determination (all
           instances of Claim resources) for adjudication either as a single Claim resource instance
           or as a Bundle containing the Claim and other referenced resources, or Bundle containing
           a batch of Claim resources, either as single Claims resources or Bundle resources, for
           processing. The only input parameter is the single Claim or Bundle resource and the only
           output is a single ClaimResponse, Bundle of ClaimResponses or an OperationOutcome resource.</p> 

      </div> 
      <p> URL: [base]/Claim/$submit</p> 
      <p> Parameters</p> 
      <table class="grid">
        <tr> 
          <td> 
            <b> Use</b> 
          </td> 
          <td> 
            <b> Name</b> 
          </td> 
          <td> 
            <b> Cardinality</b> 
          </td> 
          <td> 
            <b> Type</b> 
          </td> 
          <td> 
            <b> Binding</b> 
          </td> 
          <td> 
            <b> Documentation</b> 
          </td> 
        </tr> 
        <tr> 
          <td> IN</td> 
          <td> resource</td> 
          <td> 1..1</td> 
          <td> 
            <a href="resource.html">Resource</a> 
          </td> 
          <td/>  
          <td> 
            <div> 
              <p> A Claim resource or Bundle of claims, either as individual Claim resources or as Bundles
                 each containing a single Claim plus referenced resources.</p> 

            </div> 
          </td> 
        </tr> 
        <tr> 
          <td> OUT</td> 
          <td> return</td> 
          <td> 1..1</td> 
          <td> 
            <a href="resource.html">Resource</a> 
          </td> 
          <td/>  
          <td> 
            <div> 
              <p> A ClaimResponse resource or Bundle of claim responses, either as individual ClaimResponse
                 resources or as Bundles each containing a single ClaimResponse plus referenced resources.</p> 

            </div> 
          </td> 
        </tr> 
      </table> 
      <div/>  
    </div> 
  </text> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="2"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use"/> 
  </extension> 
  <url value="http://hl7.org/fhir/OperationDefinition/Claim-submit"/> 
  <version value="4.0.1"/> 
  <name value="Submit a Claim resource for adjudication"/> 
  <status value="draft"/> 
  <kind value="operation"/> 
  <date value="2019-11-01T09:29:23+11:00"/> 
  <publisher value="HL7 (FHIR Project)"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://hl7.org/fhir"/> 
    </telecom> 
    <telecom> 
      <system value="email"/> 
      <value value="fhir@lists.hl7.org"/> 
    </telecom> 
  </contact> 
  <description value="This operation is used to submit a Claim, Pre-Authorization or Pre-Determination (all
   instances of Claim resources) for adjudication either as a single Claim resource instance
   or as a Bundle containing the Claim and other referenced resources, or Bundle containing
   a batch of Claim resources, either as single Claims resources or Bundle resources, for
   processing. The only input parameter is the single Claim or Bundle resource and the only
   output is a single ClaimResponse, Bundle of ClaimResponses or an OperationOutcome resource."/> 
  <code value="submit"/> 
  <resource value="Claim"/> 
  <system value="false"/> 
  <type value="true"/> 
  <instance value="false"/> 
  <parameter> 
    <name value="resource"/> 
    <use value="in"/> 
    <min value="1"/> 
    <max value="1"/> 
    <documentation value="A Claim resource or Bundle of claims, either as individual Claim resources or as Bundles
     each containing a single Claim plus referenced resources."/> 
    <type value="Resource"/> 
  </parameter> 
  <parameter> 
    <name value="return"/> 
    <use value="out"/> 
    <min value="1"/> 
    <max value="1"/> 
    <documentation value="A ClaimResponse resource or Bundle of claim responses, either as individual ClaimResponse
     resources or as Bundles each containing a single ClaimResponse plus referenced resources."/> 
    <type value="Resource"/> 
  </parameter> 
</OperationDefinition> 

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.