R4 Draft for Comment

This page is part of the FHIR Specification (v3.2.0: R4 Ballot 1). 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

Financial Management Work Group

Maturity Level: N/A

Ballot Status: Informative

Compartments: Encounter, Patient, Practitioner, RelatedPerson

This is the narrative for the resource. See also the XML or JSON format.

Submit a Claim resource for adjudication

OPERATION: Submit a Claim resource for adjudication

The official URL for this operation definition is:

http://hl7.org/fhir/OperationDefinition/Claim-submit

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.

URL: [base]/Claim/$submit

Parameters

Use

Name

Cardinality

Type

Binding

Documentation

IN

resource

1..1

Resource

A Claim resource or Bundle of claims, either as individual Claim resources or as Bundles each containing a single Claim plus referenced resources.

OUT

return

1..1

Resource

A ClaimResponse resource or Bundle of claim responses, either as individual ClaimResponse resources or as Bundles each containing a single ClaimResponse plus referenced resources.

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.