Class Claim

All Implemented Interfaces:
ca.uhn.fhir.model.api.IElement, Serializable, org.hl7.fhir.instance.model.api.IAnyResource, org.hl7.fhir.instance.model.api.IBase, org.hl7.fhir.instance.model.api.IBaseHasExtensions, org.hl7.fhir.instance.model.api.IBaseHasModifierExtensions, org.hl7.fhir.instance.model.api.IBaseResource, org.hl7.fhir.instance.model.api.IDomainResource

public class Claim extends DomainResource
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.
See Also:
  • Field Details

    • identifier

      A unique identifier assigned to this claim.
    • status

      The status of the resource instance.
    • type

      protected CodeableConcept type
      The category of claim, e.g. oral, pharmacy, vision, institutional, professional.
    • subType

      A finer grained suite of claim type codes which may convey additional information such as Inpatient vs Outpatient and/or a specialty service.
    • use

      A code to indicate whether the nature of the request is: Claim - A request to an Insurer to adjudicate the supplied charges for health care goods and services under the identified policy and to pay the determined Benefit amount, if any; Preauthorization - A request to an Insurer to adjudicate the supplied proposed future charges for health care goods and services under the identified policy and to approve the services and provide the expected benefit amounts and potentially to reserve funds to pay the benefits when Claims for the indicated services are later submitted; or, Pre-determination - A request to an Insurer to adjudicate the supplied 'what if' charges for health care goods and services under the identified policy and report back what the Benefit payable would be had the services actually been provided.
    • patient

      protected Reference patient
      The party to whom the professional services and/or products have been supplied or are being considered and for whom actual or forecast reimbursement is sought.
    • billablePeriod

      The period for which charges are being submitted.
    • created

      protected DateTimeType created
      The date this resource was created.
    • enterer

      protected Reference enterer
      Individual who created the claim, predetermination or preauthorization.
    • insurer

      protected Reference insurer
      The Insurer who is target of the request.
    • provider

      protected Reference provider
      The provider which is responsible for the claim, predetermination or preauthorization.
    • priority

      The provider-required urgency of processing the request. Typical values include: stat, normal, deferred.
    • fundsReserve

      A code to indicate whether and for whom funds are to be reserved for future claims.
    • prescription

      Prescription is the document/authorization given to the claim author for them to provide products and services for which consideration (reimbursement) is sought. Could be a RX for medications, an 'order' for oxygen or wheelchair or physiotherapy treatments.
    • originalPrescription

      Original prescription which has been superseded by this prescription to support the dispensing of pharmacy services, medications or products.
    • payee

      The party to be reimbursed for cost of the products and services according to the terms of the policy.
    • referral

      protected Reference referral
      The referral information received by the claim author, it is not to be used when the author generates a referral for a patient. A copy of that referral may be provided as supporting information. Some insurers require proof of referral to pay for services or to pay specialist rates for services.
    • encounter

      protected List<Reference> encounter
      The Encounters during which this Claim was created or to which the creation of this record is tightly associated.
    • facility

      protected Reference facility
      Facility where the services were provided.
    • diagnosisRelatedGroup

      A package billing code or bundle code used to group products and services to a particular health condition (such as heart attack) which is based on a predetermined grouping code system.
    • careTeam

      The members of the team who provided the products and services.
    • supportingInfo

      Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.
    • diagnosis

      Information about diagnoses relevant to the claim items.
    • procedure

      Procedures performed on the patient relevant to the billing items with the claim.
    • insurance

      Financial instruments for reimbursement for the health care products and services specified on the claim.
    • accident

      Details of an accident which resulted in injuries which required the products and services listed in the claim.
    • patientPaid

      protected Money patientPaid
      The amount paid by the patient, in total at the claim claim level or specifically for the item and detail level, to the provider for goods and services.
    • item

      A claim line. Either a simple product or service or a 'group' of details which can each be a simple items or groups of sub-details.
    • total

      protected Money total
      The total value of the all the items in the claim.
    • SP_CARE_TEAM

      public static final String SP_CARE_TEAM
      Search parameter: care-team

      Description: Member of the CareTeam
      Type: reference
      Path: Claim.careTeam.provider

      See Also:
    • CARE_TEAM

      public static final ca.uhn.fhir.rest.gclient.ReferenceClientParam CARE_TEAM
      Fluent Client search parameter constant for care-team

      Description: Member of the CareTeam
      Type: reference
      Path: Claim.careTeam.provider

    • INCLUDE_CARE_TEAM

      public static final ca.uhn.fhir.model.api.Include INCLUDE_CARE_TEAM
      Constant for fluent queries to be used to add include statements. Specifies the path value of "Claim:care-team".
    • SP_CREATED

      public static final String SP_CREATED
      Search parameter: created

      Description: The creation date for the Claim
      Type: date
      Path: Claim.created

      See Also:
    • CREATED

      public static final ca.uhn.fhir.rest.gclient.DateClientParam CREATED
      Fluent Client search parameter constant for created

      Description: The creation date for the Claim
      Type: date
      Path: Claim.created

    • SP_DETAIL_UDI

      public static final String SP_DETAIL_UDI
      Search parameter: detail-udi

      Description: UDI associated with a line item, detail product or service
      Type: reference
      Path: Claim.item.detail.udi

      See Also:
    • DETAIL_UDI

      public static final ca.uhn.fhir.rest.gclient.ReferenceClientParam DETAIL_UDI
      Fluent Client search parameter constant for detail-udi

      Description: UDI associated with a line item, detail product or service
      Type: reference
      Path: Claim.item.detail.udi

    • INCLUDE_DETAIL_UDI

      public static final ca.uhn.fhir.model.api.Include INCLUDE_DETAIL_UDI
      Constant for fluent queries to be used to add include statements. Specifies the path value of "Claim:detail-udi".
    • SP_ENCOUNTER

      public static final String SP_ENCOUNTER
      Search parameter: encounter

      Description: Encounters associated with a billed line item
      Type: reference
      Path: Claim.item.encounter

      See Also:
    • ENCOUNTER

      public static final ca.uhn.fhir.rest.gclient.ReferenceClientParam ENCOUNTER
      Fluent Client search parameter constant for encounter

      Description: Encounters associated with a billed line item
      Type: reference
      Path: Claim.item.encounter

    • INCLUDE_ENCOUNTER

      public static final ca.uhn.fhir.model.api.Include INCLUDE_ENCOUNTER
      Constant for fluent queries to be used to add include statements. Specifies the path value of "Claim:encounter".
    • SP_ENTERER

      public static final String SP_ENTERER
      Search parameter: enterer

      Description: The party responsible for the entry of the Claim
      Type: reference
      Path: Claim.enterer

      See Also:
    • ENTERER

      public static final ca.uhn.fhir.rest.gclient.ReferenceClientParam ENTERER
      Fluent Client search parameter constant for enterer

      Description: The party responsible for the entry of the Claim
      Type: reference
      Path: Claim.enterer

    • INCLUDE_ENTERER

      public static final ca.uhn.fhir.model.api.Include INCLUDE_ENTERER
      Constant for fluent queries to be used to add include statements. Specifies the path value of "Claim:enterer".
    • SP_FACILITY

      public static final String SP_FACILITY
      Search parameter: facility

      Description: Facility where the products or services have been or will be provided
      Type: reference
      Path: Claim.facility

      See Also:
    • FACILITY

      public static final ca.uhn.fhir.rest.gclient.ReferenceClientParam FACILITY
      Fluent Client search parameter constant for facility

      Description: Facility where the products or services have been or will be provided
      Type: reference
      Path: Claim.facility

    • INCLUDE_FACILITY

      public static final ca.uhn.fhir.model.api.Include INCLUDE_FACILITY
      Constant for fluent queries to be used to add include statements. Specifies the path value of "Claim:facility".
    • SP_IDENTIFIER

      public static final String SP_IDENTIFIER
      Search parameter: identifier

      Description: The primary identifier of the financial resource
      Type: token
      Path: Claim.identifier

      See Also:
    • IDENTIFIER

      public static final ca.uhn.fhir.rest.gclient.TokenClientParam IDENTIFIER
      Fluent Client search parameter constant for identifier

      Description: The primary identifier of the financial resource
      Type: token
      Path: Claim.identifier

    • SP_INSURER

      public static final String SP_INSURER
      Search parameter: insurer

      Description: The target payor/insurer for the Claim
      Type: reference
      Path: Claim.insurer

      See Also:
    • INSURER

      public static final ca.uhn.fhir.rest.gclient.ReferenceClientParam INSURER
      Fluent Client search parameter constant for insurer

      Description: The target payor/insurer for the Claim
      Type: reference
      Path: Claim.insurer

    • INCLUDE_INSURER

      public static final ca.uhn.fhir.model.api.Include INCLUDE_INSURER
      Constant for fluent queries to be used to add include statements. Specifies the path value of "Claim:insurer".
    • SP_ITEM_UDI

      public static final String SP_ITEM_UDI
      Search parameter: item-udi

      Description: UDI associated with a line item product or service
      Type: reference
      Path: Claim.item.udi

      See Also:
    • ITEM_UDI

      public static final ca.uhn.fhir.rest.gclient.ReferenceClientParam ITEM_UDI
      Fluent Client search parameter constant for item-udi

      Description: UDI associated with a line item product or service
      Type: reference
      Path: Claim.item.udi

    • INCLUDE_ITEM_UDI

      public static final ca.uhn.fhir.model.api.Include INCLUDE_ITEM_UDI
      Constant for fluent queries to be used to add include statements. Specifies the path value of "Claim:item-udi".
    • SP_PATIENT

      public static final String SP_PATIENT
      Search parameter: patient

      Description: Patient receiving the products or services
      Type: reference
      Path: Claim.patient

      See Also:
    • PATIENT

      public static final ca.uhn.fhir.rest.gclient.ReferenceClientParam PATIENT
      Fluent Client search parameter constant for patient

      Description: Patient receiving the products or services
      Type: reference
      Path: Claim.patient

    • INCLUDE_PATIENT

      public static final ca.uhn.fhir.model.api.Include INCLUDE_PATIENT
      Constant for fluent queries to be used to add include statements. Specifies the path value of "Claim:patient".
    • SP_PAYEE

      public static final String SP_PAYEE
      Search parameter: payee

      Description: The party receiving any payment for the Claim
      Type: reference
      Path: Claim.payee.party

      See Also:
    • PAYEE

      public static final ca.uhn.fhir.rest.gclient.ReferenceClientParam PAYEE
      Fluent Client search parameter constant for payee

      Description: The party receiving any payment for the Claim
      Type: reference
      Path: Claim.payee.party

    • INCLUDE_PAYEE

      public static final ca.uhn.fhir.model.api.Include INCLUDE_PAYEE
      Constant for fluent queries to be used to add include statements. Specifies the path value of "Claim:payee".
    • SP_PRIORITY

      public static final String SP_PRIORITY
      Search parameter: priority

      Description: Processing priority requested
      Type: token
      Path: Claim.priority

      See Also:
    • PRIORITY

      public static final ca.uhn.fhir.rest.gclient.TokenClientParam PRIORITY
      Fluent Client search parameter constant for priority

      Description: Processing priority requested
      Type: token
      Path: Claim.priority

    • SP_PROCEDURE_UDI

      public static final String SP_PROCEDURE_UDI
      Search parameter: procedure-udi

      Description: UDI associated with a procedure
      Type: reference
      Path: Claim.procedure.udi

      See Also:
    • PROCEDURE_UDI

      public static final ca.uhn.fhir.rest.gclient.ReferenceClientParam PROCEDURE_UDI
      Fluent Client search parameter constant for procedure-udi

      Description: UDI associated with a procedure
      Type: reference
      Path: Claim.procedure.udi

    • INCLUDE_PROCEDURE_UDI

      public static final ca.uhn.fhir.model.api.Include INCLUDE_PROCEDURE_UDI
      Constant for fluent queries to be used to add include statements. Specifies the path value of "Claim:procedure-udi".
    • SP_PROVIDER

      public static final String SP_PROVIDER
      Search parameter: provider

      Description: Provider responsible for the Claim
      Type: reference
      Path: Claim.provider

      See Also:
    • PROVIDER

      public static final ca.uhn.fhir.rest.gclient.ReferenceClientParam PROVIDER
      Fluent Client search parameter constant for provider

      Description: Provider responsible for the Claim
      Type: reference
      Path: Claim.provider

    • INCLUDE_PROVIDER

      public static final ca.uhn.fhir.model.api.Include INCLUDE_PROVIDER
      Constant for fluent queries to be used to add include statements. Specifies the path value of "Claim:provider".
    • SP_STATUS

      public static final String SP_STATUS
      Search parameter: status

      Description: The status of the Claim instance.
      Type: token
      Path: Claim.status

      See Also:
    • STATUS

      public static final ca.uhn.fhir.rest.gclient.TokenClientParam STATUS
      Fluent Client search parameter constant for status

      Description: The status of the Claim instance.
      Type: token
      Path: Claim.status

    • SP_SUBDETAIL_UDI

      public static final String SP_SUBDETAIL_UDI
      Search parameter: subdetail-udi

      Description: UDI associated with a line item, detail, subdetail product or service
      Type: reference
      Path: Claim.item.detail.subDetail.udi

      See Also:
    • SUBDETAIL_UDI

      public static final ca.uhn.fhir.rest.gclient.ReferenceClientParam SUBDETAIL_UDI
      Fluent Client search parameter constant for subdetail-udi

      Description: UDI associated with a line item, detail, subdetail product or service
      Type: reference
      Path: Claim.item.detail.subDetail.udi

    • INCLUDE_SUBDETAIL_UDI

      public static final ca.uhn.fhir.model.api.Include INCLUDE_SUBDETAIL_UDI
      Constant for fluent queries to be used to add include statements. Specifies the path value of "Claim:subdetail-udi".
    • SP_USE

      public static final String SP_USE
      Search parameter: use

      Description: The kind of financial resource
      Type: token
      Path: Claim.use

      See Also:
    • USE

      public static final ca.uhn.fhir.rest.gclient.TokenClientParam USE
      Fluent Client search parameter constant for use

      Description: The kind of financial resource
      Type: token
      Path: Claim.use

  • Constructor Details

  • Method Details