Resource OperationDefinition/FHIR Server from package hl7.fhir.us.davinci-pr#current (31 ms)

Resources that use this resource

CapabilityStatement
PostableRemittanceClientCapabilities	Postable Remittance Client Capabilities
PostableRemittanceServerCapabilities	Postable Remittance Server Capabilities

Resources that this resource uses

No resources found

Narrative

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Source

{
  "resourceType" : "OperationDefinition",
  "id" : "SearchByClaim",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: OperationDefinition SearchByClaim</b></p><a name=\"SearchByClaim\"> </a><a name=\"hcSearchByClaim\"> </a><a name=\"SearchByClaim-en-US\"> </a><p>URL: [base]/$searchByClaim</p><p>Input parameters Profile:<a href=\"StructureDefinition-searchByClaimParameters.html\">Search By Claim Incoming Parameters</a></p><p>Output parameters Profile:<a href=\"StructureDefinition-searchResultParameters.html\">Search Result Outgoing Parameters</a></p><h3>Parameters</h3><table class=\"grid\"><tr><td><b>Use</b></td><td><b>Name</b></td><td><b>Scope</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>TIN</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Medical Group / Billing Provider / Payee TIN</p>\n</div></td></tr><tr><td>IN</td><td>DateOfService</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#Period\">Period</a></td><td/><td><div><p>Date of Service</p>\n</div></td></tr><tr><td>IN</td><td>PayerID</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Payer Identifer</p>\n</div></td></tr><tr><td>IN</td><td>PayerName</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Payer Name</p>\n</div></td></tr><tr><td>IN</td><td>PatientID</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Patient Member (or Subscriber) Insurance ID</p>\n</div></td></tr><tr><td>IN</td><td>Claim</td><td/><td>1..1</td><td></td><td/><td><div><p>Information about the claim being searched for.</p>\n</div></td></tr><tr><td>IN</td><td>Claim.ProviderClaimID</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Provider generated Claim ID (also known as Patient Account Number)</p>\n</div></td></tr><tr><td>IN</td><td>Claim.ProviderID</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>NPI or Payer Assigned Provider Identifier</p>\n</div></td></tr><tr><td>IN</td><td>Claim.PayerClaimID</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Payer Generated Claim ID (DCN or ICN)</p>\n</div></td></tr><tr><td>IN</td><td>Claim.ClaimChargeAmount</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#Money\">Money</a></td><td/><td><div><p>Claim Charge Amount</p>\n</div></td></tr><tr><td>OUT</td><td>TIN</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Medical Group / Billing Provider / Payee TIN</p>\n</div></td></tr><tr><td>OUT</td><td>Payer</td><td/><td>0..1</td><td></td><td/><td><div><p>Details of payer information.</p>\n</div></td></tr><tr><td>OUT</td><td>Payer.PayerID</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Payer Identifier</p>\n</div></td></tr><tr><td>OUT</td><td>Payer.PayerName</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Payer Name</p>\n</div></td></tr><tr><td>OUT</td><td>Claim</td><td/><td>0..*</td><td></td><td/><td><div><p>Details to verify correct claim found.</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PayerClaimID</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Payer Generated Claim ID (DCN or ICN)</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.ProviderClaimID</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Provider generated Claim ID</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.ClaimReceivedDate</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#date\">date</a></td><td/><td><div><p>Claim Received Date</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.ProviderID</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>NPI or Payer Assigned Provider Identifier</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo</td><td/><td>0..*</td><td></td><td/><td><div><p>Details of adjudicated payment.</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.PaymentDate</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#date\">date</a></td><td/><td><div><p>Payment Date</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.PaymentNumber</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Payment Number</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.PaymentAmount</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#Money\">Money</a></td><td/><td><div><p>Payment Amount</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.Remittance</td><td/><td>0..*</td><td></td><td/><td><div><p>Details of remittance advice.</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.Remittance.RemittanceAdviceIdentifier</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Remittance Advice Identifier</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.Remittance.RemittanceAdviceType</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#code\">code</a></td><td><a href=\"ValueSet-RemittanceAdviceType.html\">Remittance Advice Value Set</a> (Required)</td><td><div><p>Remittance Advice Type</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.Remittance.RemittanceAdviceDate</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#date\">date</a></td><td/><td><div><p>Remittance Advice Date</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.Remittance.RemittanceAdviceFileSize</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#integer\">integer</a></td><td/><td><div><p>Remittance Advice File Size</p>\n</div></td></tr><tr><td>OUT</td><td>Patient</td><td/><td>1..1</td><td></td><td/><td><div><p>Details to verify correct patient found.</p>\n</div></td></tr><tr><td>OUT</td><td>Patient.DateOfBirth</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#date\">date</a></td><td/><td><div><p>Patient date of birth</p>\n</div></td></tr><tr><td>OUT</td><td>Patient.PatientID</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Patient Member (or Subscriber) Insurance ID</p>\n</div></td></tr><tr><td>OUT</td><td>Patient.PatientFirstName</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Patient First Name</p>\n</div></td></tr><tr><td>OUT</td><td>Patient.PatientLastName</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Patient Last Name</p>\n</div></td></tr></table></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "claims"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger" : 1,
      "_valueInteger" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/davinci-pr/ImplementationGuide/hl7.fhir.us.davinci-pr"
          }
        ]
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "trial-use",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/davinci-pr/ImplementationGuide/hl7.fhir.us.davinci-pr"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/us/davinci-pr/OperationDefinition/SearchByClaim",
  "version" : "1.0.0-ballot",
  "name" : "SearchByClaim",
  "title" : "Search for Postable Remittance By Claim",
  "status" : "active",
  "kind" : "operation",
  "date" : "2024-12-16T14:03:45+00:00",
  "publisher" : "HL7 International / Payer/Provider Information Exchange Work Group",
  "contact" : [
    {
      "name" : "HL7 International / Payer/Provider Information Exchange Work Group",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/claims"
        }
      ]
    }
  ],
  "description" : "This operation is used to search for a postable remittance by providing claim information.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US",
          "display" : "United States of America"
        }
      ]
    }
  ],
  "code" : "searchByClaim",
  "system" : true,
  "type" : false,
  "instance" : false,
  "inputProfile" : "http://hl7.org/fhir/us/davinci-pr/StructureDefinition/searchByClaimParameters",
  "outputProfile" : "http://hl7.org/fhir/us/davinci-pr/StructureDefinition/searchResultParameters",
  "parameter" : [
    {
      "name" : "TIN",
      "use" : "in",
      "min" : 1,
      "max" : "1",
      "documentation" : "Medical Group / Billing Provider / Payee TIN",
      "type" : "string"
    },
    {
      "name" : "DateOfService",
      "use" : "in",
      "min" : 0,
      "max" : "1",
      "documentation" : "Date of Service",
      "type" : "Period"
    },
    {
      "name" : "PayerID",
      "use" : "in",
      "min" : 0,
      "max" : "1",
      "documentation" : "Payer Identifer",
      "type" : "string"
    },
    {
      "name" : "PayerName",
      "use" : "in",
      "min" : 0,
      "max" : "1",
      "documentation" : "Payer Name",
      "type" : "string"
    },
    {
      "name" : "PatientID",
      "use" : "in",
      "min" : 0,
      "max" : "1",
      "documentation" : "Patient Member (or Subscriber) Insurance ID",
      "type" : "string"
    },
    {
      "name" : "Claim",
      "use" : "in",
      "min" : 1,
      "max" : "1",
      "documentation" : "Information about the claim being searched for.",
      "part" : [
        {
          "name" : "ProviderClaimID",
          "use" : "in",
          "min" : 1,
          "max" : "1",
          "documentation" : "Provider generated Claim ID (also known as Patient Account Number)",
          "type" : "string"
        },
        {
          "name" : "ProviderID",
          "use" : "in",
          "min" : 0,
          "max" : "1",
          "documentation" : "NPI or Payer Assigned Provider Identifier",
          "type" : "string"
        },
        {
          "name" : "PayerClaimID",
          "use" : "in",
          "min" : 0,
          "max" : "1",
          "documentation" : "Payer Generated Claim ID (DCN or ICN)",
          "type" : "string"
        },
        {
          "name" : "ClaimChargeAmount",
          "use" : "in",
          "min" : 0,
          "max" : "1",
          "documentation" : "Claim Charge Amount",
          "type" : "Money"
        }
      ]
    },
    {
      "name" : "TIN",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "documentation" : "Medical Group / Billing Provider / Payee TIN",
      "type" : "string"
    },
    {
      "name" : "Payer",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "documentation" : "Details of payer information.",
      "part" : [
        {
          "name" : "PayerID",
          "use" : "out",
          "min" : 1,
          "max" : "1",
          "documentation" : "Payer Identifier",
          "type" : "string"
        },
        {
          "name" : "PayerName",
          "use" : "out",
          "min" : 1,
          "max" : "1",
          "documentation" : "Payer Name",
          "type" : "string"
        }
      ]
    },
    {
      "name" : "Claim",
      "use" : "out",
      "min" : 0,
      "max" : "*",
      "documentation" : "Details to verify correct claim found.",
      "part" : [
        {
          "name" : "PayerClaimID",
          "use" : "out",
          "min" : 1,
          "max" : "1",
          "documentation" : "Payer Generated Claim ID (DCN or ICN)",
          "type" : "string"
        },
        {
          "name" : "ProviderClaimID",
          "use" : "out",
          "min" : 1,
          "max" : "1",
          "documentation" : "Provider generated Claim ID",
          "type" : "string"
        },
        {
          "name" : "ClaimReceivedDate",
          "use" : "out",
          "min" : 1,
          "max" : "1",
          "documentation" : "Claim Received Date",
          "type" : "date"
        },
        {
          "name" : "ProviderID",
          "use" : "out",
          "min" : 1,
          "max" : "1",
          "documentation" : "NPI or Payer Assigned Provider Identifier",
          "type" : "string"
        },
        {
          "name" : "PaymentInfo",
          "use" : "out",
          "min" : 0,
          "max" : "*",
          "documentation" : "Details of adjudicated payment.",
          "part" : [
            {
              "name" : "PaymentDate",
              "use" : "out",
              "min" : 1,
              "max" : "1",
              "documentation" : "Payment Date",
              "type" : "date"
            },
            {
              "name" : "PaymentNumber",
              "use" : "out",
              "min" : 1,
              "max" : "1",
              "documentation" : "Payment Number",
              "type" : "string"
            },
            {
              "name" : "PaymentAmount",
              "use" : "out",
              "min" : 1,
              "max" : "1",
              "documentation" : "Payment Amount",
              "type" : "Money"
            },
            {
              "name" : "Remittance",
              "use" : "out",
              "min" : 0,
              "max" : "*",
              "documentation" : "Details of remittance advice.",
              "part" : [
                {
                  "name" : "RemittanceAdviceIdentifier",
                  "use" : "out",
                  "min" : 1,
                  "max" : "1",
                  "documentation" : "Remittance Advice Identifier",
                  "type" : "string"
                },
                {
                  "name" : "RemittanceAdviceType",
                  "use" : "out",
                  "min" : 1,
                  "max" : "1",
                  "documentation" : "Remittance Advice Type",
                  "type" : "code",
                  "binding" : {
                    "strength" : "required",
                    "valueSet" : "http://hl7.org/fhir/us/davinci-pr/ValueSet/RemittanceAdviceType"
                  }
                },
                {
                  "name" : "RemittanceAdviceDate",
                  "use" : "out",
                  "min" : 1,
                  "max" : "1",
                  "documentation" : "Remittance Advice Date",
                  "type" : "date"
                },
                {
                  "name" : "RemittanceAdviceFileSize",
                  "use" : "out",
                  "min" : 1,
                  "max" : "1",
                  "documentation" : "Remittance Advice File Size",
                  "type" : "integer"
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name" : "Patient",
      "use" : "out",
      "min" : 1,
      "max" : "1",
      "documentation" : "Details to verify correct patient found.",
      "part" : [
        {
          "name" : "DateOfBirth",
          "use" : "out",
          "min" : 1,
          "max" : "1",
          "documentation" : "Patient date of birth",
          "type" : "date"
        },
        {
          "name" : "PatientID",
          "use" : "out",
          "min" : 1,
          "max" : "1",
          "documentation" : "Patient Member (or Subscriber) Insurance ID",
          "type" : "string"
        },
        {
          "name" : "PatientFirstName",
          "use" : "out",
          "min" : 1,
          "max" : "1",
          "documentation" : "Patient First Name",
          "type" : "string"
        },
        {
          "name" : "PatientLastName",
          "use" : "out",
          "min" : 1,
          "max" : "1",
          "documentation" : "Patient Last Name",
          "type" : "string"
        }
      ]
    }
  ]
}

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