XIG: OperationDefinition/SearchByClaim

FHIR IG Statistics: OperationDefinition/SearchByClaim

Package	hl7.fhir.us.davinci-pr
Resource Type	OperationDefinition
Id	SearchByClaim
FHIR Version	R4
Source	http://hl7.org/fhir/us/davinci-pr/https://build.fhir.org/ig/HL7/davinci-pr/OperationDefinition-SearchByClaim.html
URL	http://hl7.org/fhir/us/davinci-pr/OperationDefinition/SearchByClaim
Version	1.0.0
Status	active
Date	2025-04-07T20:24:22+00:00
Name	SearchByClaim
Title	Search for Postable Remittance By Claim
Realm	us
Authority	hl7
Description	This operation is used to search for a postable remittance by providing claim information.
Type	false
Kind	operation

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

Note: links and images are rebased to the (stated) source

Generated Narrative: OperationDefinition SearchByClaim

URL: [base]/$searchByClaim

Input parameters Profile:Search By Claim Incoming Parameters

Output parameters Profile:Search Result Outgoing Parameters

Parameters

Use

Name

Scope

Cardinality

Type

Binding

Documentation

TIN

1..1

string

Medical Group / Billing Provider / Payee TIN

PayerID

0..1

string

Payer Identifer

PayerName

0..1

string

Payer Name

ServiceStartDate

0..1

date

Start Date of Service

ServiceEndDate

0..1

date

End Date of Service

PatientID

0..1

string

Patient Member (or Subscriber) Insurance ID

Claim

1..1

Information about the claim being searched for.

Claim.ProviderClaimID

1..1

string

Provider generated Claim ID (also known as Patient Account Number)

Claim.ProviderID

0..1

string

NPI or Payer Assigned Provider Identifier

Claim.PayerClaimID

0..1

string

Payer Generated Claim ID (DCN or ICN)

Claim.ClaimChargeAmount

0..1

Money

Claim Charge Amount

OUT

TIN

1..1

string

Medical Group / Billing Provider / Payee TIN

OUT

Payer

1..1

Details of payer information.

OUT

Payer.PayerID

1..1

string

Payer Identifier

OUT

Payer.PayerName

1..1

string

Payer Name

OUT

Claim

1..*

Details to verify correct claim found.

OUT

Claim.PayerClaimID

1..1

string

Payer Generated Claim ID (DCN or ICN)

OUT

Claim.ProviderClaimID

1..1

string

Provider generated Claim ID

OUT

Claim.ClaimReceivedDate

1..1

date

Claim Received Date

OUT

Claim.ProviderID

1..1

string

NPI or Payer Assigned Provider Identifier

OUT

Claim.PaymentInfo

1..*

Details of adjudicated payment.

OUT

Claim.PaymentInfo.PaymentDate

1..1

date

Payment Date

OUT

Claim.PaymentInfo.PaymentNumber

1..1

string

Payment Number

OUT

Claim.PaymentInfo.PaymentAmount

1..1

Money

Payment Amount

OUT

Claim.PaymentInfo.Remittance

1..*

Details of remittance advice.

OUT

Claim.PaymentInfo.Remittance.RemittanceAdviceIdentifier

1..1

string

Remittance Advice Identifier

OUT

Claim.PaymentInfo.Remittance.RemittanceAdviceType

1..1

code

Remittance Advice Value Set (Required)

Remittance Advice Type

OUT

Claim.PaymentInfo.Remittance.RemittanceAdviceDate

1..1

date

Remittance Advice Date

OUT

Claim.PaymentInfo.Remittance.RemittanceAdviceFileSize

1..1

integer

Remittance Advice File Size

OUT

Patient

1..1

Details to verify correct patient found.

OUT

Patient.DateOfBirth

1..1

date

Patient date of birth

OUT

Patient.PatientID

1..1

string

Patient Member (or Subscriber) Insurance ID

OUT

Patient.PatientFirstName

1..1

string

Patient First Name

OUT

Patient.PatientLastName

1..1

string

Patient Last Name

Source

{
  "resourceType": "OperationDefinition",
  "id": "SearchByClaim",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "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",
  "name": "SearchByClaim",
  "title": "Search for Postable Remittance By Claim",
  "status": "active",
  "kind": "operation",
  "date": "2025-04-07T20:24:22+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": "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": "ServiceStartDate",
      "use": "in",
      "min": 0,
      "max": "1",
      "documentation": "Start Date of Service",
      "type": "date"
    },
    {
      "name": "ServiceEndDate",
      "use": "in",
      "min": 0,
      "max": "1",
      "documentation": "End Date of Service",
      "type": "date"
    },
    {
      "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": 1,
      "max": "1",
      "documentation": "Medical Group / Billing Provider / Payee TIN",
      "type": "string"
    },
    {
      "name": "Payer",
      "use": "out",
      "min": 1,
      "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": 1,
      "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": 1,
          "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": 1,
              "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"
        }
      ]
    }
  ]
}