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FHIR IG Statistics: OperationDefinition/SearchByClaim

Packagehl7.fhir.us.davinci-pr
TypeOperationDefinition
IdSearchByClaim
FHIR VersionR4
Sourcehttp://hl7.org/fhir/us/davinci-pr/https://build.fhir.org/ig/HL7/davinci-pr/OperationDefinition-SearchByClaim.html
URLhttp://hl7.org/fhir/us/davinci-pr/OperationDefinition/SearchByClaim
Version1.0.0
Statusactive
Date2025-04-07T20:24:22+00:00
NameSearchByClaim
TitleSearch for Postable Remittance By Claim
Realmus
Authorityhl7
DescriptionThis operation is used to search for a postable remittance by providing claim information.
Typefalse
Kindoperation

Resources that use this resource

CapabilityStatement
PostableRemittanceClientCapabilitiesPostable Remittance Client Capabilities
PostableRemittanceServerCapabilitiesPostable 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

UseNameScopeCardinalityTypeBindingDocumentation
INTIN1..1string

Medical Group / Billing Provider / Payee TIN

INPayerID0..1string

Payer Identifer

INPayerName0..1string

Payer Name

INServiceStartDate0..1date

Start Date of Service

INServiceEndDate0..1date

End Date of Service

INPatientID0..1string

Patient Member (or Subscriber) Insurance ID

INClaim1..1

Information about the claim being searched for.

INClaim.ProviderClaimID1..1string

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

INClaim.ProviderID0..1string

NPI or Payer Assigned Provider Identifier

INClaim.PayerClaimID0..1string

Payer Generated Claim ID (DCN or ICN)

INClaim.ClaimChargeAmount0..1Money

Claim Charge Amount

OUTTIN1..1string

Medical Group / Billing Provider / Payee TIN

OUTPayer1..1

Details of payer information.

OUTPayer.PayerID1..1string

Payer Identifier

OUTPayer.PayerName1..1string

Payer Name

OUTClaim1..*

Details to verify correct claim found.

OUTClaim.PayerClaimID1..1string

Payer Generated Claim ID (DCN or ICN)

OUTClaim.ProviderClaimID1..1string

Provider generated Claim ID

OUTClaim.ClaimReceivedDate1..1date

Claim Received Date

OUTClaim.ProviderID1..1string

NPI or Payer Assigned Provider Identifier

OUTClaim.PaymentInfo1..*

Details of adjudicated payment.

OUTClaim.PaymentInfo.PaymentDate1..1date

Payment Date

OUTClaim.PaymentInfo.PaymentNumber1..1string

Payment Number

OUTClaim.PaymentInfo.PaymentAmount1..1Money

Payment Amount

OUTClaim.PaymentInfo.Remittance1..*

Details of remittance advice.

OUTClaim.PaymentInfo.Remittance.RemittanceAdviceIdentifier1..1string

Remittance Advice Identifier

OUTClaim.PaymentInfo.Remittance.RemittanceAdviceType1..1codeRemittance Advice Value Set (Required)

Remittance Advice Type

OUTClaim.PaymentInfo.Remittance.RemittanceAdviceDate1..1date

Remittance Advice Date

OUTClaim.PaymentInfo.Remittance.RemittanceAdviceFileSize1..1integer

Remittance Advice File Size

OUTPatient1..1

Details to verify correct patient found.

OUTPatient.DateOfBirth1..1date

Patient date of birth

OUTPatient.PatientID1..1string

Patient Member (or Subscriber) Insurance ID

OUTPatient.PatientFirstName1..1string

Patient First Name

OUTPatient.PatientLastName1..1string

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"
        }
      ]
    }
  ]
}