Package | hl7.fhir.us.davinci-pr |
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 |
CapabilityStatement | |
PostableRemittanceClientCapabilities | Postable Remittance Client Capabilities |
PostableRemittanceServerCapabilities | Postable Remittance Server Capabilities |
No resources found
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
Use | Name | Scope | Cardinality | Type | Binding | Documentation |
IN | TIN | 1..1 | string | Medical Group / Billing Provider / Payee TIN | ||
IN | PayerID | 0..1 | string | Payer Identifer | ||
IN | PayerName | 0..1 | string | Payer Name | ||
IN | ServiceStartDate | 0..1 | date | Start Date of Service | ||
IN | ServiceEndDate | 0..1 | date | End Date of Service | ||
IN | PatientID | 0..1 | string | Patient Member (or Subscriber) Insurance ID | ||
IN | Claim | 1..1 | Information about the claim being searched for. | |||
IN | Claim.ProviderClaimID | 1..1 | string | Provider generated Claim ID (also known as Patient Account Number) | ||
IN | Claim.ProviderID | 0..1 | string | NPI or Payer Assigned Provider Identifier | ||
IN | Claim.PayerClaimID | 0..1 | string | Payer Generated Claim ID (DCN or ICN) | ||
IN | 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 |
{ "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" } ] } ] }