Claim

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.

http://hl7.org/fhir/R4/claim.html

Endpoints

post
/Claim

Attributes

status
string required

The status of the resource instance.

Supported codes for create interactions are: active

type
json required

The category of claim.

Supported codes for create interactions are: professional with a system of http://hl7.org/fhir/ValueSet/claim-type

use
string required

A code to indicate the nature of the request

Supported codes for create interactions are: claim

patient
json required

The Canvas patient resource for the claim

created
date required

The date this resource was created.
Canvas will use this as the date of service for the claims in this message.

Expected format is : YYYY-MM-DD

provider
json required

The Canvas provider resource for the staff responsible for the claim.

priority
json required

The provider-required urgency of processing the request.

Supported codes for create interactions are: normal with a system of http://hl7.org/fhir/ValueSet/process-priority

supportingInfo
array[json]

Additional information about the Claim

Canvas supports a single iteration for a reason for visit - the text in the valueString will be used.

diagnosis
array[json] required

Information about diagnoses relevant to the claim items.

These diagnoses will create Assessments in Canvas.

The sequence should be unique within the Claim message, usually starting at 1 and incrementing as needed.

Must be a diagnosisCodeableConcept

Codes are supported from the following systems: http://hl7.org/fhir/ValueSet/icd-10

insurance
array[json] required

FHIR resource for the coverage(s) to use when adjudicating the claim

sequence should be unique for each insurance in the claim message.

focal indicates whether this insurance should be used to adjudicate the claim in this message. Canvas will ignore any elements that are False.

coverage is a Canvas coverage resource identifying the coverage for this iteration of insurance

Additional information on a Coverage can be obtained from the Coverage search endpoint

item
array[json] required

List of service charges to be used in the claim.

sequence should be unique for each item in the message.

diagnosisSequence should have one or more sequence values from the diagnosis section.

productOrService is an object that specifies the coding of the service. Canvas uses the first coding where system is http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code.

modifier specifies the list of charge modifier codings. Canvas accepts the first element where the coding’s system is http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSModifiers. Canvas uses the 2 character modifiers from this ValueSet.

post
/Claim

Claim create

Create a Claim resource.

Attributes

status
string required

The status of the resource instance.

Supported codes for create interactions are: active

type
json required

The category of claim.

Supported codes for create interactions are: professional with a system of http://hl7.org/fhir/ValueSet/claim-type

use
string required

A code to indicate the nature of the request

Supported codes for create interactions are: claim

patient
json required

The Canvas patient resource for the claim

created
date required

The date this resource was created.
Canvas will use this as the date of service for the claims in this message.

Expected format is : YYYY-MM-DD

provider
json required

The Canvas provider resource for the staff responsible for the claim.

priority
json required

The provider-required urgency of processing the request.

Supported codes for create interactions are: normal with a system of http://hl7.org/fhir/ValueSet/process-priority

supportingInfo
array[json]

Additional information about the Claim

Canvas supports a single iteration for a reason for visit - the text in the valueString will be used.

diagnosis
array[json] required

Information about diagnoses relevant to the claim items.

These diagnoses will create Assessments in Canvas.

The sequence should be unique within the Claim message, usually starting at 1 and incrementing as needed.

Must be a diagnosisCodeableConcept

Codes are supported from the following systems: http://hl7.org/fhir/ValueSet/icd-10

insurance
array[json] required

FHIR resource for the coverage(s) to use when adjudicating the claim

sequence should be unique for each insurance in the claim message.

focal indicates whether this insurance should be used to adjudicate the claim in this message. Canvas will ignore any elements that are False.

coverage is a Canvas coverage resource identifying the coverage for this iteration of insurance

Additional information on a Coverage can be obtained from the Coverage search endpoint

item
array[json] required

List of service charges to be used in the claim.

sequence should be unique for each item in the message.

diagnosisSequence should have one or more sequence values from the diagnosis section.

productOrService is an object that specifies the coding of the service. Canvas uses the first coding where system is http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code.

modifier specifies the list of charge modifier codings. Canvas accepts the first element where the coding’s system is http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSModifiers. Canvas uses the 2 character modifiers from this ValueSet.

Responses

201 Created
The server has successfully processed the request, the new resource has been created and is now ready for interaction.

Errors

400 Bad Request
The request was invalid or cannot be otherwise served. An accompanying error message will explain further.
401 Unauthorized
The request requires user authentication.
403 Forbidden
The request requires user authorization.
405 Method Not Allowed
The request performs an operation that is either not supported or allowed.
422 Unprocessable Entity
The request cannot be processed due to semantic issues or conflicts with the database state.
  • curl --request POST \
    --url 'https://fumage-example.canvasmedical.com/Claim' \
    --header 'Authorization: Bearer <token>' \
    --header 'accept: application/json' \
    --header 'content-type: application/json' \
    --data '
{
  "resourceType": "Claim",
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/ValueSet/claim-type",
        "code": "professional"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/b3084f7e884e4af2b7e23b1dca494abd",
    "type": "Patient"
  },
  "created": "2021-08-16",
  "provider": {
    "reference": "Practitioner/4150cd20de8a470aa570a852859ac87e",
    "type": "Practitioner"
  },
  "priority": {
    "coding": [
      {
        "code": "normal",
        "system": "http://hl7.org/fhir/ValueSet/process-priority"
      }
    ]
  },
  "supportingInfo": [
    {
      "sequence": 1,
      "category": {
        "coding": [
          {
            "code": "patientreasonforvisit",
            "system": "http://hl7.org/fhir/ValueSet/claim-informationcategory",
            "display": "Patient Reason for Visit"
          }
        ]
      },
      "valueString": "This is only...a test"
    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "code": "F41.1",
            "system": "http://hl7.org/fhir/ValueSet/icd-10",
            "display": "Generalized anxiety"
          }
        ]
      }
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/02d4f77a-ebaf-47d5-b162-6313244aed5f"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "diagnosisSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code",
            "code": "exam",
            "display": "Office visit"
          }
        ]
      },
      "modifier": [
        {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSModifiers",
              "code": "21"
            }
          ]
        }
      ],
      "quantity": {
        "value": 1
      },
      "unitPrice": {
        "value": 75
      }
    }
  ]
}'

  • import requests

url = "https://fumage-example.canvasmedical.com/Claim"

headers = {
    "accept": "application/json",
    "Authorization": "Bearer <token>",
    "content-type": "application/json"
}
payload = {
  "resourceType": "Claim",
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/ValueSet/claim-type",
        "code": "professional"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/b3084f7e884e4af2b7e23b1dca494abd",
    "type": "Patient"
  },
  "created": "2021-08-16",
  "provider": {
    "reference": "Practitioner/4150cd20de8a470aa570a852859ac87e",
    "type": "Practitioner"
  },
  "priority": {
    "coding": [
      {
        "code": "normal",
        "system": "http://hl7.org/fhir/ValueSet/process-priority"
      }
    ]
  },
  "supportingInfo": [
    {
      "sequence": 1,
      "category": {
        "coding": [
          {
            "code": "patientreasonforvisit",
            "system": "http://hl7.org/fhir/ValueSet/claim-informationcategory",
            "display": "Patient Reason for Visit"
          }
        ]
      },
      "valueString": "This is only...a test"
    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "code": "F41.1",
            "system": "http://hl7.org/fhir/ValueSet/icd-10",
            "display": "Generalized anxiety"
          }
        ]
      }
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": True,
      "coverage": {
        "reference": "Coverage/02d4f77a-ebaf-47d5-b162-6313244aed5f"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "diagnosisSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code",
            "code": "exam",
            "display": "Office visit"
          }
        ]
      },
      "modifier": [
        {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/ValueSet/AMACPTCMSHCPCSModifiers",
              "code": "21"
            }
          ]
        }
      ],
      "quantity": {
        "value": 1
      },
      "unitPrice": {
        "value": 75
      }
    }
  ]
}
response = requests.post(url, json=payload, headers=headers)

print(response.text)

  • null

  • {
  "resourceType": "OperationOutcome",
  "issue": [
    {
      "severity": "error",
      "code": "invalid",
      "details": {
        "text": "Bad request"
      }
    }
  ]
}

  • {
  "resourceType": "OperationOutcome",
  "issue": [
    {
      "severity": "error",
      "code": "unknown",
      "details": {
        "text": "Authentication failed"
      }
    }
  ]
}

  • {
  "resourceType": "OperationOutcome",
  "issue": [
    {
      "severity": "error",
      "code": "forbidden",
      "details": {
        "text": "Authorization failed"
      }
    }
  ]
}

  • {
  "resourceType": "OperationOutcome",
  "issue": [
    {
      "severity": "error",
      "code": "not-supported",
      "details": {
        "text": "Operation is not supported"
      }
    }
  ]
}

  • {
  "resourceType": "OperationOutcome",
  "issue": [
    {
      "severity": "error",
      "code": "business-rule",
      "details": {
        "text": "Unprocessable entity"
      }
    }
  ]
}