Claim

Last updated: 18 Jun 2025

Introduction #

This module defines the data models used to manage healthcare claim workflows.

Basic usage #

To retrieve a claim by its identifier:

from canvas_sdk.v1.data.claim import Claim

claim = Claim.objects.get(id="9d2e0f58-338b-11ec-8d3d-0242ac130003")

Filtering #

# Active claims only
active_claims = Claim.objects.active()

Attributes #

Claim #

Represents a complete healthcare claim.

Field Name	Type
id	UUID
dbid	Integer
note	Note
installment_plan	InstallmentPlan
current_queue	ClaimQueue
current_coverage	ClaimCoverage
accept_assign	Boolean
auto_accident	Boolean
auto_accident_state	String
employment_related	Boolean
other_accident	Boolean
accident_code	String
illness_date	Date
remote_batch_id	String
remote_file_id	String
prior_auth	String
narrative	String
account_number	String
snoozed_until	Date
patient_balance	Decimal
aggregate_coverage_balance	Decimal
created	DateTime
modified	DateTime

Computed Properties:

• total_charges: Total charges for active line items
• total_paid: Sum of paid amounts from postings
• total_adjusted: Sum of adjustments and transfers
• balance: Remaining balance (coverage + patient)
• total_patient_paid: Paid amount by the patient
• total_payer_paid: Paid amount by coverages

ClaimLineItem #

Represents individual billed procedures or services tied to a claim.

Field Name	Type
dbid	Integer
billing_line_item	BillingLineItem
claim	Claim
status	ClaimLineItemStatus
charge	Decimal
from_date	String
thru_date	String
narrative	String
ndc_code	String
ndc_dosage	String
ndc_measure	String
place_of_service	PracticeLocationPOS
proc_code	String
display	String
remote_chg_id	String
units	Integer
epsdt	String
family_planning	FamilyPlanningOptions
created	DateTime
modified	DateTime

ClaimCoverage #

Links a claim to a specific insurance coverage.

Field Name	Type
dbid	Integer
claim	Claim
coverage	Coverage
active	Boolean
payer_name	String
payer_id	String
payer_typecode	String
payer_order	ClaimPayerOrder
payer_addr1	String
payer_addr2	String
payer_city	String
payer_state	String
payer_zip	String
payer_plan_type	ClaimTypeCode
coverage_type	CoverageType
subscriber_employer	String
subscriber_group	String
subscriber_number	String
subscriber_plan	String
subscriber_dob	String
subscriber_first_name	String
subscriber_last_name	String
subscriber_middle_name	String
subscriber_phone	String
subscriber_sex	PersonSex
subscriber_addr1	String
subscriber_addr2	String
subscriber_city	String
subscriber_state	String
subscriber_zip	String
subscriber_country	String
patient_relationship_to_subscriber	CoverageRelationshipCode
pay_to_addr1	String
pay_to_addr2	String
pay_to_city	String
pay_to_state	String
pay_to_zip	String
resubmission_code	String
payer_icn	String
created	DateTime
modified	DateTime

ClaimQueue #

Defines the metadata for claim queues used in revenue workflows.

Field Name	Type
dbid	Integer
queue_sort_ordering	Integer
name	String
display_name	String
description	String
show_in_revenue	Boolean
visible_columns	Array[ClaimQueueColumns]
created	DateTime
modified	DateTime

ClaimPatient #

Captures patient-level data related to a specific claim.

Field Name	Type
dbid	Integer
claim	Claim
photo	String
dob	String
first_name	String
last_name	String
middle_name	String
phone	String
sex	PersonSex
ssn	String
addr1	String
addr2	String
city	String
state	String
zip	String
country	String
created	DateTime
modified	DateTime

InstallmentPlan #

Represents a payment plan between a patient and provider.

Field Name	Type
creator	CanvasUser
patient	Patient
total_amount	Decimal
status	InstallmentPlanStatus
expected_payoff_date	Date
created_at	DateTime
updated_at	DateTime

Enumeration types #

ClaimLineItemStatus #

Value	Label
active	Active
removed	Removed

LineItemCodes #

Value
COPAY
UNLINKED

FamilyPlanningOptions #

Value	Label
Y	Yes
N	No

ClaimLineItemStatus #

Value	Label
active	Active
removed	Removed

LineItemCodes #

Value
COPAY
UNLINKED

FamilyPlanningOptions #

Value	Label
Y	Yes
N	No

ClaimPayerOrder #

Value	Label
Primary	Primary
Secondary	Secondary
Tertiary	Tertiary
Quaternary	Quaternary
Quinary	Quinary

ClaimTypeCode #

Code	Description
12	Working Aged (Age 65 or older)
13	End-Stage Renal Disease
14	No-fault
15	Workers Compensation
41	Black Lung
42	Veterans Administration
43	Disabled (Under Age 65)
47	Other Liability Insurance is primary
””	No Typecode necessary

ClaimQueueColumns #

Value	Label
NoteType	Note type
ClaimID	Claim ID
DateOfService	Date of service
Patient	Patient
ActiveInsurance	Active insurance
InsuranceBalance	Insurance balance
PatientBalance	Patient balance
DaysInQueue	Days in queue
Provider	Provider
Guarantor	Guarantor
LatestRemit	Latest remit
LastInvoiced	Last invoiced
SnoozedUntil	Snoozed until
Labels	Labels

ClaimQueues #

Value	Label
1	Appointment
2	NeedsClinicianReview
3	NeedsCodingReview
4	QueuedForSubmission
5	FiledAwaitingResponse
6	RejectedNeedsReview
7	AdjudicatedOpenBalance
8	PatientBalance
9	ZeroBalance
10	Trash

InstallmentPlanStatus #

Value	Label
active	Active
completed	Completed
cancelled	Cancelled