Da Vinci Postable Remittance
0.1.0 - ci-build
Da Vinci Postable Remittance
0.1.0 - ci-build
Da Vinci Postable Remittance, published by HL7 International / Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pr/ and changes regularly. See the Directory of published versions
| Page standards status: Trial-use | Maturity Level: 3 |
{
"resourceType" : "OperationDefinition",
"id" : "SearchByClaim",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: OperationDefinition SearchByClaim</b></p><a name=\"SearchByClaim\"> </a><a name=\"hcSearchByClaim\"> </a><a name=\"SearchByClaim-en-US\"> </a><p>URL: [base]/$searchByClaim</p><p>Input parameters Profile:<a href=\"StructureDefinition-searchByClaimParameters.html\">Search By Claim Incoming Parameters</a></p><p>Output parameters Profile:<a href=\"StructureDefinition-searchResultParameters.html\">Search Result Outgoing Parameters</a></p><h3>Parameters</h3><table class=\"grid\"><tr><td><b>Use</b></td><td><b>Name</b></td><td><b>Scope</b></td><td><b>Cardinality</b></td><td><b>Type</b></td><td><b>Binding</b></td><td><b>Documentation</b></td></tr><tr><td>IN</td><td>TIN</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Medical Group / Billing Provider / Payee TIN</p>\n</div></td></tr><tr><td>IN</td><td>DateOfService</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#Period\">Period</a></td><td/><td><div><p>Date of Service</p>\n</div></td></tr><tr><td>IN</td><td>PayerID</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Payer Identifer</p>\n</div></td></tr><tr><td>IN</td><td>PayerName</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Payer Name</p>\n</div></td></tr><tr><td>IN</td><td>PatientID</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Patient Member (or Subscriber) Insurance ID</p>\n</div></td></tr><tr><td>IN</td><td>Claim</td><td/><td>1..1</td><td></td><td/><td><div><p>Information about the claim being searched for.</p>\n</div></td></tr><tr><td>IN</td><td>Claim.ProviderClaimID</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Provider generated Claim ID (also known as Patient Account Number)</p>\n</div></td></tr><tr><td>IN</td><td>Claim.ProviderID</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>NPI or Payer Assigned Provider Identifier</p>\n</div></td></tr><tr><td>IN</td><td>Claim.PayerClaimID</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Payer Generated Claim ID (DCN or ICN)</p>\n</div></td></tr><tr><td>IN</td><td>Claim.ClaimChargeAmount</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#Money\">Money</a></td><td/><td><div><p>Claim Charge Amount</p>\n</div></td></tr><tr><td>OUT</td><td>TIN</td><td/><td>0..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Medical Group / Billing Provider / Payee TIN</p>\n</div></td></tr><tr><td>OUT</td><td>Payer</td><td/><td>0..1</td><td></td><td/><td><div><p>Details of payer information.</p>\n</div></td></tr><tr><td>OUT</td><td>Payer.PayerID</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Payer Identifier</p>\n</div></td></tr><tr><td>OUT</td><td>Payer.PayerName</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Payer Name</p>\n</div></td></tr><tr><td>OUT</td><td>Claim</td><td/><td>0..*</td><td></td><td/><td><div><p>Details to verify correct claim found.</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PayerClaimID</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Payer Generated Claim ID (DCN or ICN)</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.ProviderClaimID</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Provider generated Claim ID</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.ClaimReceivedDate</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#date\">date</a></td><td/><td><div><p>Claim Received Date</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.ProviderID</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>NPI or Payer Assigned Provider Identifier</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo</td><td/><td>0..*</td><td></td><td/><td><div><p>Details of adjudicated payment.</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.PaymentDate</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#date\">date</a></td><td/><td><div><p>Payment Date</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.PaymentNumber</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Payment Number</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.PaymentAmount</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#Money\">Money</a></td><td/><td><div><p>Payment Amount</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.Remittance</td><td/><td>0..*</td><td></td><td/><td><div><p>Details of remittance advice.</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.Remittance.RemittanceAdviceIdentifier</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Remittance Advice Identifier</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.Remittance.RemittanceAdviceType</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#code\">code</a></td><td><a href=\"ValueSet-RemittanceAdviceType.html\">Remittance Advice Value Set</a> (Required)</td><td><div><p>Remittance Advice Type</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.Remittance.RemittanceAdviceDate</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#date\">date</a></td><td/><td><div><p>Remittance Advice Date</p>\n</div></td></tr><tr><td>OUT</td><td>Claim.PaymentInfo.Remittance.RemittanceAdviceFileSize</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#integer\">integer</a></td><td/><td><div><p>Remittance Advice File Size</p>\n</div></td></tr><tr><td>OUT</td><td>Patient</td><td/><td>1..1</td><td></td><td/><td><div><p>Details to verify correct patient found.</p>\n</div></td></tr><tr><td>OUT</td><td>Patient.DateOfBirth</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#date\">date</a></td><td/><td><div><p>Patient date of birth</p>\n</div></td></tr><tr><td>OUT</td><td>Patient.PatientID</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Patient Member (or Subscriber) Insurance ID</p>\n</div></td></tr><tr><td>OUT</td><td>Patient.PatientFirstName</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Patient First Name</p>\n</div></td></tr><tr><td>OUT</td><td>Patient.PatientLastName</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/datatypes.html#string\">string</a></td><td/><td><div><p>Patient Last Name</p>\n</div></td></tr></table></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode" : "claims"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger" : 3,
"_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" : "0.1.0",
"name" : "SearchByClaim",
"title" : "Search for Postable Remittance By Claim",
"status" : "active",
"kind" : "operation",
"date" : "2024-09-22T14:07:54+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" : "DateOfService",
"use" : "in",
"min" : 0,
"max" : "1",
"documentation" : "Date of Service",
"type" : "Period"
},
{
"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" : "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" : 0,
"max" : "1",
"documentation" : "Medical Group / Billing Provider / Payee TIN",
"type" : "string"
},
{
"name" : "Payer",
"use" : "out",
"min" : 0,
"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" : 0,
"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" : 0,
"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" : 0,
"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"
}
]
}
]
}
IG © 2024+ HL7 International / Payer/Provider Information Exchange Work Group. Package hl7.fhir.us.davinci-pr#0.1.0 based on FHIR 4.0.1. Generated 2024-09-22
Links: Table of Contents |
QA Report
| Version History |
|
Propose a change