API end point: https://fhir.careevolution.com/Master.Adapter1.WebClient/api/fhir.

Resource Claim (DSTU2)

Maps CareEvolution Claim concepts

Supported interactions

Search parameters

Name Type Modifiers , prefixes Multiple values Can be chained Description
_id Token Yes See here
_lastUpdated Date lt le gt ge See here
_source Token :missing Yes See here
created Date :missing eq ne lt le gt ge sa eb ap

Searches for claims by start date-time

date Date :missing eq ne lt le gt ge sa eb ap See here
encounter Reference :missing Yes Yes

Searches for claims by their associated encounter

identifier Token :missing Yes

The primary identifier of the financial resource

patient Reference :missing Yes Yes

Patient

provenance-agent Reference :missing Yes Yes

Search by provenance, specified by its author (aka originator) Organization

provider Reference :missing Yes Yes

Searches for claims by practitioner (caregiver), considering all possible references: provider, payee.provider and the http://careevolution.com/fhirextensions#claim-providers extension

status Token :not :in :not-in :missing Yes

Searches for claims by status

type Token :missing Yes See here

Sorts

Supports multiple sorts

Includes

Operations

To FHIR mappings

FHIR CareEvolution
coverage InsuranceID
created StartDate
diagnosis.diagnosis
Bindings:  http://hl7.org/fhir/sid/icd-10-cm  http://hl7.org/fhir/sid/icd-9-cm/diagnosis  http://snomed.info/sct
Problems.Term
Domain: DiagnosisCode
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemDate') Problems.Date
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemType') Problems.Type
Domain: DiagnosisType
diagnosis.sequence Problems.Sequence
extension('http://careevolution.com/fhirextensions#claim-adjudicationDate') AdjudicationDate
extension('http://careevolution.com/fhirextensions#claim-admitDate') AdmitDate
extension('http://careevolution.com/fhirextensions#claim-admitSource')
Bindings:  https://www.nubc.org/CodeSystem/PointOfOrigin  https://www.nubc.org/CodeSystem/PointOfOriginNewBorn
AdmitSource
Domain: AdmitSource
extension('http://careevolution.com/fhirextensions#claim-admitType')
Bindings:  https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  https://rosetta.careevolution.com/UBFacilityType  http://hl7.org/fhir/v3/ActCode
AdmitType
Domain: AdmissionType
extension('http://careevolution.com/fhirextensions#claim-billClass')
Bindings:  https://www.nubc.org/CodeSystem/TypeOfBill
BillClass
Domain: BillClass
extension('http://careevolution.com/fhirextensions#claim-controlNumber') ControlNumber
extension('http://careevolution.com/fhirextensions#claim-dischargeDate') DischargeDate
extension('http://careevolution.com/fhirextensions#claim-disposition') Disposition
Domain: ClaimDisposition
extension('http://careevolution.com/fhirextensions#claim-drg')
Bindings:  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software
Drg
Domain: ClaimDrg
extension('http://careevolution.com/fhirextensions#claim-encounterID') EncounterID
extension('http://careevolution.com/fhirextensions#claim-endDate') EndDate
extension('http://careevolution.com/fhirextensions#claim-facilityType')
Bindings:  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  https://rosetta.careevolution.com/UBFacilityType  http://hl7.org/fhir/v3/ActCode
FacilityType
Domain: FacilityType
extension('http://careevolution.com/fhirextensions#claim-innetwork') InNetwork
Domain: ClaimInNetwork
extension('http://careevolution.com/fhirextensions#claim-mrn') Mrn
extension('http://careevolution.com/fhirextensions#claim-nonPaymentReason')
Bindings:  https://x12.org/codes/remittance-advice-remark-codes  https://x12.org/codes/claim-adjustment-reason-codes
NonPaymentReason
Domain: NonPaymentReason
extension('http://careevolution.com/fhirextensions#claim-paidDate') PaidDate
extension('http://careevolution.com/fhirextensions#claim-patientStatus') PatientStatus
Domain: PatientStatus
extension('http://careevolution.com/fhirextensions#claim-providers') CaregiverRelationships
Services.CaregiverRelationships
extension('http://careevolution.com/fhirextensions#claim-status') Status
Domain: ClaimStatus
extension('http://careevolution.com/fhirextensions#claim-totalAllowed') TotalAllowed
extension('http://careevolution.com/fhirextensions#claim-totalCharges') TotalCharges
extension('http://careevolution.com/fhirextensions#claim-totalcoinsuranceamount') TotalCoinsuranceAmount
extension('http://careevolution.com/fhirextensions#claim-totalcopayamount') TotalCopayAmount
extension('http://careevolution.com/fhirextensions#claim-totaldeductibleamount') TotalDeductibleAmount
extension('http://careevolution.com/fhirextensions#claim-totalhsapaidamount') TotalHsaPaidAmount
extension('http://careevolution.com/fhirextensions#claim-totalnotcoveredamount') TotalNotCoveredAmount
extension('http://careevolution.com/fhirextensions#claim-totalPaid') TotalPaid
extension('http://careevolution.com/fhirextensions#claim-totalPatientPaid') TotalPatientPaid
extension('http://careevolution.com/fhirextensions#claim-totalpatientresponsibleamount') TotalPatientResponsibleAmount
extension('http://careevolution.com/fhirextensions#dataSource') DataSource
extension('http://careevolution.com/fhirextensions#properties') Properties
facility Encounter.EncounterLocations
identifier Identifier
AlternateIdentifier
item.extension('http://careevolution.com/fhirextensions#claim-endDate') Services.EndDate
item.extension('http://careevolution.com/fhirextensions#claim-locationType')
Bindings:  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  https://rosetta.careevolution.com/UBFacilityType  http://hl7.org/fhir/v3/ActCode
Services.LocationType
Domain: ServiceLocation
item.extension('http://careevolution.com/fhirextensions#claim-patientPaid') Services.PatientPaid
item.extension('http://careevolution.com/fhirextensions#claim-revenueCode')
Bindings:  https://www.nubc.org/CodeSystem/RevenueCodes
Services.RevenueCode
Domain: RevenueCode
item.extension('http://careevolution.com/fhirextensions#claimService-allowedamount') Services.AllowedAmount
item.extension('http://careevolution.com/fhirextensions#claimService-coinsuranceamount') Services.CoinsuranceAmount
item.extension('http://careevolution.com/fhirextensions#claimService-copayamount') Services.CopayAmount
item.extension('http://careevolution.com/fhirextensions#claimService-deductibleamount') Services.DeductibleAmount
item.extension('http://careevolution.com/fhirextensions#claimService-hsapaidamount') Services.HsaPaidAmount
item.extension('http://careevolution.com/fhirextensions#claimService-notcoveredamount') Services.NotCoveredAmount
item.extension('http://careevolution.com/fhirextensions#claimService-patientresponsibleamount') Services.PatientResponsibleAmount
item.extension('http://careevolution.com/fhirextensions#claim-status') Services.Status
Domain: ClaimServiceStatus
item.modifier
Bindings:  https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://snomed.info/sct
Services.Modifier1
Domain: BillingModifier
Services.Modifier2
Domain: BillingModifier
Services.Modifier3
Domain: BillingModifier
Services.Modifier4
Domain: BillingModifier
Services.Modifier5
Domain: BillingModifier
item.net Services.AmountPaid
item.quantity Services.Units
item.sequence Services.Sequence
item.service
Bindings:  http://www.ada.org/cdt  https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://www.icd10data.com/icd10pcs  http://hl7.org/fhir/sid/icd-9-cm/procedure  http://snomed.info/sct
Services.ServiceCode
Domain: ServiceCode
item.serviceDate Services.StartDate
item.unitPrice Services.AmountClaimed
patient PatientID
payee CaregiverRelationships Maps CaregiverRelationships with RelationshipType=PayToProvider
provider CaregiverRelationships Maps CaregiverRelationships with RelationshipType=ClaimProvider
referral ReferralID
text Comment
type
Bindings:  valueset-claim-type
ClaimType
Domain: ClaimType

From FHIR mappings

FHIR CareEvolution
coverage InsuranceID
created StartDate
diagnosis.diagnosis
Bindings:  http://hl7.org/fhir/sid/icd-10-cm  http://hl7.org/fhir/sid/icd-9-cm/diagnosis  http://snomed.info/sct
Problems.Term
Domain: DiagnosisCode
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemDate') Problems.Date
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemType') Problems.Type
Domain: DiagnosisType
diagnosis.sequence Problems.Sequence
extension('http://careevolution.com/fhirextensions#claim-adjudicationDate') AdjudicationDate
extension('http://careevolution.com/fhirextensions#claim-admitDate') AdmitDate
extension('http://careevolution.com/fhirextensions#claim-admitSource')
Bindings:  https://www.nubc.org/CodeSystem/PointOfOrigin  https://www.nubc.org/CodeSystem/PointOfOriginNewBorn
AdmitSource
Domain: AdmitSource
extension('http://careevolution.com/fhirextensions#claim-admitType')
Bindings:  https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  https://rosetta.careevolution.com/UBFacilityType  http://hl7.org/fhir/v3/ActCode
AdmitType
Domain: AdmissionType
extension('http://careevolution.com/fhirextensions#claim-billClass')
Bindings:  https://www.nubc.org/CodeSystem/TypeOfBill
BillClass
Domain: BillClass
extension('http://careevolution.com/fhirextensions#claim-controlNumber') ControlNumber
extension('http://careevolution.com/fhirextensions#claim-dischargeDate') DischargeDate
extension('http://careevolution.com/fhirextensions#claim-disposition') Disposition
Domain: ClaimDisposition
extension('http://careevolution.com/fhirextensions#claim-drg')
Bindings:  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software
Drg
Domain: ClaimDrg
extension('http://careevolution.com/fhirextensions#claim-encounterID') EncounterID
extension('http://careevolution.com/fhirextensions#claim-endDate') EndDate
extension('http://careevolution.com/fhirextensions#claim-facilityType')
Bindings:  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  https://rosetta.careevolution.com/UBFacilityType  http://hl7.org/fhir/v3/ActCode
FacilityType
Domain: FacilityType
extension('http://careevolution.com/fhirextensions#claim-innetwork') InNetwork
Domain: ClaimInNetwork
extension('http://careevolution.com/fhirextensions#claim-mrn') Mrn
extension('http://careevolution.com/fhirextensions#claim-nonPaymentReason')
Bindings:  https://x12.org/codes/remittance-advice-remark-codes  https://x12.org/codes/claim-adjustment-reason-codes
NonPaymentReason
Domain: NonPaymentReason
extension('http://careevolution.com/fhirextensions#claim-paidDate') PaidDate
extension('http://careevolution.com/fhirextensions#claim-patientStatus') PatientStatus
Domain: PatientStatus
extension('http://careevolution.com/fhirextensions#claim-providers') CaregiverRelationships
Services.CaregiverRelationships
extension('http://careevolution.com/fhirextensions#claim-status') Status
Domain: ClaimStatus
extension('http://careevolution.com/fhirextensions#claim-totalAllowed') TotalAllowed
extension('http://careevolution.com/fhirextensions#claim-totalCharges') TotalCharges
extension('http://careevolution.com/fhirextensions#claim-totalcoinsuranceamount') TotalCoinsuranceAmount
extension('http://careevolution.com/fhirextensions#claim-totalcopayamount') TotalCopayAmount
extension('http://careevolution.com/fhirextensions#claim-totaldeductibleamount') TotalDeductibleAmount
extension('http://careevolution.com/fhirextensions#claim-totalhsapaidamount') TotalHsaPaidAmount
extension('http://careevolution.com/fhirextensions#claim-totalnotcoveredamount') TotalNotCoveredAmount
extension('http://careevolution.com/fhirextensions#claim-totalPaid') TotalPaid
extension('http://careevolution.com/fhirextensions#claim-totalPatientPaid') TotalPatientPaid
extension('http://careevolution.com/fhirextensions#claim-totalpatientresponsibleamount') TotalPatientResponsibleAmount
extension('http://careevolution.com/fhirextensions#dataSource') DataSource
extension('http://careevolution.com/fhirextensions#properties') Properties
id Identifier
identifier Identifier
AlternateIdentifier
item.extension('http://careevolution.com/fhirextensions#claim-endDate') Services.EndDate
item.extension('http://careevolution.com/fhirextensions#claim-locationType')
Bindings:  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  https://rosetta.careevolution.com/UBFacilityType  http://hl7.org/fhir/v3/ActCode
Services.LocationType
Domain: ServiceLocation
item.extension('http://careevolution.com/fhirextensions#claim-patientPaid') Services.PatientPaid
item.extension('http://careevolution.com/fhirextensions#claim-revenueCode')
Bindings:  https://www.nubc.org/CodeSystem/RevenueCodes
Services.RevenueCode
Domain: RevenueCode
item.extension('http://careevolution.com/fhirextensions#claimService-allowedamount') Services.AllowedAmount
item.extension('http://careevolution.com/fhirextensions#claimService-coinsuranceamount') Services.CoinsuranceAmount
item.extension('http://careevolution.com/fhirextensions#claimService-copayamount') Services.CopayAmount
item.extension('http://careevolution.com/fhirextensions#claimService-deductibleamount') Services.DeductibleAmount
item.extension('http://careevolution.com/fhirextensions#claimService-hsapaidamount') Services.HsaPaidAmount
item.extension('http://careevolution.com/fhirextensions#claimService-notcoveredamount') Services.NotCoveredAmount
item.extension('http://careevolution.com/fhirextensions#claimService-patientresponsibleamount') Services.PatientResponsibleAmount
item.extension('http://careevolution.com/fhirextensions#claim-status') Services.Status
Domain: ClaimServiceStatus
item.modifier
Bindings:  https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://snomed.info/sct
Services.Modifier1
Domain: BillingModifier
Services.Modifier2
Domain: BillingModifier
Services.Modifier3
Domain: BillingModifier
Services.Modifier4
Domain: BillingModifier
Services.Modifier5
Domain: BillingModifier
item.net Services.AmountPaid
item.quantity Services.Units
item.sequence Services.Sequence
item.service
Bindings:  http://www.ada.org/cdt  https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://www.icd10data.com/icd10pcs  http://hl7.org/fhir/sid/icd-9-cm/procedure  http://snomed.info/sct
Services.ServiceCode
Domain: ServiceCode
item.serviceDate Services.StartDate
item.unitPrice Services.AmountClaimed
patient PatientID
payee CaregiverRelationships Maps CaregiverRelationships with RelationshipType=PayToProvider
provider CaregiverRelationships Maps CaregiverRelationships with RelationshipType=ClaimProvider
referral ReferralID
text Comment
type
Bindings:  valueset-claim-type
ClaimType
Domain: ClaimType