API end point: https://fhir.careevolution.com/Master.Adapter1.WebClient/api/fhir-r4.

Resource Claim (R4)

Maps CareEvolution Claim and contained Medication 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
created Date eq ne lt le gt ge sa eb ap See here
encounter Reference :missing Yes Yes See here
enddate Date eq ne lt le gt ge sa eb ap

Searches for claims by end date-time

identifier Token Yes See here
patient Reference :missing Yes Yes See here
provenance-agent Reference 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

startdate Date eq ne lt le gt ge sa eb ap

Searches for claims by start date-time

status Token :not :in :not-in Yes See here
type Token Yes See here

Sorts

Supports multiple sorts

Includes

Operations

To FHIR mappings

FHIR CareEvolution
billablePeriod Claim.StartDate
Claim.EndDate
careTeam.provider Claim.CaregiverRelationships.CaregiverID Excludes CaregiverRelationships with RelationshipType equal to ClaimProvider or PayToProvider
Claim.Services.CaregiverRelationships.CaregiverID
careTeam.responsible Claim.CaregiverRelationships.Responsible Excludes CaregiverRelationships with RelationshipType equal to ClaimProvider or PayToProvider
Claim.Services.CaregiverRelationships.Responsible
careTeam.role
Bindings:  valueset-claim-careteamrole
Claim.CaregiverRelationships.RelationshipType
Domain: CaregiverRelationshipType
Excludes CaregiverRelationships with RelationshipType equal to ClaimProvider or PayToProvider
Claim.Services.CaregiverRelationships.RelationshipType
Domain: CaregiverRelationshipType
created Claim.CreatedDate
diagnosis.diagnosis
Bindings:  http://hl7.org/fhir/sid/icd-10-cm  http://hl7.org/fhir/sid/icd-9-cm  http://snomed.info/sct
Claim.Problems.Term
Domain: DiagnosisCode
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemDate') Claim.Problems.Date
diagnosis.onAdmission
Bindings:  http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
Claim.Problems.OnAdmission
Domain: DiagnosisStatusOnAdmission
diagnosis.sequence Claim.Problems.Sequence
diagnosis.type
Bindings:  http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
Claim.Problems.Type
Domain: DiagnosisType
extension('http://careevolution.com/fhirextensions#claim-adjudicationDate') Claim.AdjudicationDate
extension('http://careevolution.com/fhirextensions#claim-admitDate') Claim.AdmitDate
extension('http://careevolution.com/fhirextensions#claim-admitSource')
Bindings:  https://www.nubc.org/CodeSystem/PointOfOrigin  https://www.nubc.org/CodeSystem/PointOfOrigin-NewBorn
Claim.AdmitSource
Domain: AdmitSource
extension('http://careevolution.com/fhirextensions#claim-billClass')
Bindings:  https://www.nubc.org/CodeSystem/TypeOfBill
Claim.BillClass
Domain: BillClass
extension('http://careevolution.com/fhirextensions#claim-controlNumber') Claim.ControlNumber
extension('http://careevolution.com/fhirextensions#claim-dischargeDate') Claim.DischargeDate
extension('http://careevolution.com/fhirextensions#claim-disposition') Claim.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
Claim.Drg
Domain: ClaimDrg
extension('http://careevolution.com/fhirextensions#claim-encounterID') Claim.EncounterID
extension('http://careevolution.com/fhirextensions#claim-facilityType')
Bindings:  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set
Claim.FacilityType
Domain: FacilityType
extension('http://careevolution.com/fhirextensions#claim-innetwork') Claim.InNetwork
Domain: ClaimInNetwork
extension('http://careevolution.com/fhirextensions#claim-mrn') Claim.Mrn
extension('http://careevolution.com/fhirextensions#claim-nonPaymentReason')
Bindings:  https://x12.org/codes/claim-adjustment-reason-codes  https://x12.org/codes/remittance-advice-remark-codes
Claim.NonPaymentReason
Domain: NonPaymentReason
extension('http://careevolution.com/fhirextensions#claim-paidDate') Claim.PaidDate
extension('http://careevolution.com/fhirextensions#claim-patientStatus') Claim.PatientStatus
Domain: PatientStatus
extension('http://careevolution.com/fhirextensions#claim-referralID') Claim.ReferralID
extension('http://careevolution.com/fhirextensions#claim-revision') Claim.Revision
extension('http://careevolution.com/fhirextensions#claim-totalAllowed') Claim.TotalAllowed
extension('http://careevolution.com/fhirextensions#claim-totalcoinsuranceamount') Claim.TotalCoinsuranceAmount
extension('http://careevolution.com/fhirextensions#claim-totalcopayamount') Claim.TotalCopayAmount
extension('http://careevolution.com/fhirextensions#claim-totaldeductibleamount') Claim.TotalDeductibleAmount
extension('http://careevolution.com/fhirextensions#claim-totalhsapaidamount') Claim.TotalHsaPaidAmount
extension('http://careevolution.com/fhirextensions#claim-totalnotcoveredamount') Claim.TotalNotCoveredAmount
extension('http://careevolution.com/fhirextensions#claim-totalPaid') Claim.TotalPaid
extension('http://careevolution.com/fhirextensions#claim-totalPatientPaid') Claim.TotalPatientPaid
extension('http://careevolution.com/fhirextensions#claim-totalpatientresponsibleamount') Claim.TotalPatientResponsibleAmount
extension('http://careevolution.com/fhirextensions#dataSource') Claim.DataSource
extension('http://careevolution.com/fhirextensions#properties') Claim.Properties
facility Claim.Encounter.EncounterLocations
identifier Claim.Identifier
Claim.AlternateIdentifier
insurance.coverage Claim.InsuranceID
Claim.InsuranceIdentifier
insurer Claim.InsuranceID
Claim.InsuranceIdentifier
item.category Claim.Services.RevenueCode
Domain: RevenueCode
Claim.Services.Property('IsFromFhirCategoryProperty')
item.detail.category.coding.display Medications.Comment
item.extension('http://careevolution.com/fhirextensions#claim-amountPaid') Claim.Services.AmountPaid
item.extension('http://careevolution.com/fhirextensions#claim-endDate') Claim.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
Claim.Services.LocationType
Domain: ServiceLocation
item.extension('http://careevolution.com/fhirextensions#claim-patientPaid') Claim.Services.PatientPaid
item.extension('http://careevolution.com/fhirextensions#claimService-allowedamount') Claim.Services.AllowedAmount
item.extension('http://careevolution.com/fhirextensions#claimService-coinsuranceamount') Claim.Services.CoinsuranceAmount
item.extension('http://careevolution.com/fhirextensions#claimService-copayamount') Claim.Services.CopayAmount
item.extension('http://careevolution.com/fhirextensions#claimService-deductibleamount') Claim.Services.DeductibleAmount
item.extension('http://careevolution.com/fhirextensions#claimService-hsapaidamount') Claim.Services.HsaPaidAmount
item.extension('http://careevolution.com/fhirextensions#claimService-notcoveredamount') Claim.Services.NotCoveredAmount
item.extension('http://careevolution.com/fhirextensions#claimService-patientresponsibleamount') Claim.Services.PatientResponsibleAmount
item.extension('http://careevolution.com/fhirextensions#claim-status') Claim.Services.Status
Domain: ClaimServiceStatus
item.extension('http://careevolution.com/fhirextensions#properties') Medications.Properties
item.modifier
Bindings:  http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://snomed.info/sct
Claim.Services.Modifier1
Domain: BillingModifier
Claim.Services.Modifier2
Domain: BillingModifier
Claim.Services.Modifier3
Domain: BillingModifier
Claim.Services.Modifier4
Domain: BillingModifier
Claim.Services.Modifier5
Domain: BillingModifier
item.net Medications.AmountBilled
Claim.Services.AmountClaimed
item.productOrService
Bindings:  http://hl7.org/fhir/sid/cvx  http://hl7.org/fhir/sid/ndc  http://www.nlm.nih.gov/research/umls/rxnorm  http://snomed.info/sct  http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://www.cms.gov/Medicare/Coding/ICD10  http://hl7.org/fhir/sid/icd-9-cm
Medications.Term
Domain: MedicationType
Claim.Services.ServiceCode
Domain: ServiceCode
item.quantity
Bindings:  http://unitsofmeasure.org
Medications.Quantity
Medications.Units
Domain: MedicationUnits
Medications.Term
Domain: MedicationType
Claim.Services.Units
item.quantity.extension('https://bluebutton.cms.gov/resources/variables/days_suply_num') Medications.DaysSupplied
item.quantity.extension('https://bluebutton.cms.gov/resources/variables/fill_num') Medications.RefillNumber
item.revenue Claim.Services.RevenueCode
Domain: RevenueCode
Claim.Services.Property('IsFromFhirCategoryProperty')
item.sequence Medications.Identifier
Claim.Services.Sequence
item.serviced Medications.Date
Claim.Services.StartDate
patient Claim.PatientID
payee Claim.CaregiverRelationships Maps CaregiverRelationships with RelationshipType=PayToProvider
procedure.date Claim.Procedures.Date
procedure.procedure
Bindings:  http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://hl7.org/fhir/sid/cvx  http://www.cms.gov/Medicare/Coding/ICD10  http://hl7.org/fhir/sid/icd-9-cm  http://snomed.info/sct
Claim.Procedures.Term
Domain: ProcedureCode
procedure.sequence Claim.Procedures.Sequence
procedure.type Claim.Procedures.Type
Domain: ProcedureType
provider Claim.CaregiverRelationships Maps CaregiverRelationships with RelationshipType=ClaimProvider
status
Bindings:  valueset-fm-status
Claim.Status
Domain: ClaimStatus
subType
Bindings:  https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set
Claim.AdmitType
Domain: AdmissionType
supportingInfo.category
Bindings:  claim-informationcategory
Claim.ClaimSupportingInformation.Type
Domain: SupportingInformationType
supportingInfo.code Claim.ClaimSupportingInformation.Term
Domain: SupportingInformationCode
supportingInfo.reason Claim.ClaimSupportingInformation.Reason
Domain: SupportingInformationReason
supportingInfo.sequence Claim.ClaimSupportingInformation.Sequence
supportingInfo.timing Claim.ClaimSupportingInformation.StartDate
Claim.ClaimSupportingInformation.EndDate
supportingInfo.value Claim.ClaimSupportingInformation.Value
text Claim.Comment
total Claim.TotalCharges
type
Bindings:  valueset-claim-type
Claim.ClaimType
Domain: ClaimType

From FHIR mappings

FHIR CareEvolution
billablePeriod Claim.StartDate
Claim.EndDate
careTeam.provider Claim.CaregiverRelationships.CaregiverID
Claim.Services.CaregiverRelationships.CaregiverID
careTeam.responsible Claim.CaregiverRelationships.Responsible
Claim.Services.CaregiverRelationships.Responsible
careTeam.role
Bindings:  valueset-claim-careteamrole
Claim.CaregiverRelationships.RelationshipType
Domain: CaregiverRelationshipType
Claim.Services.CaregiverRelationships.RelationshipType
Domain: CaregiverRelationshipType
created Claim.CreatedDate
diagnosis.diagnosis
Bindings:  http://hl7.org/fhir/sid/icd-10-cm  http://hl7.org/fhir/sid/icd-9-cm  http://snomed.info/sct
Claim.Problems.Term
Domain: DiagnosisCode
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemDate') Claim.Problems.Date
diagnosis.onAdmission
Bindings:  http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
Claim.Problems.OnAdmission
Domain: DiagnosisStatusOnAdmission
diagnosis.sequence Claim.Problems.Sequence
diagnosis.type
Bindings:  http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
Claim.Problems.Type
Domain: DiagnosisType
extension Claim.Properties
extension('http://careevolution.com/fhirextensions#claim-adjudicationDate') Claim.AdjudicationDate
extension('http://careevolution.com/fhirextensions#claim-admitDate') Claim.AdmitDate
extension('http://careevolution.com/fhirextensions#claim-admitSource')
Bindings:  https://www.nubc.org/CodeSystem/PointOfOrigin  https://www.nubc.org/CodeSystem/PointOfOrigin-NewBorn
Claim.AdmitSource
Domain: AdmitSource
extension('http://careevolution.com/fhirextensions#claim-billClass')
Bindings:  https://www.nubc.org/CodeSystem/TypeOfBill
Claim.BillClass
Domain: BillClass
extension('http://careevolution.com/fhirextensions#claim-controlNumber') Claim.ControlNumber
extension('http://careevolution.com/fhirextensions#claim-dischargeDate') Claim.DischargeDate
extension('http://careevolution.com/fhirextensions#claim-disposition') Claim.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
Claim.Drg
Domain: ClaimDrg
extension('http://careevolution.com/fhirextensions#claim-encounterID') Claim.EncounterID
extension('http://careevolution.com/fhirextensions#claim-facilityType')
Bindings:  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set
Claim.FacilityType
Domain: FacilityType
extension('http://careevolution.com/fhirextensions#claim-innetwork') Claim.InNetwork
Domain: ClaimInNetwork
extension('http://careevolution.com/fhirextensions#claim-mrn') Claim.Mrn
extension('http://careevolution.com/fhirextensions#claim-nonPaymentReason')
Bindings:  https://x12.org/codes/claim-adjustment-reason-codes  https://x12.org/codes/remittance-advice-remark-codes
Claim.NonPaymentReason
Domain: NonPaymentReason
extension('http://careevolution.com/fhirextensions#claim-paidDate') Claim.PaidDate
extension('http://careevolution.com/fhirextensions#claim-patientStatus') Claim.PatientStatus
Domain: PatientStatus
extension('http://careevolution.com/fhirextensions#claim-revision') Claim.Revision
extension('http://careevolution.com/fhirextensions#claim-totalAllowed') Claim.TotalAllowed
extension('http://careevolution.com/fhirextensions#claim-totalcoinsuranceamount') Claim.TotalCoinsuranceAmount
extension('http://careevolution.com/fhirextensions#claim-totalcopayamount') Claim.TotalCopayAmount
extension('http://careevolution.com/fhirextensions#claim-totaldeductibleamount') Claim.TotalDeductibleAmount
extension('http://careevolution.com/fhirextensions#claim-totalhsapaidamount') Claim.TotalHsaPaidAmount
extension('http://careevolution.com/fhirextensions#claim-totalnotcoveredamount') Claim.TotalNotCoveredAmount
extension('http://careevolution.com/fhirextensions#claim-totalPaid') Claim.TotalPaid
extension('http://careevolution.com/fhirextensions#claim-totalPatientPaid') Claim.TotalPatientPaid
extension('http://careevolution.com/fhirextensions#claim-totalpatientresponsibleamount') Claim.TotalPatientResponsibleAmount
extension('http://careevolution.com/fhirextensions#dataSource') Claim.DataSource
extension('http://careevolution.com/fhirextensions#properties') Claim.Properties
id Claim.Identifier
identifier Claim.Identifier
Claim.AlternateIdentifier
insurance.coverage Claim.InsuranceID
Claim.InsuranceIdentifier
insurer Claim.InsuranceID
Claim.InsuranceIdentifier
item.category Claim.Services.RevenueCode
Domain: RevenueCode
Claim.Services.Property('IsFromFhirCategoryProperty')
item.detail.category.coding.display Medications.Comment
item.extension Claim.Services.Properties
item.extension('http://careevolution.com/fhirextensions#claim-amountPaid') Claim.Services.AmountPaid
item.extension('http://careevolution.com/fhirextensions#claim-endDate') Claim.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
Claim.Services.LocationType
Domain: ServiceLocation
item.extension('http://careevolution.com/fhirextensions#claim-patientPaid') Claim.Services.PatientPaid
item.extension('http://careevolution.com/fhirextensions#claimService-allowedamount') Claim.Services.AllowedAmount
item.extension('http://careevolution.com/fhirextensions#claimService-coinsuranceamount') Claim.Services.CoinsuranceAmount
item.extension('http://careevolution.com/fhirextensions#claimService-copayamount') Claim.Services.CopayAmount
item.extension('http://careevolution.com/fhirextensions#claimService-deductibleamount') Claim.Services.DeductibleAmount
item.extension('http://careevolution.com/fhirextensions#claimService-hsapaidamount') Claim.Services.HsaPaidAmount
item.extension('http://careevolution.com/fhirextensions#claimService-notcoveredamount') Claim.Services.NotCoveredAmount
item.extension('http://careevolution.com/fhirextensions#claimService-patientresponsibleamount') Claim.Services.PatientResponsibleAmount
item.extension('http://careevolution.com/fhirextensions#claim-status') Claim.Services.Status
Domain: ClaimServiceStatus
item.extension('http://careevolution.com/fhirextensions#properties') Medications.Properties
item.modifier
Bindings:  http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://snomed.info/sct
Claim.Services.Modifier1
Domain: BillingModifier
Claim.Services.Modifier2
Domain: BillingModifier
Claim.Services.Modifier3
Domain: BillingModifier
Claim.Services.Modifier4
Domain: BillingModifier
Claim.Services.Modifier5
Domain: BillingModifier
item.net Medications.AmountBilled
Claim.Services.AmountClaimed
item.productOrService
Bindings:  http://hl7.org/fhir/sid/cvx  http://hl7.org/fhir/sid/ndc  http://www.nlm.nih.gov/research/umls/rxnorm  http://snomed.info/sct  http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://www.cms.gov/Medicare/Coding/ICD10  http://hl7.org/fhir/sid/icd-9-cm
Medications.Term
Domain: MedicationType
Claim.Services.ServiceCode
Domain: ServiceCode
item.quantity
Bindings:  http://unitsofmeasure.org
Medications.Quantity
Medications.Units
Domain: MedicationUnits
Claim.Services.Units
item.quantity.extension('https://bluebutton.cms.gov/resources/variables/days_suply_num') Medications.DaysSupplied
item.quantity.extension('https://bluebutton.cms.gov/resources/variables/fill_num') Medications.RefillNumber
item.revenue Claim.Services.RevenueCode
Domain: RevenueCode
Claim.Services.Property('IsFromFhirCategoryProperty')
item.sequence Medications.Identifier
Claim.Services.Sequence
item.serviced Medications.Date
Claim.Services.StartDate
patient Claim.PatientID
payee Claim.CaregiverRelationships Maps CaregiverRelationships with RelationshipType=PayToProvider
procedure.date Claim.Procedures.Date
procedure.procedure
Bindings:  http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://hl7.org/fhir/sid/cvx  http://www.cms.gov/Medicare/Coding/ICD10  http://hl7.org/fhir/sid/icd-9-cm  http://snomed.info/sct
Claim.Procedures.Term
Domain: ProcedureCode
procedure.sequence Claim.Procedures.Sequence
procedure.type Claim.Procedures.Type
Domain: ProcedureType
provider Claim.CaregiverRelationships Maps CaregiverRelationships with RelationshipType=ClaimProvider
status
Bindings:  valueset-fm-status
Claim.Status
Domain: ClaimStatus
subType
Bindings:  https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set
Claim.AdmitType
Domain: AdmissionType
supportingInfo.category
Bindings:  claim-informationcategory
Claim.ClaimSupportingInformation.Type
Domain: SupportingInformationType
supportingInfo.code Claim.ClaimSupportingInformation.Term
Domain: SupportingInformationCode
supportingInfo.reason Claim.ClaimSupportingInformation.Reason
Domain: SupportingInformationReason
supportingInfo.sequence Claim.ClaimSupportingInformation.Sequence
supportingInfo.timing Claim.ClaimSupportingInformation.StartDate
Claim.ClaimSupportingInformation.EndDate
supportingInfo.value Claim.ClaimSupportingInformation.Value
text Claim.Comment
total Claim.TotalCharges
type
Bindings:  valueset-claim-type
Claim.ClaimType
Domain: ClaimType