API end point: https://fhir.careevolution.com/Master.Adapter1.WebClient/api/fhir-stu3.

Resource Claim (STU3)

Maps CareEvolution Claim and contained Medication concepts

Supported interactions

Search parameters

Name Type Modifiers , prefixes Multiple values Can be chained Description
_id Token Yes

Resource id

_lastUpdated Date lt le gt ge

When the resource last changed

_source Uri :missing Yes

Where the resource comes from

created Date :missing eq ne lt le gt ge sa eb ap

Searches for claims by start date-time

encounter Reference (Encounter) :missing Yes Yes

Encounters associated with a billed line item

enddate Date :missing eq ne lt le gt ge sa eb ap

Searches for claims by end date-time

hospitalization Date :missing eq ne lt le gt ge sa eb ap See here
identifier Token :missing Yes

The primary identifier of the financial resource

patient Reference (Patient) :missing Yes Yes

The patient the Claim is about

provenance-agent Reference (Organization) :missing Yes Yes

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

provider Reference (Practitioner) :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 :missing eq ne lt le gt ge sa eb ap

Searches for claims by start date-time

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
billablePeriod Claim.Property('ClaimBillablePeriodStartDate')
Claim.Property('ClaimBillablePeriodEndDate')
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.StartDate
diagnosis.diagnosis
Bindings:  http://snomed.info/sct  http://hl7.org/fhir/sid/icd-10-cm  http://hl7.org/fhir/sid/icd-9-cm
Claim.Problems.Term
Domain: DiagnosisCode
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemDate') Claim.Problems.Date
diagnosis.sequence Claim.Problems.Sequence
diagnosis.type Claim.Problems.Type
Domain: DiagnosisType
extension('http://careevolution.com/fhirextensions#claim-adjudicationDate') Claim.AdjudicationDate
extension('http://careevolution.com/fhirextensions#claim-admitSource')
Bindings:  https://www.nubc.org/CodeSystem/PointOfOrigin  https://www.nubc.org/CodeSystem/PointOfOriginNewBorn
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-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  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
Claim.Drg
Domain: ClaimDrg
extension('http://careevolution.com/fhirextensions#claim-encounterID') Claim.EncounterID
extension('http://careevolution.com/fhirextensions#claim-endDate') Claim.EndDate
extension('http://careevolution.com/fhirextensions#claim-facilityType')
Bindings:  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  http://hl7.org/fhir/v3/ActCode  https://rosetta.careevolution.com/UBFacilityType
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/remittance-advice-remark-codes  https://x12.org/codes/claim-adjustment-reason-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-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
hospitalization Claim.AdmitDate
Claim.DischargeDate
identifier Claim.Identifier
Claim.AlternateIdentifier
information.category
Bindings:  valueset-claim-informationcategory
Claim.ClaimSupportingInformation.Type
Domain: SupportingInformationType
information.code Claim.ClaimSupportingInformation.Term
Domain: SupportingInformationCode
information.reason Claim.ClaimSupportingInformation.Reason
Domain: SupportingInformationReason
information.sequence Claim.ClaimSupportingInformation.Sequence
information.timing Claim.ClaimSupportingInformation.StartDate
Claim.ClaimSupportingInformation.EndDate
information.value Claim.ClaimSupportingInformation.Value
insurance.coverage 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  http://hl7.org/fhir/v3/ActCode  https://rosetta.careevolution.com/UBFacilityType
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-nonPaymentReason')
Bindings:  https://x12.org/codes/remittance-advice-remark-codes  https://x12.org/codes/claim-adjustment-reason-codes
Claim.Services.NonPaymentReason
Domain: NonPaymentReason
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:  https://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 Claim.Services.AmountClaimed
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
Medications.Sequence
Claim.Services.Sequence
item.service
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.ada.org/cdt  https://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.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.ada.org/cdt  http://snomed.info/sct  https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://www.cms.gov/Medicare/Coding/ICD10  http://hl7.org/fhir/sid/icd-9-cm
Claim.Procedures.Term
Domain: ProcedureCode
procedure.sequence Claim.Procedures.Sequence
provider Claim.CaregiverRelationships Maps CaregiverRelationships with RelationshipType=ClaimProvider
referral Claim.ReferralID
related Claim.Property('OriginalClaimNumber')
status
Bindings:  valueset-fm-status
Claim.Status
Domain: ClaimStatus
subType
Bindings:  https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit  http://hl7.org/fhir/v3/ActCode  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  https://rosetta.careevolution.com/UBFacilityType
Claim.AdmitType
Domain: AdmissionType
text Claim.Comment
total Claim.TotalCharges
type
Bindings:  valueset-claim-type
Claim.ClaimType
Domain: ClaimType

From FHIR mappings

FHIR CareEvolution
billablePeriod Claim.Property('ClaimBillablePeriodStartDate')
Claim.Property('ClaimBillablePeriodEndDate')
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.StartDate
diagnosis.diagnosis
Bindings:  http://snomed.info/sct  http://hl7.org/fhir/sid/icd-10-cm  http://hl7.org/fhir/sid/icd-9-cm
Claim.Problems.Term
Domain: DiagnosisCode
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemDate') Claim.Problems.Date
diagnosis.sequence Claim.Problems.Sequence
diagnosis.type Claim.Problems.Type
Domain: DiagnosisType
extension Claim.Properties
extension('http://careevolution.com/fhirextensions#claim-adjudicationDate') Claim.AdjudicationDate
extension('http://careevolution.com/fhirextensions#claim-admitSource')
Bindings:  https://www.nubc.org/CodeSystem/PointOfOrigin  https://www.nubc.org/CodeSystem/PointOfOriginNewBorn
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-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  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
Claim.Drg
Domain: ClaimDrg
extension('http://careevolution.com/fhirextensions#claim-encounterID') Claim.EncounterID
extension('http://careevolution.com/fhirextensions#claim-endDate') Claim.EndDate
extension('http://careevolution.com/fhirextensions#claim-facilityType')
Bindings:  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  http://hl7.org/fhir/v3/ActCode  https://rosetta.careevolution.com/UBFacilityType
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/remittance-advice-remark-codes  https://x12.org/codes/claim-adjustment-reason-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-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
hospitalization Claim.AdmitDate
Claim.DischargeDate
id Claim.Identifier
identifier Claim.Identifier
Claim.AlternateIdentifier
information.category
Bindings:  valueset-claim-informationcategory
Claim.ClaimSupportingInformation.Type
Domain: SupportingInformationType
information.code Claim.ClaimSupportingInformation.Term
Domain: SupportingInformationCode
information.reason Claim.ClaimSupportingInformation.Reason
Domain: SupportingInformationReason
information.sequence Claim.ClaimSupportingInformation.Sequence
information.timing Claim.ClaimSupportingInformation.StartDate
Claim.ClaimSupportingInformation.EndDate
information.value Claim.ClaimSupportingInformation.Value
insurance.coverage 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  http://hl7.org/fhir/v3/ActCode  https://rosetta.careevolution.com/UBFacilityType
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-nonPaymentReason')
Bindings:  https://x12.org/codes/remittance-advice-remark-codes  https://x12.org/codes/claim-adjustment-reason-codes
Claim.Services.NonPaymentReason
Domain: NonPaymentReason
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:  https://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 Claim.Services.AmountClaimed
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
Medications.Sequence
Claim.Services.Sequence
item.service
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.ada.org/cdt  https://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.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.ada.org/cdt  http://snomed.info/sct  https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://www.cms.gov/Medicare/Coding/ICD10  http://hl7.org/fhir/sid/icd-9-cm
Claim.Procedures.Term
Domain: ProcedureCode
procedure.sequence Claim.Procedures.Sequence
provider Claim.CaregiverRelationships Maps CaregiverRelationships with RelationshipType=ClaimProvider
referral Claim.ReferralID
related Claim.Property('OriginalClaimNumber')
status
Bindings:  valueset-fm-status
Claim.Status
Domain: ClaimStatus
subType
Bindings:  https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit  http://hl7.org/fhir/v3/ActCode  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  https://rosetta.careevolution.com/UBFacilityType
Claim.AdmitType
Domain: AdmissionType
text Claim.Comment
total Claim.TotalCharges
type
Bindings:  valueset-claim-type
Claim.ClaimType
Domain: ClaimType