> ## Documentation Index
> Fetch the complete documentation index at: https://docs.clinikapi.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Claim Responses

> Process and track insurance adjudication results for submitted claims.

# Claim Responses

Claim Responses (FHIR `ClaimResponse`) represent adjudication results from insurers. They contain the outcome of a submitted claim including payment details, adjudicated line items, and processing notes.

## Create a Claim Response

```ts theme={null}
const { data: response } = await clinik.claimResponses.create({
  status: 'active',
  type: 'professional',
  use: 'claim',
  patientId: 'pt_abc123',
  insurerId: 'org_ins789',
  requestId: 'claim_xyz456',
  outcome: 'complete',
  disposition: 'Claim adjudicated per contract terms',
  item: [
    {
      itemSequence: 1,
      adjudication: [
        { category: 'submitted', amount: { value: 200.00, currency: 'USD' } },
        { category: 'eligible', amount: { value: 180.00, currency: 'USD' } },
        { category: 'benefit', amount: { value: 144.00, currency: 'USD' } },
        { category: 'copay', amount: { value: 36.00, currency: 'USD' } },
      ],
    },
    {
      itemSequence: 2,
      adjudication: [
        { category: 'submitted', amount: { value: 45.00, currency: 'USD' } },
        { category: 'eligible', amount: { value: 45.00, currency: 'USD' } },
        { category: 'benefit', amount: { value: 36.00, currency: 'USD' } },
        { category: 'copay', amount: { value: 9.00, currency: 'USD' } },
      ],
    },
  ],
  total: [
    { category: 'submitted', amount: { value: 245.00, currency: 'USD' } },
    { category: 'eligible', amount: { value: 225.00, currency: 'USD' } },
    { category: 'benefit', amount: { value: 180.00, currency: 'USD' } },
    { category: 'patient', amount: { value: 45.00, currency: 'USD' } },
  ],
  payment: {
    type: 'complete',
    amount: { value: 180.00, currency: 'USD' },
    date: '2024-04-15',
  },
  processNote: [
    { number: 1, text: 'Line 1 reduced to contracted rate per provider agreement' },
  ],
});
```

## Pre-Authorization Response

```ts theme={null}
const { data: preAuthResp } = await clinik.claimResponses.create({
  status: 'active',
  type: 'professional',
  use: 'preauthorization',
  patientId: 'pt_abc123',
  insurerId: 'org_ins789',
  requestId: 'claim_preauth123',
  outcome: 'complete',
  disposition: 'Pre-authorization approved',
  preAuthRef: 'PA-2024-00456',
  processNote: [
    { number: 1, text: 'Approved for total knee replacement. Valid for 90 days.' },
  ],
});
```

## Denied Claim

```ts theme={null}
const { data: denied } = await clinik.claimResponses.create({
  status: 'active',
  type: 'professional',
  use: 'claim',
  patientId: 'pt_abc123',
  insurerId: 'org_ins789',
  requestId: 'claim_denied789',
  outcome: 'error',
  disposition: 'Claim denied — service not covered under current plan',
  processNote: [
    { number: 1, text: 'CPT 99215 requires prior authorization for this plan type' },
  ],
});
```

## Search Claim Responses

```ts theme={null}
// All responses for a patient
const { data } = await clinik.claimResponses.search({
  patientId: 'pt_abc123',
});

// Find response for a specific claim
const { data: forClaim } = await clinik.claimResponses.search({
  requestId: 'claim_xyz456',
});

// Filter by outcome
const { data: errors } = await clinik.claimResponses.search({
  patientId: 'pt_abc123',
  outcome: 'error',
});
```

## Outcome Types

| Outcome    | Description                    |
| ---------- | ------------------------------ |
| `queued`   | Claim is queued for processing |
| `complete` | Processing is complete         |
| `error`    | Claim was denied or had errors |
| `partial`  | Partially processed            |