Claims
Claims (FHIRClaim) represent healthcare billing requests submitted to insurers for reimbursement. ClinikAPI simplifies the most common claim fields — for advanced scenarios like coordination of benefits or detailed sub-items, use the FHIR passthrough.
Submit a Professional Claim
const { data: claim } = await clinik.claims.create({
status: 'active',
type: 'professional',
use: 'claim',
patientId: 'pt_abc123',
providerId: 'Practitioner/prac_dr456',
priority: 'normal',
billablePeriod: {
start: '2024-03-15',
end: '2024-03-15',
},
insurance: [
{ sequence: 1, focal: true, coverageId: 'cov_primary789' },
],
diagnosis: [
{ sequence: 1, code: 'E11.9' }, // Type 2 diabetes
{ sequence: 2, code: 'I10' }, // Essential hypertension
],
item: [
{
sequence: 1,
productOrService: '99214',
unitPrice: { value: 200.00, currency: 'USD' },
net: { value: 200.00, currency: 'USD' },
},
{
sequence: 2,
productOrService: '85025',
quantity: { value: 1, unit: 'test' },
unitPrice: { value: 45.00, currency: 'USD' },
net: { value: 45.00, currency: 'USD' },
},
],
total: { value: 245.00, currency: 'USD' },
});
Pre-Authorization Request
const { data: preAuth } = await clinik.claims.create({
status: 'active',
type: 'professional',
use: 'preauthorization',
patientId: 'pt_abc123',
providerId: 'Practitioner/prac_surgeon456',
priority: 'normal',
insurance: [
{ sequence: 1, focal: true, coverageId: 'cov_primary789' },
],
diagnosis: [
{ sequence: 1, code: 'M17.11' }, // Primary osteoarthritis, right knee
],
procedure: [
{ sequence: 1, code: '27447', date: '2024-04-15' }, // Total knee replacement
],
item: [
{
sequence: 1,
productOrService: '27447',
unitPrice: { value: 35000.00, currency: 'USD' },
net: { value: 35000.00, currency: 'USD' },
},
],
total: { value: 35000.00, currency: 'USD' },
note: 'Conservative treatment failed after 6 months of physical therapy',
});
Search Claims
// All claims for a patient
const { data } = await clinik.claims.search({
patientId: 'pt_abc123',
});
// Filter by status and use
const { data: activeClaims } = await clinik.claims.search({
patientId: 'pt_abc123',
status: 'active',
use: 'claim',
});
// Filter by date range
const { data: recent } = await clinik.claims.search({
dateFrom: '2024-01-01',
dateTo: '2024-03-31',
providerId: 'Practitioner/prac_dr456',
});
Claim Types
| Type | Description |
|---|---|
institutional | Hospital / facility claims |
oral | Dental claims |
pharmacy | Pharmacy claims |
professional | Physician / provider claims |
vision | Vision care claims |