> ## 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.

# Claims

> Submit and manage healthcare billing claims for insurance reimbursement.

# Claims

Claims (FHIR `Claim`) 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](/guides/raw-fhir).

## Submit a Professional Claim

```ts theme={null}
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

```ts theme={null}
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

```ts theme={null}
// 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          |