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clinik.claimResponses

Claim responses (FHIR ClaimResponse) represent adjudication results from insurers in response to submitted claims. ClinikAPI exposes the most commonly used fields — use the FHIR passthrough for advanced adjudication scenarios.

create

const { data, meta } = await clinik.claimResponses.create(request): Promise<ApiResponse<ClaimResponse>>
FieldTypeRequiredDescription
statusstringYesactive, cancelled, draft
typestringYesClaim type
usestringYesclaim, preauthorization, predetermination
patientIdstringYesPatient ID
createdstringNoWhen created (defaults to now)
insurerIdstringYesInsurer Organization ID
requestIdstringNoClaim ID this responds to
outcomestringYesqueued, complete, error, partial
dispositionstringNoDisposition message
preAuthRefstringNoPre-authorization reference
payeeTypestringNoPayee type
itemArrayNoAdjudicated line items
totalArrayNoTotals by category
paymentobjectNoPayment details
processNoteArrayNoProcessing notes
notestringNoAdditional notes

Item Object

FieldTypeRequiredDescription
itemSequencenumberYesCorresponding claim item sequence
adjudicationArrayYesAdjudication details

Adjudication Object

FieldTypeRequiredDescription
categorystringYesCategory (e.g. submitted, eligible, benefit, copay)
amount{ value, currency? }NoAmount

Example

const { data } = await clinik.claimResponses.create({
  status: 'active',
  type: 'professional',
  use: 'claim',
  patientId: 'pt_abc123',
  insurerId: 'org_ins789',
  requestId: 'claim_xyz456',
  outcome: 'complete',
  disposition: 'Claim processed successfully',
  item: [
    {
      itemSequence: 1,
      adjudication: [
        { category: 'submitted', amount: { value: 150.00, currency: 'USD' } },
        { category: 'eligible', amount: { value: 135.00, currency: 'USD' } },
        { category: 'benefit', amount: { value: 108.00, currency: 'USD' } },
        { category: 'copay', amount: { value: 27.00, currency: 'USD' } },
      ],
    },
  ],
  total: [
    { category: 'submitted', amount: { value: 195.00, currency: 'USD' } },
    { category: 'benefit', amount: { value: 156.00, currency: 'USD' } },
  ],
  payment: {
    type: 'complete',
    amount: { value: 156.00, currency: 'USD' },
    date: '2024-04-01',
  },
});
Same pattern as other resources. Update supports status and disposition. Search supports patientId, status, use, outcome, requestId filters.