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clinik.eobs

Explanation of Benefits (FHIR ExplanationOfBenefit) provide a complete picture of claim adjudication. ClinikAPI exposes the most commonly used fields — use the FHIR passthrough for advanced EOB scenarios.

create

const { data, meta } = await clinik.eobs.create(request): Promise<ApiResponse<ExplanationOfBenefit>>
FieldTypeRequiredDescription
statusstringYesactive, cancelled, draft
typestringYesinstitutional, oral, pharmacy, professional, vision
usestringYesclaim, preauthorization, predetermination
patientIdstringYesPatient ID
createdstringNoWhen created (defaults to now)
insurerIdstringYesInsurer Organization ID
providerIdstringYesProvider (Practitioner/Organization ID)
outcomestringYesqueued, complete, error, partial
dispositionstringNoDisposition message
claimIdstringNoClaim ID
claimResponseIdstringNoClaimResponse ID
billablePeriod{ start?, end? }NoBillable period
insuranceArrayYesInsurance coverage (min 1)
itemArrayNoLine items with adjudication
totalArrayNoTotals by category
paymentobjectNoPayment details
processNoteArrayNoProcessing notes

Insurance Object

FieldTypeRequiredDescription
focalbooleanYesWhether this is the focal coverage
coverageIdstringYesCoverage resource ID

Item Object

FieldTypeRequiredDescription
sequencenumberYesSequence number
productOrServicestringYesProduct or service code
quantity{ value, unit? }NoQuantity
unitPrice{ value, currency? }NoUnit price
net{ value, currency? }NoNet amount
adjudicationArrayNoAdjudication details

Example

const { data } = await clinik.eobs.create({
  status: 'active',
  type: 'professional',
  use: 'claim',
  patientId: 'pt_abc123',
  insurerId: 'org_ins_bluecross',
  providerId: 'Practitioner/prac_dr456',
  outcome: 'complete',
  claimId: 'claim_xyz456',
  insurance: [{ focal: true, coverageId: 'cov_primary789' }],
  item: [
    {
      sequence: 1,
      productOrService: '99214',
      unitPrice: { value: 200.00, currency: 'USD' },
      net: { value: 200.00, currency: 'USD' },
      adjudication: [
        { category: 'submitted', amount: { value: 200.00, currency: 'USD' } },
        { category: 'benefit', amount: { value: 144.00, currency: 'USD' } },
      ],
    },
  ],
  total: [
    { category: 'submitted', amount: { value: 200.00, currency: 'USD' } },
    { category: 'benefit', amount: { value: 144.00, currency: 'USD' } },
  ],
  payment: {
    type: 'complete',
    amount: { value: 144.00, currency: 'USD' },
    date: '2024-04-01',
  },
});
Same pattern as other resources. Update supports status, disposition. Search supports patientId, status, use, outcome, claimId filters.