Table of Contents

Claim

The Claim data model is used for transactions between a healthcare organization and a payer, which can include preauthorization for a patient, a submission of a payment request, the status of that submission, the details of the payment, and the explanation of benefits (EOB).

We currently support Claim.Submission, which healthcare organizations send to payers with a payment request detailing the services rendered to a patient. We also support Claim.Payment, which payers use to send a payment notification to a healthcare organization, or for other situations where funds are transferred from one party to another.

The Claim data model differs from the Financial data model in that claims are generally a summary of patient care that's sent or received after an admission or encounter is concluded. If you're looking for handling financial charges on the fly during a patient's care, check out the Financial data model.