{
  "description": "This operation is used to search for a postable remittance by providing claim information.",
  "_filename": "OperationDefinition-SearchByClaim.json",
  "package_name": "hl7.fhir.us.davinci-pr",
  "date": "2025-04-08T15:41:44+00:00",
  "system": true,
  "publisher": "HL7 International / Payer/Provider Information Exchange Work Group",
  "instance": false,
  "jurisdiction": [ {
    "coding": [ {
      "code": "US",
      "system": "urn:iso:std:iso:3166",
      "display": "United States of America"
    } ]
  } ],
  "name": "SearchByClaim",
  "type": "false",
  "experimental": null,
  "outputProfile": "http://hl7.org/fhir/us/davinci-pr/StructureDefinition/searchResultParameters",
  "resourceType": "OperationDefinition",
  "title": "Search for Postable Remittance By Claim",
  "package_version": "1.0.0",
  "extension": [ {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode": "claims"
  }, {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger": 1,
    "_valueInteger": {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical": "http://hl7.org/fhir/us/davinci-pr/ImplementationGuide/hl7.fhir.us.davinci-pr"
      } ]
    }
  }, {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode": "trial-use",
    "_valueCode": {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical": "http://hl7.org/fhir/us/davinci-pr/ImplementationGuide/hl7.fhir.us.davinci-pr"
      } ]
    }
  } ],
  "status": "active",
  "id": "fb13e3aa-dd8f-4cbd-b839-3f99633ed604",
  "kind": "operation",
  "url": "http://hl7.org/fhir/us/davinci-pr/OperationDefinition/SearchByClaim",
  "code": "searchByClaim",
  "version": "1.0.0",
  "contact": [ {
    "name": "HL7 International / Payer/Provider Information Exchange Work Group",
    "telecom": [ {
      "value": "http://www.hl7.org/Special/committees/claims",
      "system": "url"
    } ]
  } ],
  "inputProfile": "http://hl7.org/fhir/us/davinci-pr/StructureDefinition/searchByClaimParameters",
  "parameter": [ {
    "max": "1",
    "min": 1,
    "use": "in",
    "name": "TIN",
    "type": "string",
    "documentation": "Medical Group / Billing Provider / Payee TIN"
  }, {
    "max": "1",
    "min": 0,
    "use": "in",
    "name": "PayerID",
    "type": "string",
    "documentation": "Payer Identifer"
  }, {
    "max": "1",
    "min": 0,
    "use": "in",
    "name": "PayerName",
    "type": "string",
    "documentation": "Payer Name"
  }, {
    "max": "1",
    "min": 0,
    "use": "in",
    "name": "ServiceStartDate",
    "type": "date",
    "documentation": "Start Date of Service"
  }, {
    "max": "1",
    "min": 0,
    "use": "in",
    "name": "ServiceEndDate",
    "type": "date",
    "documentation": "End Date of Service"
  }, {
    "max": "1",
    "min": 0,
    "use": "in",
    "name": "PatientID",
    "type": "string",
    "documentation": "Patient Member (or Subscriber) Insurance ID"
  }, {
    "max": "1",
    "min": 1,
    "use": "in",
    "name": "Claim",
    "part": [ {
      "max": "1",
      "min": 1,
      "use": "in",
      "name": "ProviderClaimID",
      "type": "string",
      "documentation": "Provider generated Claim ID (also known as Patient Account Number)"
    }, {
      "max": "1",
      "min": 0,
      "use": "in",
      "name": "ProviderID",
      "type": "string",
      "documentation": "NPI or Payer Assigned Provider Identifier"
    }, {
      "max": "1",
      "min": 0,
      "use": "in",
      "name": "PayerClaimID",
      "type": "string",
      "documentation": "Payer Generated Claim ID (DCN or ICN)"
    }, {
      "max": "1",
      "min": 0,
      "use": "in",
      "name": "ClaimChargeAmount",
      "type": "Money",
      "documentation": "Claim Charge Amount"
    } ],
    "documentation": "Information about the claim being searched for."
  }, {
    "max": "1",
    "min": 1,
    "use": "out",
    "name": "TIN",
    "type": "string",
    "documentation": "Medical Group / Billing Provider / Payee TIN"
  }, {
    "max": "1",
    "min": 1,
    "use": "out",
    "name": "Payer",
    "part": [ {
      "max": "1",
      "min": 1,
      "use": "out",
      "name": "PayerID",
      "type": "string",
      "documentation": "Payer Identifier"
    }, {
      "max": "1",
      "min": 1,
      "use": "out",
      "name": "PayerName",
      "type": "string",
      "documentation": "Payer Name"
    } ],
    "documentation": "Details of payer information."
  }, {
    "max": "*",
    "min": 1,
    "use": "out",
    "name": "Claim",
    "part": [ {
      "max": "1",
      "min": 1,
      "use": "out",
      "name": "PayerClaimID",
      "type": "string",
      "documentation": "Payer Generated Claim ID (DCN or ICN)"
    }, {
      "max": "1",
      "min": 1,
      "use": "out",
      "name": "ProviderClaimID",
      "type": "string",
      "documentation": "Provider generated Claim ID"
    }, {
      "max": "1",
      "min": 1,
      "use": "out",
      "name": "ClaimReceivedDate",
      "type": "date",
      "documentation": "Claim Received Date"
    }, {
      "max": "1",
      "min": 1,
      "use": "out",
      "name": "ProviderID",
      "type": "string",
      "documentation": "NPI or Payer Assigned Provider Identifier"
    }, {
      "max": "*",
      "min": 1,
      "use": "out",
      "name": "PaymentInfo",
      "part": [ {
        "max": "1",
        "min": 1,
        "use": "out",
        "name": "PaymentDate",
        "type": "date",
        "documentation": "Payment Date"
      }, {
        "max": "1",
        "min": 1,
        "use": "out",
        "name": "PaymentNumber",
        "type": "string",
        "documentation": "Payment Number"
      }, {
        "max": "1",
        "min": 1,
        "use": "out",
        "name": "PaymentAmount",
        "type": "Money",
        "documentation": "Payment Amount"
      }, {
        "max": "*",
        "min": 1,
        "use": "out",
        "name": "Remittance",
        "part": [ {
          "max": "1",
          "min": 1,
          "use": "out",
          "name": "RemittanceAdviceIdentifier",
          "type": "string",
          "documentation": "Remittance Advice Identifier"
        }, {
          "max": "1",
          "min": 1,
          "use": "out",
          "name": "RemittanceAdviceType",
          "type": "code",
          "binding": {
            "strength": "required",
            "valueSet": "http://hl7.org/fhir/us/davinci-pr/ValueSet/RemittanceAdviceType"
          },
          "documentation": "Remittance Advice Type"
        }, {
          "max": "1",
          "min": 1,
          "use": "out",
          "name": "RemittanceAdviceDate",
          "type": "date",
          "documentation": "Remittance Advice Date"
        }, {
          "max": "1",
          "min": 1,
          "use": "out",
          "name": "RemittanceAdviceFileSize",
          "type": "integer",
          "documentation": "Remittance Advice File Size"
        } ],
        "documentation": "Details of remittance advice."
      } ],
      "documentation": "Details of adjudicated payment."
    } ],
    "documentation": "Details to verify correct claim found."
  }, {
    "max": "1",
    "min": 1,
    "use": "out",
    "name": "Patient",
    "part": [ {
      "max": "1",
      "min": 1,
      "use": "out",
      "name": "DateOfBirth",
      "type": "date",
      "documentation": "Patient date of birth"
    }, {
      "max": "1",
      "min": 1,
      "use": "out",
      "name": "PatientID",
      "type": "string",
      "documentation": "Patient Member (or Subscriber) Insurance ID"
    }, {
      "max": "1",
      "min": 1,
      "use": "out",
      "name": "PatientFirstName",
      "type": "string",
      "documentation": "Patient First Name"
    }, {
      "max": "1",
      "min": 1,
      "use": "out",
      "name": "PatientLastName",
      "type": "string",
      "documentation": "Patient Last Name"
    } ],
    "documentation": "Details to verify correct patient found."
  } ]
}