API end point: https://patient360ny.bcbsdirect.com/P360Member/api/fhir.

Resource Claim (DSTU2)

Maps CareEvolution Claim concepts with a Claim DataSource code NOT containing the value 'ExplanationOfBenefit'

• Supported interactions
• Search parameters
• Sorts
• Includes
• Operations
• To FHIR mappings
• From FHIR mappings

Supported interactions

• read
• search
• create
• update
• delete

Search parameters

Name	Type	Modifiers , prefixes	Multiple values	Can be chained	Description
_id	Token		Yes		Resource id
_lastUpdated	Date	lt le gt ge			When the resource last changed
_source	Uri	:missing	Yes		Where the resource comes from
created	Date	:missing eq ne lt le gt ge sa eb ap			Searches for claims by start date-time
date	Date	:missing eq ne lt le gt ge sa eb ap			See here
encounter	Reference (Encounter)	:missing	Yes	Yes	Searches for claims by their associated encounter
identifier	Token	:missing	Yes		The primary identifier of the financial resource
patient	Reference (Patient)	:missing	Yes	Yes	The patient the Claim is about
provenance-agent	Reference (Organization)	:missing	Yes	Yes	Search by provenance, specified by its author (aka originator) Organization
provider	Reference (Practitioner)	:missing	Yes	Yes	Searches for claims by practitioner (caregiver), considering all possible references: provider, payee.provider and the http://careevolution.com/fhirextensions#claim-providers extension
status	Token	:not :in :not-in :missing	Yes		Searches for claims by status
type	Token	:missing	Yes		See here

Sorts

• _id
• created
• identifier

Supports multiple sorts

Includes

• encounter
• patient
• provenance-agent
• provider
• Condition:claim
• Immunization:claim
• MedicationDispense:claim
• Procedure:claim
• Provenance:target

Operations

• validate - Validate a resource

To FHIR mappings

FHIR	CareEvolution
coverage	InsuranceID
created	StartDate
diagnosis.diagnosis	Problems.Term Domain: DiagnosisCode
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemDate')	Problems.Date
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemType')	Problems.Type Domain: DiagnosisType
diagnosis.sequence	Problems.Sequence
extension('http://careevolution.com/fhirextensions#claim-adjudicationDate')	AdjudicationDate
extension('http://careevolution.com/fhirextensions#claim-admitDate')	AdmitDate
extension('http://careevolution.com/fhirextensions#claim-admitSource')	AdmitSource Domain: AdmitSource
extension('http://careevolution.com/fhirextensions#claim-admitType')	AdmitType Domain: AdmissionType
extension('http://careevolution.com/fhirextensions#claim-billClass')	BillClass Domain: BillClass
extension('http://careevolution.com/fhirextensions#claim-controlNumber')	ControlNumber
extension('http://careevolution.com/fhirextensions#claim-dischargeDate')	DischargeDate
extension('http://careevolution.com/fhirextensions#claim-disposition')	Disposition Domain: ClaimDisposition
extension('http://careevolution.com/fhirextensions#claim-drg')	Drg Domain: ClaimDrg
extension('http://careevolution.com/fhirextensions#claim-encounterID')	EncounterID
extension('http://careevolution.com/fhirextensions#claim-endDate')	EndDate
extension('http://careevolution.com/fhirextensions#claim-facilityType')	FacilityType Domain: FacilityType
extension('http://careevolution.com/fhirextensions#claim-innetwork')	InNetwork Domain: ClaimInNetwork
extension('http://careevolution.com/fhirextensions#claim-mrn')	Mrn
extension('http://careevolution.com/fhirextensions#claim-nonPaymentReason')	NonPaymentReason Domain: NonPaymentReason
extension('http://careevolution.com/fhirextensions#claim-paidDate')	PaidDate
extension('http://careevolution.com/fhirextensions#claim-patientStatus')	PatientStatus Domain: PatientStatus
extension('http://careevolution.com/fhirextensions#claim-providers')	CaregiverRelationships
	Services.CaregiverRelationships
extension('http://careevolution.com/fhirextensions#claim-status')	Status Domain: ClaimStatus
extension('http://careevolution.com/fhirextensions#claim-totalAllowed')	TotalAllowed
extension('http://careevolution.com/fhirextensions#claim-totalCharges')	TotalCharges
extension('http://careevolution.com/fhirextensions#claim-totalcoinsuranceamount')	TotalCoinsuranceAmount
extension('http://careevolution.com/fhirextensions#claim-totalcopayamount')	TotalCopayAmount
extension('http://careevolution.com/fhirextensions#claim-totaldeductibleamount')	TotalDeductibleAmount
extension('http://careevolution.com/fhirextensions#claim-totalhsapaidamount')	TotalHsaPaidAmount
extension('http://careevolution.com/fhirextensions#claim-totalnotcoveredamount')	TotalNotCoveredAmount
extension('http://careevolution.com/fhirextensions#claim-totalPaid')	TotalPaid
extension('http://careevolution.com/fhirextensions#claim-totalPatientPaid')	TotalPatientPaid
extension('http://careevolution.com/fhirextensions#claim-totalpatientresponsibleamount')	TotalPatientResponsibleAmount
extension('http://careevolution.com/fhirextensions#dataSource')	DataSource
extension('http://careevolution.com/fhirextensions#properties')	Properties
facility	Encounter.EncounterLocations
identifier	Identifier
	AlternateIdentifier
item.extension('http://careevolution.com/fhirextensions#claim-endDate')	Services.EndDate
item.extension('http://careevolution.com/fhirextensions#claim-locationType')	Services.LocationType Domain: ServiceLocation
item.extension('http://careevolution.com/fhirextensions#claim-patientPaid')	Services.PatientPaid
item.extension('http://careevolution.com/fhirextensions#claim-revenueCode')	Services.RevenueCode Domain: RevenueCode
item.extension('http://careevolution.com/fhirextensions#claimService-allowedamount')	Services.AllowedAmount
item.extension('http://careevolution.com/fhirextensions#claimService-coinsuranceamount')	Services.CoinsuranceAmount
item.extension('http://careevolution.com/fhirextensions#claimService-copayamount')	Services.CopayAmount
item.extension('http://careevolution.com/fhirextensions#claimService-deductibleamount')	Services.DeductibleAmount
item.extension('http://careevolution.com/fhirextensions#claimService-hsapaidamount')	Services.HsaPaidAmount
item.extension('http://careevolution.com/fhirextensions#claimService-nonPaymentReason')	Services.NonPaymentReason Domain: NonPaymentReason
item.extension('http://careevolution.com/fhirextensions#claimService-notcoveredamount')	Services.NotCoveredAmount
item.extension('http://careevolution.com/fhirextensions#claimService-patientresponsibleamount')	Services.PatientResponsibleAmount
item.extension('http://careevolution.com/fhirextensions#claim-status')	Services.Status Domain: ClaimServiceStatus
item.modifier	Services.Modifier1 Domain: BillingModifier
	Services.Modifier2 Domain: BillingModifier
	Services.Modifier3 Domain: BillingModifier
	Services.Modifier4 Domain: BillingModifier
	Services.Modifier5 Domain: BillingModifier
item.net	Services.AmountPaid
item.quantity	Services.Units
item.sequence	Services.Sequence
item.service	Services.ServiceCode Domain: ServiceCode
item.serviceDate	Services.StartDate
item.unitPrice	Services.AmountClaimed
patient	PatientID
payee	CaregiverRelationships	Maps CaregiverRelationships with RelationshipType=PayToProvider
priority	Priority Domain: ClaimPriority
	PriorityAlternateTerms Domain: ClaimPriority
	PriorityText
provider	CaregiverRelationships	Maps CaregiverRelationships with RelationshipType=ClaimProvider
referral	ReferralID
text	Comment
type Bindings:  valueset-claim-type	ClaimType Domain: ClaimType

From FHIR mappings

FHIR	CareEvolution
coverage	InsuranceID
created	StartDate
diagnosis.diagnosis	Problems.Term Domain: DiagnosisCode
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemDate')	Problems.Date
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemType')	Problems.Type Domain: DiagnosisType
diagnosis.sequence	Problems.Sequence
extension('http://careevolution.com/fhirextensions#claim-adjudicationDate')	AdjudicationDate
extension('http://careevolution.com/fhirextensions#claim-admitDate')	AdmitDate
extension('http://careevolution.com/fhirextensions#claim-admitSource')	AdmitSource Domain: AdmitSource
extension('http://careevolution.com/fhirextensions#claim-admitType')	AdmitType Domain: AdmissionType
extension('http://careevolution.com/fhirextensions#claim-billClass')	BillClass Domain: BillClass
extension('http://careevolution.com/fhirextensions#claim-controlNumber')	ControlNumber
extension('http://careevolution.com/fhirextensions#claim-dischargeDate')	DischargeDate
extension('http://careevolution.com/fhirextensions#claim-disposition')	Disposition Domain: ClaimDisposition
extension('http://careevolution.com/fhirextensions#claim-drg')	Drg Domain: ClaimDrg
extension('http://careevolution.com/fhirextensions#claim-encounterID')	EncounterID
extension('http://careevolution.com/fhirextensions#claim-endDate')	EndDate
extension('http://careevolution.com/fhirextensions#claim-facilityType')	FacilityType Domain: FacilityType
extension('http://careevolution.com/fhirextensions#claim-innetwork')	InNetwork Domain: ClaimInNetwork
extension('http://careevolution.com/fhirextensions#claim-mrn')	Mrn
extension('http://careevolution.com/fhirextensions#claim-nonPaymentReason')	NonPaymentReason Domain: NonPaymentReason
extension('http://careevolution.com/fhirextensions#claim-paidDate')	PaidDate
extension('http://careevolution.com/fhirextensions#claim-patientStatus')	PatientStatus Domain: PatientStatus
extension('http://careevolution.com/fhirextensions#claim-providers')	CaregiverRelationships
	Services.CaregiverRelationships
extension('http://careevolution.com/fhirextensions#claim-status')	Status Domain: ClaimStatus
extension('http://careevolution.com/fhirextensions#claim-totalAllowed')	TotalAllowed
extension('http://careevolution.com/fhirextensions#claim-totalCharges')	TotalCharges
extension('http://careevolution.com/fhirextensions#claim-totalcoinsuranceamount')	TotalCoinsuranceAmount
extension('http://careevolution.com/fhirextensions#claim-totalcopayamount')	TotalCopayAmount
extension('http://careevolution.com/fhirextensions#claim-totaldeductibleamount')	TotalDeductibleAmount
extension('http://careevolution.com/fhirextensions#claim-totalhsapaidamount')	TotalHsaPaidAmount
extension('http://careevolution.com/fhirextensions#claim-totalnotcoveredamount')	TotalNotCoveredAmount
extension('http://careevolution.com/fhirextensions#claim-totalPaid')	TotalPaid
extension('http://careevolution.com/fhirextensions#claim-totalPatientPaid')	TotalPatientPaid
extension('http://careevolution.com/fhirextensions#claim-totalpatientresponsibleamount')	TotalPatientResponsibleAmount
extension('http://careevolution.com/fhirextensions#dataSource')	DataSource
extension('http://careevolution.com/fhirextensions#properties')	Properties
id	Identifier
identifier	Identifier
	AlternateIdentifier
item.extension('http://careevolution.com/fhirextensions#claim-endDate')	Services.EndDate
item.extension('http://careevolution.com/fhirextensions#claim-locationType')	Services.LocationType Domain: ServiceLocation
item.extension('http://careevolution.com/fhirextensions#claim-patientPaid')	Services.PatientPaid
item.extension('http://careevolution.com/fhirextensions#claim-revenueCode')	Services.RevenueCode Domain: RevenueCode
item.extension('http://careevolution.com/fhirextensions#claimService-allowedamount')	Services.AllowedAmount
item.extension('http://careevolution.com/fhirextensions#claimService-coinsuranceamount')	Services.CoinsuranceAmount
item.extension('http://careevolution.com/fhirextensions#claimService-copayamount')	Services.CopayAmount
item.extension('http://careevolution.com/fhirextensions#claimService-deductibleamount')	Services.DeductibleAmount
item.extension('http://careevolution.com/fhirextensions#claimService-hsapaidamount')	Services.HsaPaidAmount
item.extension('http://careevolution.com/fhirextensions#claimService-nonPaymentReason')	Services.NonPaymentReason Domain: NonPaymentReason
item.extension('http://careevolution.com/fhirextensions#claimService-notcoveredamount')	Services.NotCoveredAmount
item.extension('http://careevolution.com/fhirextensions#claimService-patientresponsibleamount')	Services.PatientResponsibleAmount
item.extension('http://careevolution.com/fhirextensions#claim-status')	Services.Status Domain: ClaimServiceStatus
item.modifier	Services.Modifier1 Domain: BillingModifier
	Services.Modifier2 Domain: BillingModifier
	Services.Modifier3 Domain: BillingModifier
	Services.Modifier4 Domain: BillingModifier
	Services.Modifier5 Domain: BillingModifier
item.net	Services.AmountPaid
item.quantity	Services.Units
item.sequence	Services.Sequence
item.service	Services.ServiceCode Domain: ServiceCode
item.serviceDate	Services.StartDate
item.unitPrice	Services.AmountClaimed
patient	PatientID
payee	CaregiverRelationships	Maps CaregiverRelationships with RelationshipType=PayToProvider
priority	Priority Domain: ClaimPriority
	PriorityAlternateTerms Domain: ClaimPriority
	PriorityText
provider	CaregiverRelationships	Maps CaregiverRelationships with RelationshipType=ClaimProvider
referral	ReferralID
text	Comment
type Bindings:  valueset-claim-type	ClaimType Domain: ClaimType

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