Claims - Operations Overview

The following FHIR Operations are in scope for processing claim messages. For consistency across all implementations, a FHIR messaging paradigm will be used. Note: Some implementers may prefer to create a separate endpoint for Claim Reversals.

Functionality	Operation	Definition	Response
Submit Claims	[base]Claim/$submit	Bundle with Message Header, focus=Claim or ProffClaim or Reversal Request Parameters	Claim Response or Reversal Response
Submit Claim Reversal	[base]Claim/$reversal	Bundle with Message Header, focus=ParameterIN for Reversal	Claim Reversal Response

These Operations will be used to support the Claim for Dispense messages and the Professional Services claim. The reversal is supported using a custom claim reversal operation as there is no operation defined for this in HL7 FHIR. The Claim/$submit Operation has been defined by HL7 and is found here