Stream: implementers
Topic: Difference between Create Claim vs Claim$Submit
Ken Sinn (May 27 2020 at 20:42):
First foray into the Claim FHIR resource, and wondering if there's a significant difference between the Restful Create Claim vs the Claim$Submit operation, if we're only using the Claim resource and (contained) Patient resource, with no requirements for processing/submitting multiple Claims at once.
Vassil Peytchev (May 27 2020 at 21:49):
RESTful create of a Claim resource means that there is a Claim resource in existence. There is no expectation or obligation that the claim is to be processed. The creation of the Claim resource is likely to occur on the system that is later going to submit the claim. Only through the $submit operation is the processing of the claim initiated.
Lloyd McKenzie (May 28 2020 at 01:03):
There are actually 3 ways to ask a system to process a request. One is to post the request resource (Claim in this case) to the target system with a special meta.tag indicating that the resource is 'actionable'. However, that gives no ability to negotiate about the processing of the request or to monitor status. The second approach is to create the request (Claim) resource and then create a Task that asks for fulfillment of that request. The Task allows negotiation, an explicit accept/reject, monitoring of progress, etc. The third approach is a custom operation like Claim/$submit. In that case, there's no requirement for the Claim to be exposed at any RESTful endpoint at all. As well, the submission of the claim and getting back the response can happen in a single call (if the operation completes synchronously). The financial space has generally focused on custom operations for their processing requirements because exposing the resources to RESTful search/manipulation doesn't generally fit with historical business models. For other types of requests (e.g. ServiceRequest), the other mechanisms are more common. You can find more discussion on the FHIR workflow pages: http://build.fhir.org/workflow-communications.html
Last updated: Apr 12 2022 at 19:14 UTC
