I’m working on mapping Claim FHIR resource in my database and I am little doubtful about what resource will best suite my needs. The options being ExplanationOfBenefits, Claim and ClaimResponse
I want a resource that provides all information related to providers, diagnosis, procedures, amounts ,claimlines etc.
Should I use ExplanationOfBenefits or both Claim and ClaimResponse?
If I choose ExplanationOfBenefits, then would I have to store Claim and ClaimResponse too as ExplanationOfBenefits has reference to both resources?
Claim represents insurance claims, prior-auth requests and predetermination requests. ClaimResponse represents claim adjudications, prior authorization results and pre-determination results. ExplanationOfBenefits represents a summary of what was covered by a plan. You might well want any or all of these resources.
Thanks @lloyd for your quick response. Can you please help me with a few more questions.
I’m mapping claims from a client into my database. A client provides a claim number for each claim which uniquely identifies it. Would it be a right choice to use ExplanationOfBenefits.identifier or could you please suggest an appropriate field for claim number.
As you said ExplanationOfBenefits represents a summary of what was covered by a plan, so does it mean that we’ll have only that information in ExplanationOfBenefits that has been verified and doesn’t contain any error?