Additional Claim Data

There are many additional or substitutive pieces of data that can be attached to a claim. Depending on the payer, some of this data may be required to get a given claim approved. This page reviews additional claim data that is supported by Oystehr and how they are pulled from the FHIR data model.

Attachments

Raw supplemental information attachments can be added to a claim using the Claim.supportingInfo field. Control codes for this data are added to the Claim.supportingInfo.code.coding array:

.supportingInfo.category[system='https://www.hl7.org/fhir/R4B/valueset-claim-informationcategory.html']
- Information category codes are available here (opens in a new tab).
.supportingInfo.code[system='https://terminology.fhir.oystehr.com/CodeSystem/rcm-claim-attachment-report-type-code']
- Report type codes can be found here (opens in a new tab).
.supportingInfo.code[system='https://terminology.fhir.oystehr.com/CodeSystem/rcm-claim-attachment-transmission-code']
- Report transmission codes can be found here (opens in a new tab). Note that only a subset of these are valid for the 837 specification.

DocumentReference resource references and custom ACNs are stored in the value* fields, as shown in the examples below.

Note that each claim is limited to 10 attachments, across all formats.

Electronic Attachments

The Oystehr RCM service has first-class support for uploading electronic attachments using DocumentReference resources and the Oystehr Z3 Service. The claim submission process will retrieve referenced files from Z3 and upload them to the payer. ACNs will be managed by Oystehr and will be ignored if provided.

{
  resourceType: "Claim",
  // ...
  supportingInfo: [
    {
      sequence: 1,
      category: { coding: [{ system: 'http://terminology.hl7.org/CodeSystem/claiminformationcategory', code: 'attachment' }] },
      code: {
        coding: [
          // Specifying a report type code is optional but will be included in the claim transmission
          { system: 'https://terminology.fhir.oystehr.com/CodeSystem/rcm-claim-attachment-report-type-code', code: 'RR' },
        ]
      },
      valueReference: 'DocumentReference/e227ac41-1158-40a9-9db3-1a0837f03655',
    },
    {
      sequence: 2,
      category: { coding: [{ system: 'http://terminology.hl7.org/CodeSystem/claiminformationcategory', code: 'info' }] },
      // Omitting report type code will be sent using the generic `OZ` "Support Data for Claim" code
      valueReference: 'DocumentReference/945e21be-8ab3-4235-b41c-0b88e835dc11',
    },
  ],
  // ...
}

Non-electronic Attachments

In the rare case that you need to submit a claim without creating a DocumentReference using Z3, you will need to submit your attachments to a payer separately. You will specify your own ACN if needed in the supportingInfo entry's valueString field.

{
  resourceType: "Claim",
  // ...
  supportingInfo: [
    {
      sequence: 1,
      category: { coding: [{ system: 'http://terminology.hl7.org/CodeSystem/claiminformationcategory', code: 'info' }] },
      code: {
        coding: [
          { system: 'https://terminology.fhir.oystehr.com/CodeSystem/rcm-claim-additional-info-type', code: 'PWK' },
          { system: 'https://terminology.fhir.oystehr.com/CodeSystem/rcm-claim-attachment-report-type-code', code: 'RR' }, // Radiology Reports
          { system: 'https://terminology.fhir.oystehr.com/CodeSystem/rcm-claim-attachment-transmission-code', code: 'BM' }, // By Mail
        ]
      },
    },
    {
      sequence: 2,
      category: { coding: [{ system: 'http://terminology.hl7.org/CodeSystem/claiminformationcategory', code: 'info' }] },
      code: {
        coding: [
          { system: 'https://terminology.fhir.oystehr.com/CodeSystem/rcm-claim-additional-info-type', code: 'PWK' },
          { system: 'https://terminology.fhir.oystehr.com/CodeSystem/rcm-claim-attachment-report-type-code', code: 'XP' }, // Photographs
          { system: 'https://terminology.fhir.oystehr.com/CodeSystem/rcm-claim-attachment-transmission-code', code: 'EL' }, // Separate electronic submission via x12
        ]
      },
      valueString: '123456789', // ACN
    },
  ],
  // ...
}

Claim Note

A claim note can be added to Claim.supportingInfo using special code entries:

.supportingInfo.code[system='https://terminology.fhir.oystehr.com/CodeSystem/rcm-claim-additional-info-type', code=NTE]
.supportingInfo.code[system='https://terminology.fhir.oystehr.com/CodeSystem/rcm-claim-note-reference-code']
- Note reference codes can be found here (opens in a new tab). Note that only a few of these are valid for the 837 specification.

{
  resourceType: "Claim",
  // ...
  supportingInfo: [
    {
      sequence: 1,
      category: { coding: [{ system: 'http://terminology.hl7.org/CodeSystem/claiminformationcategory', code: 'info' }] },
      code: {
        coding: [
          { system: 'https://terminology.fhir.oystehr.com/CodeSystem/rcm-claim-additional-info-type', code: 'NTE' },
          { system: 'https://terminology.fhir.oystehr.com/CodeSystem/rcm-claim-note-reference-code', code: 'DGN' }, // Diagnosis Description
        ]
      },
      valueString: '...' // Free-form text, max length 80 characters
    },
  ],
  // ...
}

There can only be one claim note per claim.

Accident Information

When a claim relates to an accident, whether it's an automobile accident, an employment accident, or some other type of accident relevant to payers, information about the accident must be added to the claim.

There are three main pieces of data: the type of the accident, the US state in which it occurred, and the date on which it occurred.

Accident Type

There are three valid types for an accident when submitting a claim: auto accident, employment accident, and "other" accident. More than one type may apply.

These types are stored as extensions on the Claim resource. For example, a claim related to an automobile accident that occurred on the job would be have two extension entries:

{
  resourceType: "Claim",
  // ...
  extension: [
    {
      "url": "https://extensions.fhir.oystehr.com/rcm-claim-auto-accident",
      "valueBoolean": "true"
    },
    {
      "url": "https://extensions.fhir.oystehr.com/rcm-claim-employment-accident",
      "valueBoolean": "true"
    },
    // ...
  ]
}

The full set of possible extension URLs is:

Auto Accident — https://extensions.fhir.oystehr.com/rcm-claim-auto-accident (opens in a new tab)
Employment Accident — https://extensions.fhir.oystehr.com/rcm-claim-employment-accident (opens in a new tab)
Other Accident — https://extensions.fhir.oystehr.com/rcm-claim-other-accident (opens in a new tab)

Accident State

It is only necessary to provide the US state in which an accident occurred when "Auto Accident" is one of the accident types.

The state is added to the Claim using an extension, and stored as a standard 2-letter state code:

{
  resourceType: "Claim",
  // ...
  extension: [
    {
      "url": "https://extensions.fhir.oystehr.com/rcm-claim-auto-accident",
      "valueBoolean": "true"
    },
    {
      "url": "https://extensions.fhir.oystehr.com/rcm-claim-auto-accident-state",
      "valueString": "KS"
    },
    // ...
  ]
}

Accident Date

Accident date is added to the Claim's supportingInfo:

{
  resourceType: "Claim",
  // ...
  supportingInfo: [
    {
      sequence: 1,
      category: { coding: [{ system: 'http://terminology.hl7.org/CodeSystem/claiminformationcategory', code: 'info' }] },
      code: {
        coding: [
          { system: 'https://terminology.fhir.oystehr.com/CodeSystem/rcm-claim-date-type', code: '439' },
        ]
      },
      timingDate: '2026-01-01'
    },
  ]
}

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