Claim Submission

Oystehr provides the ability to submit claims through the ClaimMD clearinghouse. For information on preparing data for claim submission, please see Claim Preparation and Additional Claim Data.

Submitting a Claim

After you have assembled all data as required, you can perform claim submission with either the Typescript SDK or the API:

Perform claim submission with the v3 SDK:

import Oystehr from '@oystehr/sdk';
 
const oystehr = new Oystehr({
  accessToken: "<your_access_token>",
});
 
const result = await oystehr.rcm.submitClaim({
  claimId: "7cb4321f-8d52-4d27-93ba-f20c86cbceaf",
})

Access Policy

To submit a claim, your user or M2M client needs to have the following access policy:

{
  "rule": [
    {
      "action": "RCM:SubmitClaim",
      "effect": "Allow",
      "resource": "RCM:Claim"
    },
  ],
}

Response

The claim submission endpoint will create a ClaimResponse in your FHIR datastore and return it from the endpoint. Details can be found in the Claim Responses guide.

Correcting or Voiding a Claim

After an ERA is returned by a payer, claims can be corrected or voided by submitting the claim again with a separate "correction" or "void" action.

To submit a correction or void, you use the same claim submission process as before but with additional parameters. For example, with the Typescript SDK:

import Oystehr from '@oystehr/sdk';
 
const oystehr = new Oystehr({
  accessToken: "<your_access_token>",
});
 
const result = await oystehr.rcm.submitClaim({
  claimId: "7cb4321f-8d52-4d27-93ba-f20c86cbceaf",
  action: "correction", // or "void"
  payerClaimControlNumber: "...",
})

The "payer claim control number" can be found on ClaimResponse resources created by Oystehr and related to your Claim through a ClaimResponse.request reference. The full path for the control number value is:

ClaimResponse.extension[url='https://extensions.fhir.oystehr.com/era-icn'].valueString.

Previewing Generated x12

You can also preview the x12 generated by Oystehr without submitting the claim. This allows you to check for particular values, ensure the claim will complete pre-submission validation, or submit the claim externally. This endpoint takes the same parameters as claim submission; any provided claim submission action and payer claim control number will be included in the generated x12.

import Oystehr from '@oystehr/sdk';
 
const oystehr = new Oystehr({
  accessToken: "<your_access_token>",
});
 
const result = await oystehr.rcm.claimToX12({
  claimId: "7cb4321f-8d52-4d27-93ba-f20c86cbceaf",
})

Access Policy

To generate x12 for a claim, your user or M2M client needs to have the following access policy:

{
  "rule": [
    {
      "action": "RCM:ReadClaim",
      "effect": "Allow",
      "resource": "RCM:Claim"
    },
  ],
}

Additional Claim Data Claim Responses