hapi - Is there anyway to get FHIR Claim Resources based on related Procedure details? - Stack Overflow

This seems to be a huge oversight on HL7s FHIR standard but it seems Claims lack Search Params based on associated "items" like CPT codes or ICD diagnosis. I'm hopeful that I'm just naive and that someone can point to a way to do it without having add Custom Search Parameters.

Note, I am using HAPI R4 and it is pretty clear on what is searchable (matching the spec)

[_content, _id, _lastUpdated, _profile, _security, _source, _tag, _text, care-team, created, detail-udi, encounter, enterer, facility, identifier, insurer, item-udi, patient, payee, priority, procedure-udi, provider, status, subdetail-udi, use]

I'm very confused as to why this isn't a first class pathway considering that claims are simply a bundle of "what was done on behalf of the patient for which the provider should get paid". Even some enlightenment as to why this isn't possible or obvious would be appreciated.

Attempted to try going through the Claim's item (which is not a search param) and as expected received the following:

{
  "resourceType": "OperationOutcome",
  "issue": [ {
    "severity": "error",
    "code": "processing",
    "diagnostics": "HAPI-0524: Unknown search parameter \"item\" for resource type \"Claim\". Valid search parameters for this search are: [_content, _id, _lastUpdated, _profile, _security, _source, _tag, _text, care-team, created, detail-udi, encounter, enterer, facility, identifier, insurer, item-udi, patient, payee, priority, procedure-udi, provider, status, subdetail-udi, use]"
  } ]
}

This seems to be a huge oversight on HL7s FHIR standard but it seems Claims lack Search Params based on associated "items" like CPT codes or ICD diagnosis. I'm hopeful that I'm just naive and that someone can point to a way to do it without having add Custom Search Parameters.

Note, I am using HAPI R4 and it is pretty clear on what is searchable (matching the spec)

[_content, _id, _lastUpdated, _profile, _security, _source, _tag, _text, care-team, created, detail-udi, encounter, enterer, facility, identifier, insurer, item-udi, patient, payee, priority, procedure-udi, provider, status, subdetail-udi, use]

I'm very confused as to why this isn't a first class pathway considering that claims are simply a bundle of "what was done on behalf of the patient for which the provider should get paid". Even some enlightenment as to why this isn't possible or obvious would be appreciated.

Attempted to try going through the Claim's item (which is not a search param) and as expected received the following:

{
  "resourceType": "OperationOutcome",
  "issue": [ {
    "severity": "error",
    "code": "processing",
    "diagnostics": "HAPI-0524: Unknown search parameter \"item\" for resource type \"Claim\". Valid search parameters for this search are: [_content, _id, _lastUpdated, _profile, _security, _source, _tag, _text, care-team, created, detail-udi, encounter, enterer, facility, identifier, insurer, item-udi, patient, payee, priority, procedure-udi, provider, status, subdetail-udi, use]"
  } ]
}

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• hapi
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Share Improve this question Follow edited Jan 3 at 6:43 Amit Joshi 16.5k2323 gold badges8787 silver badges150150 bronze badges asked Jan 2 at 17:55 TheCaffinatedDeveloperTheCaffinatedDeveloper 38111 gold badge33 silver badges44 bronze badges 1

• 1 The answer of "why isn't there a standard search parameter" is that no one has brought forward a use-case. In most cases, claims are searched by patient, date, payer, and encounter - not specific CPT codes. If you think that searching by procedure code will be a common requirement, submit a change request to get that introduced in a future version of the standard. (Use the 'propose a change' link at the bottom of any page in the spec.) – Lloyd McKenzie Commented Jan 3 at 4:14

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1 Answer 1

Sorted by: Reset to default 1

With HAPI you can add custom search parameters. HAPI's documentation on this can be found here. While it is unfortunate that procedure and diagnosis are not part of the default search params for a claim, it was easy enough to add what I needed.

As an example, I was able to add a path from item's productOrService codes. Here is an example of the Search Parameter resource I created.

{
  "resourceType": "SearchParameter",
  "url": "http://example.org/fhir/SearchParameter/claim-item-productOrService",
  "version": "1.0",
  "name": "ClaimItemProductOrService",
  "status": "active",
  "description": "Search Claims by productOrService field in Claim items.",
  "code": "product-or-service",
  "base": ["Claim"],
  "type": "token",
  "expression": "Claim.item.productOrService",
  "xpath": "f:Claim/f:item/f:productOrService",
  "xpathUsage": "normal"
}

With that, you can now perform searches like https://base_fhir_server_url/Claim?product-or-service=CPT|99454 for example.