API Output

The outcome of an API operation can be found in the ClaimResponse resource of the returned FHIR bundle.

The adjudication property of the ClaimResponse resource will contain the results of the API operation. A table of possible output codes can be found below.

Name	Code	Description
Approved	A1	The prior authorization adjudication or determination has been approved
Denied	D1	The prior authorization adjudication or determination has been denied
Deferred	P1	More information is needed to adjudicate the requested operation
Error	EX1	An error occurred while processing the request. Please see the ClaimResponse and do not resubmit the request. Contact Myndshft support for more information.
Incomplete	I1	More information is needed to adjudicate the requested operation
Not Needed	NA	Prior authorization is not necessary for the given Claim

Example: ClaimResponse ↕

{
  "resource": {
    "resourceType": "ClaimResponse",
    "status": "active",
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/claim-type",
          "code": "professional",
          "display": "Professional"
        }
      ]
    },
    "use": "preauthorization",
    "patient": {
      "reference": "Patient/p01",
      "display": "Patient_Stacie"
    },
    "created": "2010-01-04T04:10:13-07:00",
    "outcome": "complete",
    "disposition": "Approved",
    "preAuthRef": "657ef0a1-f88d-4d5b-83e5-522238b7262f",
    "preAuthPeriod": {
      "start": "2021-05-06T13:31:04-07:00",
      "end": "2021-06-05T13:31:04-07:00"
    },
    "addItem": [
      {
        "extension": [
          {
            "url": "http://myndshft.com/fhir/frequency-value",
            "valueString": "5"
          },
          {
            "url": "http://myndshft.com/fhir/frequency-type",
            "valueString": "Units"
          }
        ],
        "productOrService": {
          "coding": [
            {
              "system": "http://www.ama-assn.org/go/cpt",
              "code": "63030"
            }
          ]
        },
        "noteNumber": [
          1
        ],
        "adjudication": [
          {
            "category": {
              "coding": [
                {
                  "code": "A1",
                  "display": "Approved"
                }
              ]
            }
          }
        ]
      }
    ],
    "adjudication": [
      {
        "category": {
          "coding": [
            {
              "code": "A1",
              "display": "Approved"
            }
          ]
        }
      }
    ],
    "processNote": [
      {
        "number": 1,
        "type": "display",
        "text": "PayerPolicyReferenceID - BSC_NIA_CG_304"
      }
    ],
    "insurance": [
      {
        "sequence": 1,
        "focal": true,
        "coverage": {
          "reference": "Coverage/54321"
        }
      }
    ]
  }
}