Claims Overview

Welcome to the Claims API documentation for the Health Information Exchange (HIE) APIs.

The Claims API enables you to manage and process healthcare claims efficiently and securely. It provides the ability to create, submit, edit, track, and finalize claims, ensuring seamless integration with the Social Health Authority (SHA) and other stakeholders in the healthcare ecosystem.

By leveraging the Claims API, you can automate claim workflows. The API supports a wide range of claim operations, from eligibility checks and billing to preauthorization and remittance management.

Capabilities

With the Claims API, you can:

• Submit Claims: Send new claims for processing and reimbursement.
• Edit Claims: Update claim details, including billing lines, diagnoses, and attachments.
• Track Claim Status: Monitor the progress and status of claims throughout their lifecycle.
• Perform Eligibility Checks: Instantly verify patient coverage and entitlements.
• Manage Preauthorizations: Request, update, or cancel preauthorization for specific healthcare services.
• Handle Remittances: Retrieve remittance details and payment information for processed claims.

Explore More

• Process Docs: Step-by-step guides for real-world claims scenarios.
• Guides: Best practices, troubleshooting, and advanced usage.
• API Reference: Claims endpoints and schemas in the API Catalog.

Use the sidebar to access process docs, guides, and the API reference for Claims.