The Clearing Services APIs allow to retrieve remittances.
Getting started
General aspects of integrating with Healthcode APIs, like authentication and authorisation, naming conventions, data formatting assumptions, error handling requirements, etc. are documented here.
Pay special attention to the aspects of using discovery document, the need to specify site id within the request headers, and the need to specify exact API version.
Also, be certain you are connecting to the correct environment. If you are trying to integrate into our sandbox (UAT) environment, read instructions here first to understand the requirements.
Remittances
Remittance data can be retrieved in two parts: summary and detail. The remittance summary uses the PaymentReconciliation resource, whereas the remittance detail uses the ClaimResponse resource. The following APIs enable operations on these resources.
Search Remittance Summary
The Search Remittance Summary API allows retrieval of remittance summary information using basic filter criteria.
Endpoint
Must be looked up from the discovery document using search_remittance_summary_endpoint key.
Request
curl --request POST
--url '{search_remittance_detail_advanced_endpoint}'
--header 'SU-SiteId: HC16190'
--header 'Content-Type: application/x-www-form-urlencoded'
--header 'Authorization: Bearer abCdE12...89mNopq0r'
--data-urlencode 'page=1'
--data-urlencode 'count=10'
--data-urlencode 'insurerIdentifier=slh'
--data-urlencode '_sort=createdOn'Where,
| Field | Type | Mandatory/ Optional | Description |
|---|---|---|---|
| insurerIdentifier | String | M | Insurer/Payor identifier. Following are the supported insurers/payors and its identifiers: Bupa = bup Bupa Global = bui AXA Health = ppp Aviva = nuh Vitality Health = slh Cigna International = cin Trust In Health = tih WPA = wpa Patientzone = pzo |
| _sort | String | O | Sort results by created date. Use _sort=createdOn to sort results on created date in ascending order, or _sort=-createdOn for descending order |
| _since | String | O | Last updated date time of records |
| page | String | O | Page index to be fetched {1,2,3..} |
| count | String | O | Maximum records in a page |
Response
The API returns a Bundle of PaymentReconciliation resources based on the search filters.
{
"resourceType": "Bundle",
"meta": {
"tag": [
{
"code": "page",
"display": "1"
},
{
"code": "count",
"display": "10"
},
{
"code": "maxCount",
"display": "1"
}
]
},
"type": "collection",
"total": 1,
"entry": [
{
"resource": {
"resourceType": "PaymentReconciliation",
"id": "RS69991",
"contained": [
{
"resourceType": "Organization",
"id": "1",
"identifier": [
{
"system": "https://ref.api.healthcode.co.uk/providerIdentifier",
"value": "P162345"
}
],
"name": "James Hospitals"
},
{
"resourceType": "Organization",
"id": "2",
"identifier": [
{
"system": "https://ref.api.healthcode.co.uk/insurerIdentifier",
"value": "slh"
}
],
"name": "Vitality Health"
}
],
"extension": [
{
"url": "https://clearing.api.healthcode.co.uk/extension/totalInvoices",
"valueInteger": 5
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/isExported",
"valueBoolean": true
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/paymentMethod",
"valueString": "Cheque"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/sortCode",
"valueString": "69991"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/accountNumber",
"valueString": "699913210"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/processedDate",
"valueDate": "2025-01-02"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/amountDue",
"valueMoney": {
"value": 125.46
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/broughtForward",
"valueMoney": {
"value": 0.00
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/carriedForward",
"valueMoney": {
"value": 0.00
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/totalInvoiced",
"valueMoney": {
"value": 2096.73
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/totalShortfall",
"valueMoney": {
"value": 125.46
}
}
],
"created": "2025-02-05T10:00:00+00:00",
"requestor": {
"reference": "#1"
},
"paymentIssuer": {
"reference": "#2"
},
"paymentAmount": {
"value": 1971.27
},
"paymentDate": "2025-01-02T00:00:00+00:00",
"paymentIdentifier": {
"system": "https://clearing.api.healthcode.co.uk/paymentReference",
"value": "PAY169991"
}
}
}
]
}Where,
| Name | Type | Card. | Description | FHIR Field |
|---|---|---|---|---|
| Remittance Summary ID | Id | 1-1 | Remittance Summary ID | PaymentReconciliation.id |
| Provider | Reference (Organization) | 1-1 | Provider identifier and name | PaymentReconciliation.requestor |
| Insurer | Reference (Organization) | 1-1 | Insurer identifier and name | PaymentReconciliation.paymentIssuer |
| Payment Reference | Identifier | 1-1 | The reference of the payment as presented to the bank for a transfer, or the cheque number if the method of payment is cheque | PaymentReconciliation.paymentIdentifier |
| Date Created | DateTime | 1-1 | The date when the remittances was loaded into Healthcode system | PaymentReconciliation.created |
| Payment Date | Date | 1-1 | The date of the payment which for BACS payments represents the date that the payment is actually due to be credited to the recipient’s bank account | PaymentReconciliation.paymentDate |
| Amount Paid | Money | 1-1 | The actual amount credited to the provider’s bank account or forwarded as a cheque | PaymentReconciliation.paymentAmount |
| Payment Method | String | 0-1 | This indicates how the payment is made and the allowed values are Cheque or BACS | PaymentReconciliation.extension.valueString – paymentMethod |
| Sort Code | String | 0-1 | This is provider’s bank sort code and will be included if payment method is BACS | PaymentReconciliation.extension.valueString – sortCode |
| Account Number | String | 0-1 | This is provider’s bank account number and will be included if payment method is BACS | PaymentReconciliation.extension.valueString – accountNumber |
| Processed Date | Date | 1-1 | The processing date when the remittance was created on the insurer’s/payor’s system | PaymentReconciliation.extension.valueDate – processedDate |
| Amount Due | Money | 0-1 | The total due amount | PaymentReconciliation.extension.valueMoney – amountDue |
| Brought Forward | Money | 0-1 | It contains amount due to the provider or outstanding from the provider from the previous payment period | PaymentReconciliation.extension.valueMoney – broughtForward |
| Carried Forward | Money | 0-1 | The net total of the amount brought forward from the previous payment period, plus the amount due to be paid in this payment period less the amount actually being paid | PaymentReconciliation.extension.valueMoney – carriedForward |
| Total Invoiced | Money | 1-1 | Total invoiced | PaymentReconciliation.extension.valueMoney – totalInvoiced |
| Total Shortfall | Money | 0-1 | Total shortfall | PaymentReconciliation.extension.valueMoney – totalShortfall |
| Total Invoices | Integer | 1-1 | Total number of invoices | PaymentReconciliation.extension.valueInteger – totalInvoices |
| Is Exported | Boolean | 1-1 | Indicates weather the remittance was exported or not | PaymentReconciliation.extension.valueBoolean – isExported |
Error handling
| HTTP Code | Error Code | Description |
|---|---|---|
| 400 | MSG_MISSING_MANDATORY_PARAM | Missing mandatory parameter |
| 422 | MSG_PARAM_INVALID | Parameter content is invalid |
| 400 | MSG_PARAM_EMPTY | Parameter is null/empty |
| 422 | MSG_INVALID_FORMAT | Invalid format |
Search Remittance Summary – Advanced
The Search Remittance Summary – Advanced API provides enhanced search capabilities through advanced filtering and sorting options to retrieve remittance summary information.
Endpoint
Must be looked up from the discovery document using search_remittance_summary_advanced_endpoint key.
Request
curl --request POST
--url '{search_remittance_summary_advanced_endpoint}'
--header 'SU-SiteId: HC16190'
--header 'Content-Type: application/x-www-form-urlencoded'
--header 'Authorization: Bearer abCdE12...89mNopq0r'
--data-urlencode 'page=1'
--data-urlencode 'count=10'
--data-urlencode 'insurerIdentifier=slh'
--data-urlencode 'provider=P162345'
--data-urlencode 'invoiceNumber=INV069'
--data-urlencode 'patientName=Nelson'
--data-urlencode 'membershipNumber=REG004'
--data-urlencode 'dateCreated=2025-05-01_2025-05-03'
--data-urlencode 'datePaid=2025-01-01_2025-01-03'
--data-urlencode 'paymentAmount=ge1500.00'
--data-urlencode 'amountInvoiced=ge2000.00'
--data-urlencode 'paymentReference=PAY169991'
--data-urlencode 'hasShortFall=true'
--data-urlencode 'excludeExported=true'
--data-urlencode '_sort=providerName'Where,
| Field | Type | Mandatory/ Optional | Description |
|---|---|---|---|
| insurerIdentifier | String | O | Insurer/Payor identifier. Following are the supported insurers/payors and its identifiers: Bupa = bup Bupa Global = bui AXA Health = ppp Aviva = nuh Vitality Health = slh Cigna International = cin Trust In Health = tih WPA = wpa Patientzone = pzo |
| provider | String | O | Provider’s code or name |
| invoiceNumber | String | O | Invoice number |
| patientName | String | O | Patient name |
| membershipNumber | String | O | Membership number |
| dateCreated | String | O | Date created range |
| datePaid | String | O | Date paid range |
| paymentAmount | String | O | Payment amount of remittance. Supports le (less than or equal to) and ge (greater than or equal) and eq (equal to). |
| amountInvoiced | String | O | Invoiced amount of remittance. Supports le (less than or equal to) and ge (greater than or equal) and eq (equal to). |
| paymentReference | String | O | Insurer payment reference |
| hasShortFall | Boolean | O | Filter remittances which includes shortfall |
| excludeExported | Boolean | O | Filter exported remittances |
| _sort | String | O | Sort results by created date. Use _sort=createdOn to sort results on created date in ascending order, or _sort=-createdOn for descending order |
| _since | String | O | Last updated date time of records |
| page | String | O | Page index to be fetched {1,2,3..} |
| count | String | O | Maximum records in a page |
Response
The API returns a Bundle of PaymentReconciliation resources based on the search filters.
{
"resourceType": "Bundle",
"meta": {
"tag": [
{
"code": "page",
"display": "1"
},
{
"code": "count",
"display": "10"
},
{
"code": "maxCount",
"display": "1"
}
]
},
"type": "collection",
"total": 1,
"entry": [
{
"resource": {
"resourceType": "PaymentReconciliation",
"id": "RS69991",
"contained": [
{
"resourceType": "Organization",
"id": "1",
"identifier": [
{
"system": "https://ref.api.healthcode.co.uk/providerIdentifier",
"value": "P162345"
}
],
"name": "James Hospitals"
},
{
"resourceType": "Organization",
"id": "2",
"identifier": [
{
"system": "https://ref.api.healthcode.co.uk/insurerIdentifier",
"value": "slh"
}
],
"name": "Vitality Health"
}
],
"extension": [
{
"url": "https://clearing.api.healthcode.co.uk/extension/totalInvoices",
"valueInteger": 5
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/isExported",
"valueBoolean": true
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/paymentMethod",
"valueString": "Cheque"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/sortCode",
"valueString": "69991"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/accountNumber",
"valueString": "699913210"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/processedDate",
"valueDate": "2025-01-02"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/amountDue",
"valueMoney": {
"value": 125.46
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/broughtForwarded",
"valueMoney": {
"value": 0
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/carriedForwarded",
"valueMoney": {
"value": 0
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/totalInvoiced",
"valueMoney": {
"value": 2096.73
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/totalShortfall",
"valueMoney": {
"value": 125.46
}
}
],
"created": "2025-02-05T10:00:00+00:00",
"requestor": {
"reference": "#1"
},
"paymentIssuer": {
"reference": "#2"
},
"paymentAmount": {
"value": 1971.27
},
"paymentDate": "2025-01-02T00:00:00+00:00",
"paymentIdentifier": {
"system": "https://clearing.api.healthcode.co.uk/paymentReference",
"value": "PAY169991"
}
}
}
]
}Where,
| Name | Type | Card. | Description | FHIR Field |
|---|---|---|---|---|
| Remittance Summary ID | Id | 1-1 | Remittance Summary ID | PaymentReconciliation.id |
| Provider | Reference (Organization) | 1-1 | Provider identifier and name | PaymentReconciliation.requestor |
| Insurer | Reference (Organization) | 1-1 | Insurer identifier and name | PaymentReconciliation.paymentIssuer |
| Payment Reference | Identifier | 1-1 | The reference of the payment as presented to the bank for a transfer, or the cheque number if the method of payment is cheque | PaymentReconciliation.paymentIdentifier |
| Date Created | DateTime | 1-1 | The date when the remittances was loaded into Healthcode system | PaymentReconciliation.created |
| Payment Date | Date | 1-1 | The date of the payment which for BACS payments represents the date that the payment is actually due to be credited to the recipient’s bank account | PaymentReconciliation.paymentDate |
| Amount Paid | Money | 1-1 | The actual amount credited to the provider’s bank account or forwarded as a cheque | PaymentReconciliation.paymentAmount |
| Payment Method | String | 0-1 | This indicates how the payment is made and the allowed values are Cheque or BACS | PaymentReconciliation.extension.valueString – paymentMethod |
| Sort Code | String | 0-1 | This is provider’s bank sort code and will be included if payment method is BACS | PaymentReconciliation.extension.valueString – sortCode |
| Account Number | String | 0-1 | This is provider’s bank account number and will be included if payment method is BACS | PaymentReconciliation.extension.valueString – accountNumber |
| Processed Date | Date | 1-1 | The processing date when the remittance was created on the insurer’s/payor’s system | PaymentReconciliation.extension.valueDate – processedDate |
| Amount Due | Money | 0-1 | The total due amount | PaymentReconciliation.extension.valueMoney – amountDue |
| Brought Forward | Money | 0-1 | It contains amount due to the provider or outstanding from the provider from the previous payment period | PaymentReconciliation.extension.valueMoney – broughtForward |
| Carried Forward | Money | 0-1 | The net total of the amount brought forward from the previous payment period, plus the amount due to be paid in this payment period less the amount actually being paid | PaymentReconciliation.extension.valueMoney – carriedForward |
| Total Invoiced | Money | 1-1 | Total invoiced | PaymentReconciliation.extension.valueMoney – totalInvoiced |
| Total Shortfall | Money | 0-1 | Total shortfall | PaymentReconciliation.extension.valueMoney – totalShortfall |
| Total Invoices | Integer | 1-1 | Total number of invoices | PaymentReconciliation.extension.valueInteger – totalInvoices |
| Is Exported | Boolean | 1-1 | Indicates weather the remittance was exported or not | PaymentReconciliation.extension.valueBoolean – isExported |
Error handling
| HTTP Code | Error Code | Description |
|---|---|---|
| 400 | MSG_MISSING_MANDATORY_PARAM | Missing mandatory parameter |
| 422 | MSG_PARAM_INVALID | Parameter content is invalid |
| 400 | MSG_PARAM_EMPTY | Parameter is null/empty |
| 422 | MSG_INVALID_FORMAT | Invalid format |
Search Remittance Detail
The Search Remittance Detail API allows retrieval of detailed remittance information such as patient details, invoice details and payment details using basic filter criteria.
Endpoint
Must be looked up from the discovery document using search_remittance_detail_endpoint key.
Request
curl --request POST
--url '{search_remittance_detail_endpoint}/{remittanceSummaryId}'
--header 'SU-SiteId: HC16190'
--header 'Content-Type: application/x-www-form-urlencoded'
--header 'Authorization: Bearer abCdE12...89mNopq0r'
--data-urlencode 'page=1'
--data-urlencode 'count=10'
--data-urlencode '_sort=createdOn'Where,
| Field | Type | Mandatory/ Optional | Description |
|---|---|---|---|
| remittanceSummaryId | String | M | Remittance Summary ID |
| _sort | String | O | Sort results by created date. Use _sort=createdOn to sort results on created date in ascending order, or _sort=-createdOn for descending order |
| _since | String | O | Last updated date time of records |
| page | String | O | Page index to be fetched {1,2,3..} |
| count | String | O | Maximum records in a page |
Response
The API returns a Bundle of ClaimResponse resources based on the search filters.
{
"resourceType": "Bundle",
"meta": {
"tag": [
{
"code": "page",
"display": "1"
},
{
"code": "count",
"display": "10"
},
{
"code": "maxCount",
"display": "1"
}
]
},
"type": "collection",
"total": 1,
"entry": [
{
"resource": {
"resourceType": "ClaimResponse",
"id": "RD69994",
"contained": [
{
"resourceType": "Patient",
"id": "1",
"identifier": [
{
"system": "https://clearing.api.healthcode.co.uk/membershipNumber",
"value": "REG004"
}
],
"name": [
{
"family": "Nick",
"given": [
"Nelson",
"A"
],
"prefix": [
"Mr."
]
}
]
}
],
"extension": [
{
"url": "https://clearing.api.healthcode.co.uk/extension/invoiceNumber",
"valueString": "INV069"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/invoiceDate",
"valueDate": "2024-11-04"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/paidAmount",
"valueMoney": {
"value": 190.00
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/invoiceTotal",
"valueMoney": {
"value": 250.00
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/previousPaidAmount",
"valueMoney": {
"value": 0.00
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/shortAmount",
"valueMoney": {
"value": 60.00
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/collectionService",
"valueString": "None"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/dateCompleted",
"valueDate": "2025-02-10"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/createdOn",
"valueDateTime": "2025-02-01T10:00:00+00:00"
}
],
"identifier": [
{
"system": "https://clearing.api.healthcode.co.uk/insurerBillNumber",
"value": "PC004"
},
{
"system": "https://clearing.api.healthcode.co.uk/hospitalNumber",
"value": "REF004"
},
{
"system": "https://clearing.api.healthcode.co.uk/chClaimNo",
"value": "CH001"
}
],
"patient": {
"reference": "#1"
},
"item": [
{
"adjudication": [
{
"extension": [
{
"url": "https://clearing.api.healthcode.co.uk/extension/liabilityType",
"valueString": "Patient Liability"
}
],
"category": {
"coding": [
{
"system": "https://clearing.api.healthcode.co.uk/adjudication",
"code": "deductible"
}
]
},
"reason": {
"text": "Member Excess"
},
"amount": {
"value": 30.00
}
}
]
},
{
"adjudication": [
{
"extension": [
{
"url": "https://clearing.api.healthcode.co.uk/extension/liabilityType",
"valueString": "Provider Liability"
}
],
"category": {
"coding": [
{
"system": "https://clearing.api.healthcode.co.uk/adjudication",
"code": "deductible"
}
]
},
"reason": {
"text": "Charge Exceeds Agreed Tariff"
},
"amount": {
"value": 30.00
}
}
]
}
]
}
}
]
}Where,
| Name | Type | Card. | Description | FHIR Field |
|---|---|---|---|---|
| Remittance Summary ID | Id | 1-1 | Remittance Summary ID | ClaimResponse.id |
| Membership Number | Identifier | 1-1 | Membership number | ClaimResponse.contained.Patient.identifier |
| Patient Name | HumanName | 0-1 | Patient name | ClaimResponse.contained.Patient.name |
| Invoice Number | String | 1-1 | The provider’s invoice number | ClaimResponse.extension.valueString – invoiceNumber |
| Invoice Date | Date | 1-1 | Invoice date | ClaimResponse.extension.valueDate – invoiceDate |
| Invoice Total | Money | 1-1 | Invoice total | ClaimResponse.extension.valueMoney – invoiceTotal |
| Paid Amount | Money | 1-1 | The amount actually remitted to the provider | ClaimResponse.extension.valueMoney – paidAmount |
| Previous Paid Amount | Money | 0-1 | The amount previously paid | ClaimResponse.extension.valueMoney – previousPaidAmount |
| Short Amount | Money | 0-1 | The short amount indicates the difference between the total value of the claim, any previously paid amount and the amount remitted | ClaimResponse.extension.valueMoney – shortAmount |
| Shortfall Reason | BackboneElement | 0-* | The shortfall liability type, reason and amount details | ClaimResponse.item |
| Collection Service | String | 0-1 | Collection service | ClaimResponse.extension.valueString – collectionService |
| Date Completed | Date | 1-1 | Date completed | ClaimResponse.extension.valueDate – dateCompleted |
| Created On | DateTime | 1-1 | Created on | ClaimResponse.extension.valueDateTime – createdOn |
| Insurer Bill Number | String | 1-1 | Insurer bill number | ClaimResponse.extension.valueString – insurerBillNumber |
| Hospital Number | String | 1-1 | Hospital number | ClaimResponse.extension.valueString – hospitalNumber |
| CH Claim Number | String | 0-1 | The internal reference used at Healthcode to link a particular Remittance to the original Claim | ClaimResponse.extension.valueString – chClaimNo |
Error handling
| HTTP Code | Error Code | Description |
|---|---|---|
| 400 | MSG_PARAM_EMPTY | Parameter is null/empty |
| 422 | MSG_PARAM_INVALID | Parameter content is invalid |
| 400 | MSG_MISSING_MANDATORY_PARAM | Missing mandatory parameter |
| 422 | MSG_INVALID_FORMAT | Invalid format |
Search Remittance Detail – Advanced
The Search Remittance Detail – Advanced API provides enhanced search capabilities through advanced filtering and sorting options to retrieve detailed remittance information such as patient details, invoice details and payment details.
Endpoint
Must be looked up from the discovery document using search_remittance_detail_advanced_endpoint key.
Request
curl --request POST
--url '{search_remittance_detail_advanced_endpoint}/{remittance_summary_id}'
--header 'SU-SiteId: HC16190'
--header 'Content-Type: application/x-www-form-urlencoded'
--data-urlencode 'page=1'
--data-urlencode 'count=10'
--data-urlencode '_sort=invoiceTotal'
--data-urlencode 'invoiceNumber=INV069'
--data-urlencode 'patientName=Nelson'
--data-urlencode 'membershipNumber=REG004'
--data-urlencode 'invoiceDate=2024-11-01_2024-11-05'
--data-urlencode 'hospitalNumber=REF004'
--data-urlencode 'insurerBillNumber=PC004'
--data-urlencode 'invoiceTotal=ge200.00'
--data-urlencode 'hasShortFall=true'
Where,
| Field | Type | Mandatory/ Optional | Description |
|---|---|---|---|
| remittanceSummaryId | String | M | Remittance Summary ID |
| invoiceNumber | String | O | Invoice number |
| patientName | String | O | Patient name |
| membershipNumber | String | O | Membership number |
| invoiceDate | String | O | Invoice date range |
| hospitalNumber | String | O | Hospital number |
| insurerBillNumber | String | O | Insurer bill number |
| invoiceTotal | String | O | Invoice total. Supports le (less than or equal to) and ge (greater than or equal) and eq (equal to). |
| hasShortFall | Boolean | O | Filter remittances which includes shortfall |
| _sort | String | O | Sort results by created date. Use _sort=createdOn to sort results on created date in ascending order, or _sort=-createdOn for descending order |
| _since | String | O | Last updated date time of records |
| page | String | O | Page index to be fetched {1,2,3..} |
| count | String | O | Maximum records in a page |
Response
The API returns a Bundle of ClaimResponse resources based on the search filters.
{
"resourceType": "Bundle",
"meta": {
"tag": [
{
"code": "page",
"display": "1"
},
{
"code": "count",
"display": "10"
},
{
"code": "maxCount",
"display": "1"
}
]
},
"type": "collection",
"total": 1,
"entry": [
{
"resource": {
"resourceType": "ClaimResponse",
"id": "RD69994",
"contained": [
{
"resourceType": "Patient",
"id": "1",
"identifier": [
{
"system": "https://clearing.api.healthcode.co.uk/membershipNumber",
"value": "REG004"
}
],
"name": [
{
"family": "Nick",
"given": [
"Nelson",
"A"
],
"prefix": [
"Mr."
]
}
]
}
],
"extension": [
{
"url": "https://clearing.api.healthcode.co.uk/extension/invoiceNumber",
"valueString": "INV069"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/invoiceDate",
"valueDate": "2024-11-04"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/paidAmount",
"valueMoney": {
"value": 190.00
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/invoiceTotal",
"valueMoney": {
"value": 250.00
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/previousPaidAmount",
"valueMoney": {
"value": 0.00
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/shortAmount",
"valueMoney": {
"value": 60.00
}
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/collectionService",
"valueString": "None"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/dateCompleted",
"valueDate": "2025-02-10"
},
{
"url": "https://clearing.api.healthcode.co.uk/extension/createdOn",
"valueDateTime": "2025-02-01T10:00:00+00:00"
}
],
"identifier": [
{
"system": "https://clearing.api.healthcode.co.uk/insurerBillNumber",
"value": "PC004"
},
{
"system": "https://clearing.api.healthcode.co.uk/hospitalNumber",
"value": "REF004"
},
{
"system": "https://clearing.api.healthcode.co.uk/chClaimNo",
"value": "CH001"
}
],
"patient": {
"reference": "#1"
},
"item": [
{
"adjudication": [
{
"extension": [
{
"url": "https://clearing.api.healthcode.co.uk/extension/liabilityType",
"valueString": "Patient Liability"
}
],
"category": {
"coding": [
{
"system": "https://clearing.api.healthcode.co.uk/adjudication",
"code": "deductible"
}
]
},
"reason": {
"text": "Member Excess"
},
"amount": {
"value": 30.00
}
}
]
},
{
"adjudication": [
{
"extension": [
{
"url": "https://clearing.api.healthcode.co.uk/extension/liabilityType",
"valueString": "Provider Liability"
}
],
"category": {
"coding": [
{
"system": "https://clearing.api.healthcode.co.uk/adjudication",
"code": "deductible"
}
]
},
"reason": {
"text": "Charge Exceeds Agreed Tariff"
},
"amount": {
"value": 30.00
}
}
]
}
]
}
}
]
}Where,
| Name | Type | Card. | Description | FHIR Field |
|---|---|---|---|---|
| Remittance Summary ID | Id | 1-1 | Remittance Summary ID | ClaimResponse.id |
| Membership Number | Identifier | 1-1 | Membership number | ClaimResponse.contained.Patient.identifier |
| Patient Name | HumanName | 0-1 | Patient name | ClaimResponse.contained.Patient.name |
| Invoice Number | String | 1-1 | The provider’s invoice number | ClaimResponse.extension.valueString – invoiceNumber |
| Invoice Date | Date | 1-1 | Invoice date | ClaimResponse.extension.valueDate – invoiceDate |
| Invoice Total | Money | 1-1 | Invoice total | ClaimResponse.extension.valueMoney – invoiceTotal |
| Paid Amount | Money | 1-1 | The amount actually remitted to the provider | ClaimResponse.extension.valueMoney – paidAmount |
| Previous Paid Amount | Money | 0-1 | The amount previously paid | ClaimResponse.extension.valueMoney – previousPaidAmount |
| Short Amount | Money | 0-1 | The short amount indicates the difference between the total value of the claim, any previously paid amount and the amount remitted | ClaimResponse.extension.valueMoney – shortAmount |
| Shortfall Reason | BackboneElement | 0-* | The shortfall liability type, reason and amount details | ClaimResponse.item |
| Collection Service | String | 0-1 | Collection service | ClaimResponse.extension.valueString – collectionService |
| Date Completed | Date | 1-1 | Date completed | ClaimResponse.extension.valueDate – dateCompleted |
| Created On | DateTime | 1-1 | Created on | ClaimResponse.extension.valueDateTime – createdOn |
| Insurer Bill Number | String | 1-1 | Insurer bill number | ClaimResponse.extension.valueString – insurerBillNumber |
| Hospital Number | String | 1-1 | Hospital number | ClaimResponse.extension.valueString – hospitalNumber |
| CH Claim Number | String | 0-1 | The internal reference used at Healthcode to link a particular Remittance to the original Claim | ClaimResponse.extension.valueString – chClaimNo |
Error handling
| HTTP Code | Error Code | Description |
|---|---|---|
| 400 | MSG_PARAM_EMPTY | Parameter is null/empty |
| 422 | MSG_PARAM_INVALID | Parameter content is invalid |
| 400 | MSG_MISSING_MANDATORY_PARAM | Missing mandatory parameter |
| 422 | MSG_INVALID_FORMAT | Invalid format |