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Claim

A request from an Individual to be reimbursed from a Benefit for an expense they paid. Amounts describe the expense and the eligible portion of it; they are not a record of payments.

Errors returned by claim operations carry one of these codes:

  • NOT_FOUND: the claim, Individual, Benefit, or document group does not exist or belongs to another partner.
  • FEATURE_NOT_ENABLED: claims, or the requested operation, are not enabled for this partner.
  • FORBIDDEN: the credential is not permitted to perform the operation.
  • INVALID_CLAIM_STATUS: the claim's current status does not allow the operation.
  • LINKED_BANK_ACCOUNT_REQUIRED: the Individual has no verified primary linked bank account that is ready to use; an account that must be relinked does not qualify.
  • BAD_REQUEST: the input is not valid, or a claim rule rejected it, such as a date outside the Benefit's claim period. The message describes the problem.
  • INTERNAL_SERVER_ERROR: an unexpected error occurred.
type Claim {
  amount: Money
  approvedAmount: Money
  benefitId: ID!
  claimantId: ID
  denial: ClaimDenial
  documentGroupId: ID
  id: ID!
  individualId: ID!
  informationRequest: ClaimInformationRequest
  merchant: ClaimMerchant
  organizationId: ID!
  provider: ClaimProvider
  serviceEndDate: LocalDate
  serviceStartDate: LocalDate
  status: ClaimStatus!
  statusUpdatedAt: DateTime
  submittedAt: DateTime!
  transactionDate: LocalDate!
}

Fields​

Claim.amount ● Money object​

The amount of the expense. Null, with an error for this field, when a stored amount includes a fraction of a cent.

Claim.approvedAmount ● Money object​

The portion of the expense approved as eligible. Null until the claim is approved. It can be less than amount after a partial approval, and the reimbursement can be less than it when the Benefit reimburses a percentage or applies a deductible.

Claim.benefitId ● ID! non-null scalar​

The Benefit the claim is reimbursed from.

Claim.claimantId ● ID scalar​

The Individual who received the service: the account holder or one of their dependents. Null for some claims submitted before claimants were recorded.

Claim.denial ● ClaimDenial object​

Why the claim was denied. On an approved claim, why the portion of the expense above approvedAmount was denied. Null when nothing was denied.

Claim.documentGroupId ● ID scalar​

The document group that holds the claim's documents. Null when the claim has no documents.

Claim.id ● ID! non-null scalar​

The ID of the claim, used for all operations on the claim.

Claim.individualId ● ID! non-null scalar​

The Individual (account holder) who is reimbursed for the claim.

Claim.informationRequest ● ClaimInformationRequest object​

The most recent request for more information about the claim. Null when none was made.

Claim.merchant ● ClaimMerchant object​

The merchant for the expense. Null when the claim has a care provider instead.

Claim.organizationId ● ID! non-null scalar​

The Organization of the Individual's enrollment. For a member of a division, this is the division's Organization.

Claim.provider ● ClaimProvider object​

The care provider for the expense, such as a daycare. Null when the claim has a merchant instead.

Claim.serviceEndDate ● LocalDate scalar​

The last date of the service, when recorded.

Claim.serviceStartDate ● LocalDate scalar​

The first date of the service, when recorded.

Claim.status ● ClaimStatus! non-null enum​

The current status of the claim.

Claim.statusUpdatedAt ● DateTime scalar​

When the claim's status last changed to a status other than IN_REVIEW. Null when that has not happened since submission.

Claim.submittedAt ● DateTime! non-null scalar​

When the claim was submitted.

Claim.transactionDate ● LocalDate! non-null scalar​

The date the expense was paid.

Member Of​

ApproveClaimResult object ● ClaimsResults object ● DenyClaimResult object ● RequestClaimInformationResult object ● ResubmitClaimResult object ● SubmitClaimResult object ● UpdateClaimResult object

Implemented By​

ClaimResponse union