CareRequest

Represents the general details of a care-related request including member information, admission date, decision reason, and so on. A single request can contain multiple diagnoses, services, or drugs. Care requests include preauthorizations for drugs and services, admission notifications, concurrent review of admissions, appeals, complaints, and grievances.

Supported Calls

create(), delete(), describeLayout(), describeSObjects(), getDeleted(), getUpdated(), query(), retrieve(), search(), undelete(), update(), upsert()

Fields

Field Name Details
AcknowledgementLetterSentDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date and time when an acknowledgment letter was sent to the requester.
ActualAdmissionDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Actual admission date for the patient.
ActualDischargeDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Actual discharge date for the patient.
AdmissionNotes
Type
textarea
Properties
Create, Nillable, Update
Description
Notes related to the admission.
AdmissionSource
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Where the patient was admitted from, for example, a clinic or an emergency room.
AdmissionType
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description

Type of admission, for example, emergency or elective.

AorReceivedDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description

Date and time when the Appointment of Representative (AOR) form was received.

AorRequestedDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description

Date and time when the AOR form was requested.

AppealRequestReasonType
Type
picklist
Properties
Create, Filter, Group, Nillable, Restricted picklist, Sort, Update
Description
The type of reason associated with the appeal request.
Possible values are:
  • Service Request Rejected
  • Service Claim Unpaid
  • Rejected - Service Not Required
  • Rejected - No Coverage Benefit
  • Notification Delayed
  • Specialist Referral Rejected
AppointedRepresentativeId
Type
reference
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
ID of the appointed representative for the member.
This is a relationship field.
Relationship Name
AppointedRepresentative
Relationship Type
Lookup
Refers To
Account
AppointedRepVerbalContactDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date and time of verbal contact with the member's appointed representative.
AppointedRepWrittenContactDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date and time correspondence was sent to the member's appointed representative.
ApprovedLengthOfStay
Type
int
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Approved number of days for the admission.
ApprovedLevelOfCare
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Approved level of care for the patient, for example, Hospital-Observaton or SNF-Rehabilitation.
CareRequestCaseId
Type
reference
Properties
Create, Filter, Group, Sort
Description
Case related to the care request.

A case record can only be related to a single care request record. Therefore, ensure that the Case record you specify in this field isn’t already associated with another care request.

Note

This is a relationship field.
Relationship Name
CareRequestCase
Relationship Type
Lookup
Refers To
Case
ClaimNumber
Type
string
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Claim number for the medical service or medication, if one exists.
ClinicalCaseType
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Clinical case type for the patient, for example, High Risk Fall or Adult Diabetes.
CriteriaMet
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description

Indicates whether criteria for care was met.

CumulativeLengthOfStay
Type
int
Properties
Create, Filter, Group, Nillable, Sort, Update
Description

Total number of days for the admission.

CurrentLevelOfCare
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description

Level of care that the patient is receiving.

DecisionDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date by which the decision must be made for the request.
DecisionDaysRemaining
Type
int
Properties
Filter, Group, Nillable, Sort
Description
Number of days remaining for a decision or resolution.
DecisionLetter
Type
textarea
Properties
Create, Nillable, Update
Description
The text of the determination letter sent to the member and provider.
DecisionNotes
Type
textarea
Properties
Create, Nillable, Update
Description

Notes related to the decision.

DecisionReason
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description

Reason for the decision.

DecisionReasonDescription
Type
textarea
Properties
Create, Nillable, Update
Description

Text describing the reason for the decision.

DeniedLengthOfStay
Type
int
Properties
Create, Filter, Group, Nillable, Sort, Update
Description

Number of days denied for the admission.

DeniedLevelOfCare
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description

Level of care denied for the patient.

DispositionNotes
Type
textarea
Properties
Create, Nillable, Update
Description

Notes related to the disposition of the request.

DueDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date the request is due for completion.
EffectiveFrom
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
The start date for an effective-date range.
EffectiveTo
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
The end date for an effective-date range.
ExpirationDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Expiration date for the request.
ExtensionRequestReceivedDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date and time an extension was requested.
ExternalComplaintIdentifier
Type
string
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Complaint ID number.
FacilityRecordNumber
Type
string
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
The medical record number used to identify a patient.
FacilityRoomBedType
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Type of facility bed for the patient.
FacilityRoomNumber
Type
string
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
The facility room number for the patient.
FinalLevelOfCare
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Final level of care the patient.
FirstReviewerId
Type
reference
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
The name of the person who reviewed the request.
This is a relationship field.
Relationship Name
FirstReviewer
Relationship Type
Lookup
Refers To
User
FirstReviewerNotes
Type
textarea
Properties
Create, Nillable, Update
Description
Notes from the first reviewer related to the case.
GeneralPractitionerId
Type
reference
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Member's primary or general care practitioner.
This is a relationship field.
Relationship Name
GeneralPractitioner
Relationship Type
Lookup
Refers To
Contact
GeneralPractitionerVerbalNotifiedDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date when the primary care practitioner was verbally notified of the decision
GeneralPractitionerWrittenNotifiedDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date when the primary care practitioner was notified of the decision by written correspondence.
GrievanceType
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Specifies the type of grievance.
InfoReceivedDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date and time when additional information was received from the provider or member.
InfoRequestedDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date and time when additional information was requested from the provider or member.
InitialDenialNotificationDate
Type
date
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Date of initial denial notification.
InitialDenialNotificationTime
Type
time
Properties
Create, Filter, Nillable, Sort, Update
Description
The time when the initial care request was denied.
IsExtendedRequest
Type
boolean
Properties
Create, Defaulted on create, Filter, Group, Sort, Update
Description
Indicates whether a request was extended.
IsReadmission
Type
boolean
Properties
Create, Defaulted on create, Filter, Group, Sort, Update
Description
Indicates whether the care request is for a readmission.
The default value is 'false'.
IsServiceOrMedicationReceived
Type
boolean
Properties
Create, Defaulted on create, Filter, Group, Sort, Update
Description
Indicates whether the member has already received the medial service or medication.
LastReferencedDate
Type
dateTime
Properties
Filter, Nillable, Sort
Description
The timestamp for when the current user last viewed a record related to this record.
LastViewedDate
Type
dateTime
Properties
Filter, Nillable, Sort
Description
The timestamp for when the current user last viewed this record. If this value is null, it’s possible that this record was referenced (LastReferencedDate) and not viewed.
MedicalDirectorId
Type
reference
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Name of the medical director who reviewed the request.
This is a relationship field.
Relationship Name
MedicalDirector
Relationship Type
Lookup
Refers To
User
MedicalDirectorNotes
Type
textarea
Properties
Create, Nillable, Update
Description
Notes from the medical director related to the request.
MemberCondition
Type
textarea
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Free-form description of the member's condition.
MemberContactDateTime
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date and time when the member was contacted.
MemberDateOfBirth
Type
date
Properties
Create, Filter, Group, Nillable, Sort, Update
Description

Date of birth of the member.

MemberFirstName
Type
string
Properties
Create, Filter, Group, Nillable, Sort, Update
Description

First name of the member.

MemberGender
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Gender of the member.
MemberGroupNumber
Type
string
Properties
Create, Filter, Group, Nillable, Sort, Update
Description

Insurance group number for the member.

MemberId
Type
reference
Properties
Create, Filter, Group, Nillable, Sort, Update
Description

Insurance identifier for the member.

This is a relationship field.
Relationship Name
Member
Relationship Type
Lookup
Refers To
Account
MemberIdentificationNumber
Type
string
Properties
Create, Filter, Group, Nillable, Sort, Update
Description

Insurance identification number for the member.

MemberLastName
Type
string
Properties
Create, Filter, Group, Nillable, Sort, Update
Description

Last name of the member.

MemberPrimaryPlanId
Type
reference
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
The primary insurance plan of a member associated with the care request when the member is insured under multiple plans.
This is a relationship field.
Relationship Name
MemberPrimaryPlan
Relationship Type
Lookup
Refers To
MemberPlan
MemberPrognosis
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Indicator of the provider's prognosis for the member.
MemberSecondaryPlanId
Type
reference
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
The secondary insurance plan of a member associated with the care request when the member is insured under multiple plans.
This is a relationship field.
Relationship Name
MemberSecondaryPlan
Relationship Type
Lookup
Refers To
MemberPlan
MemberStatus
Type
textarea
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
The member's status at admission, date of outpatient service, or start of care.
MemberVerbalNotificationDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date when the member was verbally notified of the decision.
MemberWrittenNotificationDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date when the member was notified of the decision by written correspondence.
ModificationDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date the case was modified.
ModifiedLengthOfStay
Type
int
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Modified number of days for the admission.
ModifiedLevelOfCare
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Modified level of care for the patient.
Name
Type
string
Properties
Create, Filter, Group, idLookup, Sort, Update
Description

Name of the care request.

NextReviewDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date the next review is scheduled for completion.
OriginalDenialMedicalDirectorId
Type
reference
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
The name of the medical director who denied the original request.
This is a relationship field.
Relationship Name
OriginalDenialMedicalDirector
Relationship Type
Lookup
Refers To
User
ParProvider
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Indicator of whether this provider has entered into an agreement with the insurance carrier.
PlaceOfService
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Place of service for the member's care such as an inpatient hospital or an ambulatory surgery center.
PractitionerContactDateTime
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date and time when the provider was contacted.
QuantityType
Type
picklist
Properties
Create, Filter, Nillable, Sort, Update
Description
Quantity type for the request such as days, units, or visits.
ReceivedDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date the request was received.
ReconsiderationDenialNotificationDate
Type
date
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
The date when the reconsidered care request was denied.
ReconsiderationDenialNotificationTime
Type
time
Properties
Create, Filter, Nillable, Sort, Update
Description
The time when the reconsidered care request was denied.
ReferenceCareRequestCaseId
Type
reference
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
The reference care request case number associated with the care request.
This is a relationship field.
Relationship Name
ReferenceCareRequestCase
Relationship Type
Lookup
Refers To
Case
ReferenceCaseNumber
Type
string
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Reference authorization number for an appeal, complaint, or grievance.
ReopenedDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date the request was reopened.
ReopenReason
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Reason the request was reopened.
The possible values are:
  • Administrative Error
  • Original Decision Overturned
ReopenReasonDescription
Type
textarea
Properties
Create, Nillable, Update
Description
Description of why the request was reopened.
RequestedDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date the request was originally requested.
RequestedLengthOfStay
Type
int
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Requested number of days for the admission.
RequestedLevelOfCare
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Requested level of care for the patient.
RequesterType
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Indicates the role of the individual initiating the request.
RequestingPractitionerId
Type
reference
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Ordering or referring practitioner for the request.
This is a relationship field.
Relationship Name
RequestingPractitioner
Relationship Type
Lookup
Refers To
Contact
RequestingPractitionerLicense
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
License type of the practitioner.
RequestingPractitionerSpecialty
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Specialty of the practitioner, for example, Family Practice or General Surgery.
RequestingPractitionerVerbalNotifiedDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date when the practitioner was verbally notified of the decision.
RequestingPractitionerWrittenNotifiedDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date when the practitioner was notified of the decision by written correspondence.
ResolutionDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date when the complaint, appeal, or grievance was resolved.
ResolutionLetterSentDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date and time when a resolution letter was sent to the requester.
ResolutionNotes
Type
textarea
Properties
Create, Nillable, Update
Description
Resolution notes for the request.
ReviewDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Date the review was completed.
RootCauseNotes
Type
textarea
Properties
Create, Nillable, Update
Description
Field for notes related to the root cause for the request.
ScheduledAdmissionDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Anticipated admission date for the patient.
ScheduledDischargeDate
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Scheduled discharge date for the patient.
ServiceDate
Type
date
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Date when patient received the service.
ServicingFacilityId
Type
reference
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Facility where the service is being provided.
This is a relationship field.
Relationship Name
ServicingFacility
Relationship Type
Lookup
Refers To
Account
ServicingPractitionerId
Type
reference
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Practitioner administering the service.
This is a relationship field.
Relationship Name
ServicingPractitioner
Relationship Type
Lookup
Refers To
Contact
ServicingPractitionerLicense
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
License type of the practitioner.
ServicingPractitionerSpecialty
Type
picklist
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
Specialty of the practitioner.
SourceSystem
Type
string
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
System from which this request was sourced.
SourceSystemIdentifier
Type
string
Properties
Create, Filter, Group, Nillable, Sort, Update
Description
ID of the system from which the request was sourced.
SourceSystemModified
Type
dateTime
Properties
Create, Filter, Nillable, Sort, Update
Description
Timestamp of the most recent update from the source system.

Associated Objects

This object has the following associated objects. If the API version isn’t specified, they’re available in the same API versions as this object. Otherwise, they’re available in the specified API version and later.

CareRequestChangeEvent (API version 59.0)
Change events are available for the object.
CareRequestFeed
Feed tracking is available for the object.
CareRequestHistory
History is available for tracked fields of the object.