Contains summary information about the claim, such as the payment amount, specified medications, and billing data.
Supported Calls
create(), delete(), describeLayout(), describeSObjects(), query(), retrieve(), search(), update(), upsert()
Fields
AcceptedOn__c
- Type: date
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Date on which the claim was accepted.
AdjudicatedAmount__c
- Type: currency
- Properties: Create, Filter, Nillable, Sort, Update
- Description: Amount paid for the service by primary payer.
AdjudicatedOn__c
- Type: date
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Date on which adjudication amount was paid by the primary payer.
BilledDRGCode__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Diagnosis-related group (DRG) code used for billing.
ClaimAmount__c
- Type: Currency
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Amount submitted with the original claim.
ClaimNumber__c
- Type: Text(64)
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Number assigned to the claim.
ClaimStatusId__c
- Type: Reference
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Current status of the claim.
DisplayUrl
- Type: url
- Properties: Create, Filter, Nillable, Sort, Update
- Description:
ExternalId
- Type: string
- Properties: Create, Defaulted on create, Filter, Nillable, Sort, Update
- Description:
DrugName__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Name of the drug.
DrugQuantity__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Authorized quantity per refill.
DrugSupplyDays__c
- Type: double
- Properties: Create, Filter, Nillable, Sort, Update
- Description: Number of days the supply is authorized for.
EDIMessage__c
- Type: textarea
- Properties: Create, Filter, Nillable, Sort, Update
- Description: Unparsed, unfiltered, raw EDI message.
FillDate__c
- Type: date
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Date on which the drug was filled by the pharmacy.
FormularyTier__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: The formulary tier level for the drug.
HIC3ClassCode__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Hierarchical Specific Therapeutic (HIC3) class code assigned to the service.
IsFormularyStatus__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Indicates whether the drug is approved for coverage.
IsGeneric__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Indicates whether the drug is generic.
IsRefillAuthorized__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Indicates whether refills for the drug are authorized.
MemberPlanId__c
- Type: reference
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: ID of member plan that this claim is related to.
Name__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Name of the claim record.
NDC__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: National Drug Code (NDC) identification number.
PartBorPartD__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Indicates whether the drug has Medicare Part B or Part D coverage.
PayerId__c
- Type: reference
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: ID of the payer that this claim is related to.
PaymentDate__c
- Type: date
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Date on which claim was paid out.
PreauthNumber__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Preauthorization number for the service.
ReferralNumber__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: ID of the referral for the service.
SourceSystem__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Name of the system where this claim originated.
SourceSystemIdentifier__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: ID of the system where this claim was sourced from.
SourceSystemModified__c
- Type: dateTime
- Properties: Create, Filter, Nillable, Sort, Update
- Description: Timestamp of the most recent update from the source system.
StandardGenericTherapeuticClass__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Therapeutic drug category according to the American Hospital Formulary Service (AHFS) classification system.
StandardTherapeuticClassDescription__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Description of the therapeutic category of drug according to the American Hospital Formulary Service (AHFS) classification system.
SubmittedOn__c
- Type: date
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Claim submission date.
Type__c
- Type: string
- Properties: Create, Filter, Group, Nillable, Sort, Update
- Description: Type of claim.
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