Care Request Input

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 or drugs. Care requests include prior authorizations for drugs and services, admission notifications, concurrent review of admissions, appeals, complaints, and grievances.

Root XML tag

<careRequest>

JSON example

1{
2		"requestingPractitionerSpecialty": "Neurologist",
3		"placeOfService": "InPatient",
4		"sourceSystemIdentifier": "0015",
5		"name": "Care Request 15",
6		"requestingPractitionerLicense": "M.D",
7		"sourceSystem": "source_system_name",
8		"servicingPractitionerLicense": "M.D",
9		"servicingPractitionerSpecialty": "Hospitalist",
10		"recordType": "Complaint"
11		}

Properties

Name	Type	Description	Required	Available Version
`acknowledgementLetterSentDate`	String	Date and time when an acknowledgment letter was sent to the requester. Maps to: `CareRequest.AcknowledgementLetterSentDate`	No	46.0
`actualAdmissionDate`	String	Actual admission date for the patient. Maps to: `CareRequest.ActualAdmissionDate`	No	46.0
`actualDischargeDate`	String	Actual discharge date for the patient. Maps to: `CareRequest.ActualDischargeDate`	No	46.0
`admissionNotes`	String	Notes related to the admission. Maps to: `CareRequest.AdmissionNotes`	No	46.0
`admissionSource`	String	Where the patient was admitted from, for example, a clinic or an emergency room. Maps to: `CareRequest.AdmissionSource`	No	46.0
`admissionType`	String	Type of admission, for example, emergency or elective. Maps to: `CareRequest.AdmissionType`	No	46.0
`ambulanceTransportDistance`	Integer	Ambulance Transport Distance	No	46.0
`ambulanceTransportReason`	String	Reason for ambulance transport. Maps to: `CareRequestExtention.AmbulanceTransportReason`	No	46.0
`ambulanceTransportType`	String	Type of ambulance transport. Maps to: `CareRequestExtention.AmbulanceTransportType`	No	46.0
`aorReceivedDate`	String	Date and time when the Appointment of Representative (AOR) form was received. Maps to: `CareRequest.AorReceivedDate`	No	46.0
`aorRequestedDate`	String	Date and time when the AOR form was requested. Maps to: `CareRequest.AorRequestedDate`	No	46.0
`appealEffectuationDateTime`	String	The effective date of the outcome of the appeal request. For example, if a claim was successfully appealed, this field displays the date when the claim was paid. Maps to: `CareRequestExtension.AppealEffectuationDateTime`	No	52.0
`appealRequestReasonType`	String	Specifies the reason for raising the appeal request. Maps to: `CareRequest.AppealRequestReasonType`	No	52.0
`appointedRepVerbalContactDate`	String	Date and time of verbal contact with the member’s appointed representative. Maps to: `CareRequest.AppointedRepVerbalContactDate`	No	46.0
`appointedRepWrittenContactDate`	String	Date and time correspondence was sent to the member’s appointed representative. Maps to: `CareRequest.AppointedRepWrittenContactDate`	No	46.0
`appointedRepresentative`	Appointed Representative Input	Appointed representative for the member. If provided, the first name, last name, birthdate, and suffix fields are used to find at a unique Id, which is used to update `CareRequest.AppointedRepresentativeId` field.	No	46.0
`approvedLengthOfStay`	Integer	Approved number of days for the admission. Maps to: `CareRequest.ApprovedLengthOfStay`	No	46.0
`approvedLevelOfCare`	String	Approved level of care for the patient, for example, Hospital-Observaton or SNF-Rehabilitation. Screen reader support enabled. Maps to: `CareRequest.ApprovedLevelOfCare`	No	46.0
`authorizationRefIdentifier`	String	The unique identifier of the authorization request. Maps to: `CareRequestExtension.AuthorizationRefIdentifier`	No	57.0
`careRequestReviewers`	Care Request Reviewer Input	The care request associated with the care request reviewer. Maps to: `CareRequest.CareRequestReviewers`	No	52.0
`caseSubStatus`	String	Sub status of care request in each stage of care request. Maps to: `CareRequest.CaseSubStatus`	No	57.0
`claimNumber`	String	Claim number for the medical service or medication, if one exists. Maps to: `CareRequest.ClaimNumber`	No	46.0
`clientSourceSysIdentifier`	String	An identifier of the client’s source system that sent the care request. This is unavailable for PATCH requests.	No	63.0
`clinicalCaseType`	String	Clinical case type for the patient, for example, High Risk Fall or Adult Diabetes. Maps to: `CareRequest.ClinicalCaseType`	No	46.0
`criteriaMet`	String	Indicates whether criteria for care was met. Maps to: `CareRequest.CriteriaMet`	No	46.0
`cumulativeLengthOfStay`	Integer	Total number of days for the admission. Maps to: `CareRequest.CumulativeLengthOfStay`	No	46.0
`currentLevelOfCare`	String	Level of care that the patient is receiving. Maps to: `CareRequest.CurrentLevelOfCare`	No	46.0
`decisionDate`	String	Date by which the decision must be made for the request. Maps to: `CareRequest.DecisionDate`	No	46.0
`decisionLetter`	String	The text of the determination letter sent to the member and provider. Maps to: `CareRequest.DecisionLetter`	No	46.0
`decisionNotes`	String	Notes related to the decision. Maps to: `CareRequest.DecisionNotes`	No	46.0
`decisionReason`	String	Reason for the decision. Maps to: `CareRequest.DecisionReason`	No	46.0
`decisionReasonDescription`	String	Text describing the reason for the decision. Maps to: `CareRequest.DecisionReasonDescription`	No	46.0
`deniedLengthOfStay`	Integer	Number of days denied for the admission. Maps to: `CareRequest.DeniedLengthOfStay`	No	46.0
`deniedLevelOfCare`	String	Level of care denied for the patient. Maps to: `CareRequest.DeniedLevelOfCare`	No	46.0
`dispositionNotes`	String	Notes related to the disposition of the request. Maps to: `CareRequest.DispositionNotes`	No	46.0
`documentAttachmentStatus`	String	The current status of the document upload based on the checklist provided to the reviewers. Maps to: `CareRequestExtention.DocumentAttachmentStatus` Valid values are: `Complete` `Incomplete`	No	55.0
`dueDate`	String	Date the request is due for completion. Maps to: `CareRequest.DueDate`	No	46.0
`effectiveFrom`	String	The start date for an effective-date range. Maps to: `CareRequest.EffectiveFrom`	No	46.0
`effectiveTo`	String	The end date for an effective-date range. Maps to: `CareRequest.EffectiveTo`	No	46.0
`expirationDate`	String	Expiration date for the request. Maps to: `CareRequest.ExpirationDate`	No	46.0
`extendedRequest`	Boolean	Indicates whether a request was extended. Maps to: `CareRequest.IsExtendedRequest`	No	46.0
`extensionRequestReceivedDate`	String	Date and time an extension was requested. Maps to: `CareRequest.ExtensionRequestReceivedDate`	No	46.0
`externalComplaintId`	String	Complaint ID number. Maps to: `CareRequest.ExternalComplaintIdentifier`	No	46.0
`facilityRecordNumber`	String	The medical record number used to identify a patient. Maps to: `CareRequest.FacilityRecordNumber`	No	46.0
`facilityRoomBedType`	String	Type of facility bed for the patient. Maps to: `CareRequest.FacilityRoomBedType`	No	46.0
`facilityRoomNumber`	String	The facility room number for the patient. Maps to: `CareRequest.FacilityRoomNumber`	No	46.0
`finalLevelOfCare`	String	Final level of care the patient. Maps to: `CareRequest.FinalLevelOfCare`	No	46.0
`firstReviewer`	First Reviewer Input	The person who reviewed the request.	No	46.0
`firstReviewerNotes`	String	Notes from the first reviewer related to the case. Maps to: `CareRequest.FirstReviewerNotes`	No	46.0
`generalPractitioner`	General Practitioner Input	Member’s primary or general care practitioner. Maps to `CareRequest.generalPractitioner`	No	46.0
`generalPractitionerVerbalNotificationDate`	String	Date when the primary care practitioner was verbally notified of the decision. Maps to: `CareRequest.GeneralPractitionerVerbalNotifiedDate`	No	46.0
`generalPractitionerWrittenNotificationDate`	String	Date when the primary care practitioner was notified of the decision by written correspondence. Maps to: `CareRequest.GeneralPractitionerWrittenNotifiedDate`	No	46.0
`grievanceType`	String	Specifies the type of grievance. Maps to: `CareRequest.GrievanceType`	No	52.0
`healthCareProvider`	String	The healthcare provider associated with the care request against whom the Grievance is filed. Maps to`CareRequestExtension.HealthCareProvider`	No	52.0
`homeHealthCertificationEndDate`	String	Certification end date for home health care. Maps to: `CareRequestExtension.HomeHealthCertificationEndDate`	No	46.0
`homeHealthCertificationStartDate`	String	Certification start date for home health care. Maps to: `CareRequestExtension.HomeHealthCertificationStartDate`	No	46.0
`homeHealthStartDate`	String	Date that home health services are scheduled or anticipated to start. Maps to: `CareRequestExtension.HomeHealthStartDate`	No	46.0
`id`	String	ID of the Care Request.	Required for PATCH.	46.0
`independentReviewDetermination`	String	The determination made by the independent review. Maps to: `CareRequestExtension.IndependentReviewDetermination`	No	52.0
`independentReviewDeterminationDate`	String	The date when the determination was made by the independent review. Maps to: `CareRequestExtension.IndependentReviewDeterminationDate`	No	52.0
`independentReviewSubmissionDate`	String	The date when the review request was submitted for independent review. Maps to: `CareRequestExtension.IndependentReviewSubmissionDate`	No	52.0
`infoReceievedDate`	String	Date and time when additional information was received from the provider or member. Maps to: `CareRequest.InfoReceivedDate`	No	46.0
`infoRequestedDate`	String	Date and time when additional information was requested from the provider or member. Maps to: `CareRequest.InfoRequestedDate`	No	46.0
`initialDenialNotificationDate`	String	Date of initial denial notification. Maps to: `CareRequest.InitialDenialNotificationDate`	No	46.0
`initialDenialNotificationTime`	String	The time when the initial care request was denied. Maps to `CareRequest.InitialDenialNotificationTime`	No	52.0
`isIndependentReviewRequired`	Boolean	Indicates whether independent review is required. Maps to `CareRequestExtension.IsIndependentReviewRequired`	No	52.0
`isReadmission`	Boolean	Indicates whether the care request is for a readmission. Maps to `CareRequest.IsReadmission`	No	52.0
`medicalDirector`	Medical Director Input	The medical director who reviewed the request.	No	46.0
`medicalDirectorNotes`	String	Notes from the medical director related to the request. Maps to: `CareRequest.MedicalDirectorNotes`	No	46.0
`memberContactDate`	String	Date and time when the member was contacted. Maps to: `CareRequest.MemberContactDateTime`	No	46.0
`memberGroupNumber`	String	Insurance group number for the member. Maps to: `CareRequest.MemberGroupNumber`	No	46.0
`memberPrimaryPlan`	String	The primary insurance plan of a member associated with the care request when the member is insured under multiple plans. Maps to: `CareRequest.MemberPrimaryPlan`	No	52.0
`memberSecondaryPlan`	String	The secondary insurance plan of a member associated with the care request when the member is insured under multiple plans. Maps to: `CareRequest.MemberSecondaryPlan`	No	52.0
`memberVerbalNotificationDate`	String	Date when the member was verbally notified of the decision. Maps to: `CareRequest.MemberVerbalNotificationDate`	No	46.0
`memberWrittenNotificationDate`	String	Date when the member was notified of the decision by written correspondence. Maps to: `CareRequest.MemberWrittenNotificationDate`	No	46.0
`modificationDate`	String	Date the case was modified. Maps to: `CareRequest.ModificationDate`	No	46.0
`modifiedLengthOfStay`	Integer	Modified number of days for the admission. Maps to: `CareRequest.ModifiedLengthOfStay`	No	46.0
`modifiedLevelOfCare`	String	Modified level of care for the patient. Maps to: `CareRequest.ModifiedLevelOfCare`	No	46.0
`name`	String	Name of the Care Request. Maps to: `CareRequest.Name`	Yes	46.0
`nextReviewDate`	String	Date the next review is scheduled for completion. Maps to: `CareRequest.NextReviewDate`	No	46.0
`nursingHomeResidentialStatus`	String	Nursing home-resident status at the time of service. Maps to: `CareRequestExtension.NursingHomeResidentialStatus`	No	46.0
`originalDenialMedicalDirector`	Original Denial Medical Director Input	The medical director who denied the original request.	No	46.0
`parProvider`	String	Indicator of whether this provider has entered into an agreement with the insurance carrier. Maps to: `CareRequest.ParProvider`	No	46.0
`placeOfService`	String	Place of service for the member’s care such as an inpatient hospital or an ambulatory surgery center. Maps to: `CareRequest.PlaceOfService`	No	46.0
`practitionerContactDate`	String	Date and time when the provider was contacted. Maps to: `CareRequest.PractitionerContactDateTime`	No	46.0
`priorDischargeStatus`	String	Specifies the previous discharge status of the member. Maps to: `CareRequestExtension.PriorDischargeStatus`	No	52.0
`quantity`	Integer	Quantity of the request.	No	46.0
`quantityType`	String	Quantity type for the request such as days, units, or visits. Maps to: `CareRequest.QuantityType`	No	46.0
`receivedDate`	String	Date the request was received. Maps to: `CareRequest.ReceivedDate`	No	46.0
`reconsiderationDenialNotificationDate`	String	Date of reconsideration denial notification. Maps to: `CareRequest.ReconsiderationDenialNotificationDate`	No	46.0
`reconsiderationDenialNotificationTime`	String	The time of reconsideration denial notification. Maps to: `CareRequest.ReconsiderationDenialNotificationTime`	No	52.0
`recordType`	String	Record type of the care request object.	No	46.0
`recordTypeId`	String	ID of the record type of the care request object.	No	46.0
`referenceCareRequestCase`	String	The reference care request case number associated with the care request. Maps to: `CareRequest.ReferenceCareRequestCase`	No	52.0
`referenceCaseNumber`	String	Reference authorization number for an appeal, complaint, or grievance. Maps to: `CareRequest.ReferenceCaseNumber`	No	46.0
`reopenDecisionDateTime`	String	Date and time the request was reopened. Maps to: `CareRequest.ReopenDecisionDateTime`	No	52.0
`reopenReason`	String	Reason the request was reopened. Maps to: `CareRequest.ReopenReason`	No	46.0
`reopenReasonDescription`	String	Description of why the request was reopened. Maps to: `CareRequest.ReopenReasonDescription`	No	46.0
`reopenRequestOutcome`	String	The result of the reopen request. Maps to: `CareRequestExtension.ReopenRequestOutcome`	No	52.0
`reopenRequestType`	String	The type of reopen request. Maps to: `CareRequestExtension.ReopenRequestType`	No	52.0
`reopenedBy`	Reopened By Input	The user who reopened the care request. Maps to: `CareRequestExtension.ReopenedBy`	No	52.0
`reopenedByUserId`	String	The ID of the user who reopened the care request. Maps to: `CareRequestExtension.ReopenedByUserId`	No	52.0
`reopenedDate`	String	Date the request was reopened. Maps to: `CareRequest.ReopenedDate`	No	46.0
`requestExtensionReason`	String	The reason for requesting the care extension. Maps to: `CareRequestExtension.RequestExtensionReason`	No	52.0
`requestExtnDecisionDateTime`	String	The date when the decision to extend the care request extension was made. Maps to: `CareRequestExtension.RequestExtnDecisionDateTime`	No	52.0
`requestOutcome`	String	Specifies the outcome of the request. Maps to: `CareRequestExtension.RequestOutcome`	No	52.0
`requestOutcomeDesc`	String	The description of the request outcome. Maps to: `CareRequestExtension.RequestOutcomeDesc`	No	52.0
`requestType`	String	Category type of the request. Maps to: `CareRequestExtension.RequestType`	No	46.0
`requestedDate`	String	Date the request was originally requested. Maps to: `CareRequest.RequestedDate`	No	46.0
`requestedLengthOfStay`	Integer	Requested length of stay for the patient. Maps to: `CareRequest.RequestedLengthOfStay`	No	57.0
`requestedLevelOfCare`	String	Requested level of care for the patient. Maps to: `CareRequest.RequestedLevelOfCare`	No	46.0
`requesterType`	String	Indicates the role of the individual initiating the request. Maps to: `CareRequest.RequesterType`	No	46.0
`requestingPractitioner`	Requesting Practitioner Input	Ordering or referring practitioner for the request.	No	46.0
`requestingPractitionerLicense`	String	Requesting Practitioner License Maps to: `CareRequest.RequestingPractitionerLicense`	No	46.0
`requestingPractitionerSpecialty`	String	Specialty of the practitioner, for example, Family Practice or General Surgery. Maps to: `CareRequest.RequestingPractitionerSpecialty`	No	46.0
`requestingPractitionerVerbalNotificationDate`	String	Date when the practitioner was verbally notified of the decision. Maps to: `CareRequest.RequestingPractitionerVerbalNotifiedDate`	No	46.0
`requestingPractitionerWrittenNotificationDate`	String	Date when the practitioner was notified of the decision by written correspondence. Maps to: `CareRequest.RequestingPractitionerWrittenNotifiedDate`	No	46.0
`resolutionDate`	String	Date when the complaint, appeal, or grievance was resolved. Maps to: `CareRequest.ResolutionDate`	No	46.0
`resolutionDescription`	String	The resolution details provided for the complaint, appeal, or grievance. Maps to: `CareRequestExtension.ResolutionDescription`	No	52.0
`resolutionLetterSentDate`	String	Date and time when a resolution letter was sent to the requester. Maps to: `CareRequest.ResolutionLetterSentDate`	No	46.0
`resolutionNotes`	String	Resolution notes for the request. Maps to: `CareRequest.ResolutionNotes`	No	46.0
`reviewDate`	String	Date the review was completed. Maps to: `CareRequest.ReviewDate`	No	46.0
`rootCauseNotes`	String	Field for notes related to the root cause for the request. Maps to: `CareRequest.RootCauseNotes`	No	46.0
`scheduledAdmissionDate`	String	Anticipated admission date for the patient. Maps to: `CareRequest.ScheduledAdmissionDate`	No	46.0
`scheduledDischargeDate`	String	Scheduled discharge date for the patient. Maps to: `CareRequest.ScheduledDischargeDate`	No	46.0
`serviceDate`	String	Date when patient received the service. Maps to: `CareRequest.ServiceDate`	No	46.0
`serviceLevel`	String	The level of service rendered. Maps to: `CareRequestExtension.ServiceLevel`	No	46.0
`serviceType`	String	Classification of the type of service. Maps to: `CareRequestExtension.ServiceType`	No	46.0
`serviceorMedicationReceived`	Boolean	Indicates whether the member has already received the medial service or medication. Maps to: `CareRequest.IsServiceOrMedicationReceived`	No	46.0
`servicingFacility`	Servicing Facility Input	Facility where the service is being provided.	No	46.0
`servicingPractitioner`	Servicing Practitioner Input	Practitioner administering the service.	No	46.0
`servicingPractitionerLicense`	String	License type of the practitioner. Maps to: `CareRequest.ServicingPractitionerLicense`	No	46.0
`servicingPractitionerSpecialty`	String	Specialty of the practitioner. Maps to: `CareRequest.ServicingPractitionerSpecialty`	No	46.0
`sourceSystem`	String	System from which this request was sourced. Maps to: `CareRequest.SourceSystem`	No	46.0
`sourceSystemIdentifier`	String	ID of the system from which the request was sourced. Maps to: `CareRequest.SourceSystemIdentifier`	No	46.0
`sourceSystemModified`	String	The timestamp of the most recent update from the source system. Maps to: `CareRequest.SourceSystemModified`	No	46.0
`supportingDocUrl`	String	The URL of supporting documentation such as a questionnaire. This is unavailable for PATCH requests.	No	63.0
`unitOfMeasure`	String	The unit of measure associated with the prior authorization request. Maps to: `CareRequestExtention.UnitOfMeasure` This field is a lookup to `UnitOfMeasure`.	No	55.0