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UnitedHealthcare
Provider Claim Inquiry Response Structure
Provider Claim Inquiry Response Structure
Claim status inquiry response with payment details
Type: object
Properties: 0
Health Insurance Healthcare FHIR Claims Eligibility
UnitedHealthcare Claim Inquiry Response is a JSON Structure definition published by UnitedHealthcare. It conforms to the https://json-structure.org/meta/core/v0/# meta-schema.
Meta-schema: https://json-structure.org/meta/core/v0/#
JSON Structure
{
"$schema": "https://json-structure.org/meta/core/v0/#",
"$id": "https://raw.githubusercontent.com/api-evangelist/unitedhealthcare/refs/heads/main/json-structure/provider-claim-inquiry-response-structure.json",
"name": "UnitedHealthcare Claim Inquiry Response",
"type": "object",
"description": "Claim status inquiry response with payment details",
"fields": [
{
"name": "claimNumber",
"type": "string",
"description": "UHC claim number"
},
{
"name": "claimStatus",
"type": "string",
"description": "Claim status",
"enum": [
"RECEIVED",
"IN_PROCESS",
"PROCESSED",
"DENIED",
"ADJUSTED",
"REVERSED"
]
},
{
"name": "serviceDate",
"type": "date",
"description": "Date of service"
},
{
"name": "billedAmount",
"type": "decimal",
"description": "Total billed charges"
},
{
"name": "allowedAmount",
"type": "decimal",
"description": "Allowed amount"
},
{
"name": "paidAmount",
"type": "decimal",
"description": "Amount paid"
},
{
"name": "patientResponsibility",
"type": "decimal",
"description": "Patient responsibility"
},
{
"name": "paymentDate",
"type": "date",
"description": "Payment date"
},
{
"name": "checkNumber",
"type": "string",
"description": "Check or EFT trace number"
},
{
"name": "denialReasonCode",
"type": "string",
"description": "Denial reason code"
},
{
"name": "denialReasonDescription",
"type": "string",
"description": "Denial reason description"
}
]
}