UnitedHealthcare · Schema
UnitedHealthcare Claim Inquiry Response
Claim status inquiry response with payment details
Health InsuranceHealthcareFHIRClaimsEligibility
Properties
| Name | Type | Description |
|---|---|---|
| claimNumber | string | UHC claim number |
| claimStatus | string | Claim status |
| serviceDate | string | Date of service |
| billedAmount | number | Total billed charges |
| allowedAmount | number | Allowed amount |
| paidAmount | number | Amount paid |
| patientResponsibility | number | Patient responsibility |
| paymentDate | string | Payment date |
| checkNumber | string | Check or EFT trace number |
| denialReasonCode | string | Denial reason code |
| denialReasonDescription | string | Denial reason description |
JSON Schema
{
"$schema": "https://json-schema.org/draft/2020-12/schema",
"$id": "https://raw.githubusercontent.com/api-evangelist/unitedhealthcare/refs/heads/main/json-schema/provider-claim-inquiry-response-schema.json",
"title": "UnitedHealthcare Claim Inquiry Response",
"description": "Claim status inquiry response with payment details",
"type": "object",
"properties": {
"claimNumber": {
"type": "string",
"description": "UHC claim number"
},
"claimStatus": {
"type": "string",
"enum": [
"RECEIVED",
"IN_PROCESS",
"PROCESSED",
"DENIED",
"ADJUSTED",
"REVERSED"
],
"description": "Claim status"
},
"serviceDate": {
"type": "string",
"format": "date",
"description": "Date of service"
},
"billedAmount": {
"type": "number",
"description": "Total billed charges"
},
"allowedAmount": {
"type": "number",
"description": "Allowed amount"
},
"paidAmount": {
"type": "number",
"description": "Amount paid"
},
"patientResponsibility": {
"type": "number",
"description": "Patient responsibility"
},
"paymentDate": {
"type": "string",
"format": "date",
"description": "Payment date"
},
"checkNumber": {
"type": "string",
"description": "Check or EFT trace number"
},
"denialReasonCode": {
"type": "string",
"description": "Denial reason code"
},
"denialReasonDescription": {
"type": "string",
"description": "Denial reason description"
}
}
}
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