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

View JSON Schema on GitHub

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"
    }
  }
}