Payerbox Docs

Claim/$inquire

Checks the status of a previously submitted prior authorization request, defined by the Da Vinci PAS IG. The response is a FHIR Bundle containing the latest ClaimResponse, or an OperationOutcome on error.

Endpoint

POST <base>/fhir/Claim/$inquire

Update chains

A prior authorization is updated or cancelled by submitting a new Claim that points at the prior one through Claim.related (relationship prior, or the legacy replaces). Under PAS 2.1.0 the decision ClaimResponse stays on the original (root) Claim of the chain; update and cancel Claims carry none of their own.

From any Claim in the chain, $inquire walks Claim.related backward to the root and returns that Claim's latest ClaimResponse. Inquiring on the original Claim, an intermediate update, or the newest update returns the same ClaimResponse. Cycle and depth guards stop a malformed chain from looping.

Under the legacy 2.0.1 model each Claim in a chain carried its own ClaimResponse, and $inquire resolved forward to the newest one. Payerbox behavior, not a PAS profile element.

Auth

SMART Backend Services. Scope: system/Claim.r system/ClaimResponse.r. See Authentication.

Parameters

DirectionParameterTypeCardinalityDescription
INresourceBundle1..1PAS Inquiry Request Bundle containing inquiry criteria
OUTreturnBundle or OperationOutcome1..1PAS Inquiry Response Bundle with status information

Example

Check status of a submitted authorization:

POST /fhir/Claim/$inquire
Content-Type: application/json
Accept: application/json

{
  "resourceType": "Bundle",
  "meta": { "profile": ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-request-bundle"] },
  "type": "collection",
  "identifier": { "system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER", "value": "test-bundle-3" },
  "timestamp": "2025-12-08T16:48:02.531010Z",
  "entry": [
    {
      "fullUrl": "urn:uuid:claim-5d4963ef-8cd8-4fa7-b002-a5c67fa2f1da",
      "resource": {
        "resourceType": "Claim",
        "id": "claim-1765213116210",
        "meta": { "profile": ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"] },
        "identifier": [{ "system": "http://example.org/claim-id", "value": "claim-1765213116210" }],
        "status": "active",
        "type": { "coding": [{ "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" }] },
        "use": "preauthorization",
        "patient": { "reference": "Patient/patient-1" },
        "created": "2025-12-08T16:58:36.210Z",
        "insurer": { "reference": "Organization/payer-org-1" },
        "provider": { "reference": "Organization/requesting-org-1", "display": "Acme Care Clinic" },
        "priority": { "coding": [{ "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal" }] },
        "insurance": [{ "sequence": 1, "focal": true, "coverage": { "reference": "Coverage/coverage-1" } }],
        "item": [
          {
            "sequence": 1,
            "category": { "coding": [{ "system": "https://codesystem.x12.org/005010/1365", "code": "42", "display": "Home Health Care" }] },
            "productOrService": { "coding": [{ "system": "http://www.ama-assn.org/go/cpt", "code": "99213", "display": "Established patient office visit" }] }
          }
        ]
      }
    }
  ]
}

{
  "resourceType": "Bundle",
  "type": "collection",
  "meta": { "profile": ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-inquiry-response-bundle"] },
  "identifier": { "system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER", "value": "test-bundle-3" },
  "timestamp": "2025-12-17T13:35:44.019420Z",
  "entry": [
    {
      "fullUrl": "ClaimResponse/c0d73c37-12ee-4cde-bfc6-aa6ed216f4dd",
      "resource": {
        "resourceType": "ClaimResponse",
        "id": "c0d73c37-12ee-4cde-bfc6-aa6ed216f4dd",
        "meta": { "profile": ["http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"] },
        "status": "active",
        "type": { "coding": [{ "code": "professional", "system": "http://terminology.hl7.org/CodeSystem/claim-type" }] },
        "use": "preauthorization",
        "patient": { "reference": "Patient/patient-1" },
        "insurer": { "reference": "Organization/payer-org-1" },
        "request": { "reference": "Claim/claim-1765213116210" },
        "created": "2025-12-17T13:34:24.316526Z",
        "outcome": "queued",
        "item": [
          {
            "itemSequence": 1,
            "adjudication": [
              { "category": { "coding": [{ "code": "submitted", "system": "http://terminology.hl7.org/CodeSystem/adjudication" }] } }
            ]
          }
        ]
      }
    }
  ]
}

See Claim/$submit, PAS.

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