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kaaran@ACC
Queries - What is a submitted claim & registered claims

Hi Dev community,

 

We have had a good question from one of our developers and thought it would be good to share with everyone - What is the difference between a submitted claim and a registered claim?

Submitted claims are claims that have been submitted to ACC and received successfully. These claims can only be queried by the submitting organisation.

Registered claims are claims that have been submitted successfully to ACC and have then been reviewed by our internal claims team, given a status (accepted/declined/under review) and are then registered in our main claims database. Registered claims are able to be queried from any organisation that has permission to access clinical information.

 

How does this relate to Query Claim APIs? - Each query is for one or the other type of claim and not both, so you will need to use the correct query for the information you are after.

A quick way to look at the Query Claim APIs - Any API which has "summary" within the URL is in relation to the submission/send status of a claim -  what has my organisation sent? did it get to ACC or not? if not, then why did it fail?

The other Query Claim APIs are for registered claims where you can see the registered details for a claim - what are the current diagnosis details? has the claim has been accepted or not? what claims have been registered for a particular patient?

 

 

If you have any other questions, please feel free to post them to the forum as we are happy to help

 

kaaran@ACC