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Care Request Input

The general details of a care-related request including member information, admission date, decision reason, and so on. A single request can contain multiple diagnoses or drugs. Care requests include prior authorizations for drugs and services, admission notifications, concurrent review of admissions, appeals, complaints, and grievances.

Root XML tag

<careRequest>

JSON example

{
		"requestingPractitionerSpecialty": "Neurologist",
		"placeOfService": "InPatient",
		"sourceSystemIdentifier": "0015",
		"name": "Care Request 15",
		"requestingPractitionerLicense": "M.D",
		"sourceSystem": "source_system_name",
		"servicingPractitionerLicense": "M.D",
		"servicingPractitionerSpecialty": "Hospitalist",
		"recordType": "Complaint"
		}

Properties

Name Type Description Required Available Version
acknowledgement​LetterSentDate​ String Date and time when an acknowledgment letter was sent to the requester. Maps to: CareRequest.AcknowledgementLetterSentDate No 46.0
actualAdmission​Date String Actual admission date for the patient. Maps to: CareRequest.ActualAdmissionDate No 46.0
actualDischarge​Date String Actual discharge date for the patient. Maps to: CareRequest.ActualDischargeDate No 46.0
admission​Notes String Notes related to the admission. Maps to: CareRequest.AdmissionNotes No 46.0
admission​Source String Where the patient was admitted from, for example, a clinic or an emergency room. Maps to: CareRequest.AdmissionSource No 46.0
admissionType String Type of admission, for example, emergency or elective. Maps to: CareRequest.AdmissionType No 46.0
ambulanceTransport​Distance​ Integer Ambulance Transport Distance No 46.0
ambulanceTransport​Reason String Reason for ambulance transport. Maps to: CareRequestExtention.AmbulanceTransportReason No 46.0
ambulanceTransport​Type String Type of ambulance transport. Maps to: CareRequestExtention.AmbulanceTransportType No 46.0
aorReceived​Date String Date and time when the Appointment of Representative (AOR) form was received. Maps to: CareRequest.AorReceivedDate No 46.0
aorRequestedDate String Date and time when the AOR form was requested. Maps to: CareRequest.AorRequestedDate No 46.0
appealEffectuation​DateTime String The effective date of the outcome of the appeal request. For example, if a claim was successfully appealed, this field displays the date when the claim was paid. Maps to: CareRequestExtension.AppealEffectuationDateTime No 52.0
appealRequest​ReasonType String Specifies the reason for raising the appeal request. Maps to: CareRequest.AppealRequestReasonType No 52.0
appointedRepVerbal​ContactDate String Date and time of verbal contact with the member's appointed representative. Maps to: CareRequest.AppointedRepVerbalContactDate No 46.0
appointedRepWritten​ContactDate String Date and time correspondence was sent to the member's appointed representative. Maps to: CareRequest.AppointedRepWrittenContactDate No 46.0
appointed​Representative Appointed Representative Input Appointed representative for the member. If provided, the first name, last name, birthdate, and suffix fields are used to find at a unique Id, which is used to update CareRequest.AppointedRepresentativeId field. No 46.0
approvedLength​OfStay Integer Approved number of days for the admission. Maps to: CareRequest.ApprovedLengthOfStay No 46.0
approvedLevel​OfCare String Approved level of care for the patient, for example, Hospital-Observaton or SNF-Rehabilitation. Screen reader support enabled. Maps to: CareRequest.ApprovedLevelOfCare No 46.0
authorization​RefIdentifier String The unique identifier of the authorization request. Maps to: CareRequestExtension.AuthorizationRefIdentifier No 57.0
careRequest​Reviewers Care Request Reviewer Input The care request associated with the care request reviewer. Maps to: CareRequest.CareRequestReviewers No 52.0
caseSubStatus String Sub status of care request in each stage of care request. Maps to: CareRequest.CaseSubStatus No 57.0
claimNumber String Claim number for the medical service or medication, if one exists. Maps to: CareRequest.ClaimNumber No 46.0
clientSourceSysIdentifier String An identifier of the client's source system that sent the care request. This is unavailable for PATCH requests. No 63.0
clinicalCase​Type String Clinical case type for the patient, for example, High Risk Fall or Adult Diabetes. Maps to: CareRequest.ClinicalCaseType No 46.0
criteriaMet String Indicates whether criteria for care was met. Maps to: CareRequest.CriteriaMet No 46.0
cumulativeLength​OfStay Integer Total number of days for the admission. Maps to: CareRequest.CumulativeLengthOfStay No 46.0
currentLevel​OfCare String Level of care that the patient is receiving. Maps to: CareRequest.CurrentLevelOfCare No 46.0
decisionDate String Date by which the decision must be made for the request. Maps to: CareRequest.DecisionDate No 46.0
decisionLetter String The text of the determination letter sent to the member and provider. Maps to: CareRequest.DecisionLetter No 46.0
decisionNotes String Notes related to the decision. Maps to: CareRequest.DecisionNotes No 46.0
decisionReason String Reason for the decision. Maps to: CareRequest.DecisionReason No 46.0
decisionReason​Description String Text describing the reason for the decision. Maps to: CareRequest.DecisionReasonDescription No 46.0
deniedLength​OfStay Integer Number of days denied for the admission. Maps to: CareRequest.DeniedLengthOfStay No 46.0
deniedLevel​OfCare String Level of care denied for the patient. Maps to: CareRequest.DeniedLevelOfCare No 46.0
disposition​Notes String Notes related to the disposition of the request. Maps to: CareRequest.DispositionNotes No 46.0
document​AttachmentStatus String The current status of the document upload based on the checklist provided to the reviewers. Maps to: CareRequestExtention.DocumentAttachmentStatus
Valid values are:
  • Complete
  • Incomplete
 No 55.0
dueDate String Date the request is due for completion. Maps to: CareRequest.DueDate No 46.0
effectiveFrom String The start date for an effective-date range. Maps to: CareRequest.EffectiveFrom No 46.0
effectiveTo String The end date for an effective-date range. Maps to: CareRequest.EffectiveTo No 46.0
expirationDate String Expiration date for the request. Maps to: CareRequest.ExpirationDate No 46.0
extendedRequest Boolean Indicates whether a request was extended. Maps to: CareRequest.IsExtendedRequest No 46.0
extensionRequest​ReceivedDate String Date and time an extension was requested. Maps to: CareRequest.ExtensionRequestReceivedDate No 46.0
external​ComplaintId String Complaint ID number. Maps to: CareRequest.ExternalComplaintIdentifier No 46.0
facility​RecordNumber String The medical record number used to identify a patient. Maps to: CareRequest.FacilityRecordNumber No 46.0
facility​RoomBedType String Type of facility bed for the patient. Maps to: CareRequest.FacilityRoomBedType No 46.0
facilityRoom​Number String The facility room number for the patient. Maps to: CareRequest.FacilityRoomNumber No 46.0
finalLevel​OfCare String Final level of care the patient. Maps to: CareRequest.FinalLevelOfCare No 46.0
firstReviewer First Reviewer Input The person who reviewed the request. No 46.0
first​ReviewerNotes String Notes from the first reviewer related to the case. Maps to: CareRequest.FirstReviewerNotes No 46.0
general​Practitioner General Practitioner Input Member's primary or general care practitioner. Maps to CareRequest.generalPractitioner No 46.0
generalPractitioner​VerbalNotification​Date String Date when the primary care practitioner was verbally notified of the decision. Maps to: CareRequest.GeneralPractitionerVerbalNotifiedDate No 46.0
generalPractitioner​WrittenNotification​Date String Date when the primary care practitioner was notified of the decision by written correspondence. Maps to: CareRequest.GeneralPractitionerWrittenNotifiedDate No 46.0
grievanceType String Specifies the type of grievance. Maps to: CareRequest.GrievanceType No 52.0
healthCare​Provider String The healthcare provider associated with the care request against whom the Grievance is filed. Maps toCareRequestExtension.HealthCareProvider No 52.0
homeHealthCertification​EndDate String Certification end date for home health care. Maps to: CareRequestExtension.HomeHealthCertificationEndDate No 46.0
homeHealthCertification​StartDate String Certification start date for home health care. Maps to: CareRequestExtension.HomeHealthCertificationStartDate No 46.0
homeHealth​StartDate String Date that home health services are scheduled or anticipated to start. Maps to: CareRequestExtension.HomeHealthStartDate No 46.0
id String ID of the Care Request. Required for PATCH. 46.0
independentReview​Determination String The determination made by the independent review. Maps to: CareRequestExtension.IndependentReviewDetermination No 52.0
independentReview​DeterminationDate String The date when the determination was made by the independent review. Maps to: CareRequestExtension.IndependentReviewDeterminationDate No 52.0
independentReview​SubmissionDate String The date when the review request was submitted for independent review. Maps to: CareRequestExtension.IndependentReviewSubmissionDate No 52.0
infoReceieved​Date String Date and time when additional information was received from the provider or member. Maps to: CareRequest.InfoReceivedDate No 46.0
infoRequested​Date String Date and time when additional information was requested from the provider or member. Maps to: CareRequest.InfoRequestedDate No 46.0
initialDenial​NotificationDate String Date of initial denial notification. Maps to: CareRequest.InitialDenialNotificationDate No 46.0
initialDenial​NotificationTime String The time when the initial care request was denied. Maps to CareRequest.InitialDenialNotificationTime No 52.0
isIndependentReview​Required Boolean Indicates whether independent review is required. Maps to CareRequestExtension.IsIndependentReviewRequired No 52.0
isReadmission Boolean Indicates whether the care request is for a readmission. Maps to CareRequest.IsReadmission No 52.0
medicalDirector Medical Director Input The medical director who reviewed the request. No 46.0
medicalDirector​Notes String Notes from the medical director related to the request. Maps to: CareRequest.MedicalDirectorNotes No 46.0
memberContact​Date String Date and time when the member was contacted. Maps to: CareRequest.MemberContactDateTime No 46.0
memberGroup​Number String Insurance group number for the member. Maps to: CareRequest.MemberGroupNumber No 46.0
memberPrimary​Plan String The primary insurance plan of a member associated with the care request when the member is insured under multiple plans. Maps to: CareRequest.MemberPrimaryPlan No 52.0
memberSecondary​Plan String The secondary insurance plan of a member associated with the care request when the member is insured under multiple plans. Maps to: CareRequest.MemberSecondaryPlan No 52.0
memberVerbal​NotificationDate String Date when the member was verbally notified of the decision. Maps to: CareRequest.MemberVerbalNotificationDate No 46.0
memberWritten​NotificationDate String Date when the member was notified of the decision by written correspondence. Maps to: CareRequest.MemberWrittenNotificationDate No 46.0
modification​Date String Date the case was modified. Maps to: CareRequest.ModificationDate No 46.0
modifiedLength​OfStay Integer Modified number of days for the admission. Maps to: CareRequest.ModifiedLengthOfStay No 46.0
modifiedLevel​OfCare String Modified level of care for the patient. Maps to: CareRequest.ModifiedLevelOfCare No 46.0
name String Name of the Care Request. Maps to: CareRequest.Name Yes 46.0
nextReview​Date String Date the next review is scheduled for completion. Maps to: CareRequest.NextReviewDate No 46.0
nursingHome​ResidentialStatus String Nursing home-resident status at the time of service. Maps to: CareRequestExtension.NursingHomeResidentialStatus No 46.0
originalDenial​MedicalDirector Original Denial Medical Director Input The medical director who denied the original request. No 46.0
parProvider String Indicator of whether this provider has entered into an agreement with the insurance carrier. Maps to: CareRequest.ParProvider No 46.0
placeOfService String Place of service for the member's care such as an inpatient hospital or an ambulatory surgery center. Maps to: CareRequest.PlaceOfService No 46.0
practitioner​ContactDate String Date and time when the provider was contacted. Maps to: CareRequest.PractitionerContactDateTime No 46.0
priorDischarge​Status String Specifies the previous discharge status of the member. Maps to: CareRequestExtension.PriorDischargeStatus No 52.0
quantity Integer Quantity of the request. No 46.0
quantityType String Quantity type for the request such as days, units, or visits. Maps to: CareRequest.QuantityType No 46.0
receivedDate String Date the request was received. Maps to: CareRequest.ReceivedDate No 46.0
reconsideration​DenialNotification​Date String Date of reconsideration denial notification. Maps to: CareRequest.ReconsiderationDenialNotificationDate No 46.0
reconsideration​DenialNotification​Time String The time of reconsideration denial notification. Maps to: CareRequest.ReconsiderationDenialNotificationTime No 52.0
recordType String Record type of the care request object. No 46.0
recordTypeId String ID of the record type of the care request object. No 46.0
referenceCare​RequestCase String The reference care request case number associated with the care request. Maps to: CareRequest.ReferenceCareRequestCase No 52.0
reference​CaseNumber String Reference authorization number for an appeal, complaint, or grievance. Maps to: CareRequest.ReferenceCaseNumber No 46.0
reopenDecision​DateTime String Date and time the request was reopened. Maps to: CareRequest.ReopenDecisionDateTime No 52.0
reopenReason String Reason the request was reopened. Maps to: CareRequest.ReopenReason No 46.0
reopenReason​Description String Description of why the request was reopened. Maps to: CareRequest.ReopenReasonDescription No 46.0
reopenRequest​Outcome String The result of the reopen request. Maps to: CareRequestExtension.ReopenRequestOutcome No 52.0
reopenRequest​Type String The type of reopen request. Maps to: CareRequestExtension.ReopenRequestType No 52.0
reopenedBy Reopened By Input The user who reopened the care request. Maps to: CareRequestExtension.ReopenedBy No 52.0
reopenedBy​UserId String The ID of the user who reopened the care request. Maps to: CareRequestExtension.ReopenedByUserId No 52.0
reopenedDate String Date the request was reopened. Maps to: CareRequest.ReopenedDate No 46.0
requestExtension​Reason String The reason for requesting the care extension. Maps to: CareRequestExtension.RequestExtensionReason No 52.0
requestExtnDecision​DateTime String The date when the decision to extend the care request extension was made. Maps to: CareRequestExtension.RequestExtnDecisionDateTime No 52.0
requestOutcome String Specifies the outcome of the request. Maps to: CareRequestExtension.RequestOutcome No 52.0
requestOutcome​Desc String The description of the request outcome. Maps to: CareRequestExtension.RequestOutcomeDesc No 52.0
requestType String Category type of the request. Maps to: CareRequestExtension.RequestType No 46.0
requestedDate String Date the request was originally requested. Maps to: CareRequest.RequestedDate No 46.0
requestedLength​OfStay Integer Requested length of stay for the patient. Maps to: CareRequest.RequestedLengthOfStay No 57.0
requestedLevel​OfCare String Requested level of care for the patient. Maps to: CareRequest.RequestedLevelOfCare No 46.0
requesterType String Indicates the role of the individual initiating the request. Maps to: CareRequest.RequesterType No 46.0
requesting​Practitioner Requesting Practitioner Input Ordering or referring practitioner for the request. No 46.0
requesting​PractitionerLicense String Requesting Practitioner License Maps to: CareRequest.RequestingPractitionerLicense No 46.0
requesting​PractitionerSpecialty String Specialty of the practitioner, for example, Family Practice or General Surgery. Maps to: CareRequest.RequestingPractitionerSpecialty No 46.0
requesting​PractitionerVerbal​NotificationDate String Date when the practitioner was verbally notified of the decision. Maps to: CareRequest.RequestingPractitionerVerbalNotifiedDate No 46.0
requesting​PractitionerWritten​NotificationDate String Date when the practitioner was notified of the decision by written correspondence. Maps to: CareRequest.RequestingPractitionerWrittenNotifiedDate No 46.0
resolutionDate String Date when the complaint, appeal, or grievance was resolved. Maps to: CareRequest.ResolutionDate No 46.0
resolution​Description String The resolution details provided for the complaint, appeal, or grievance. Maps to: CareRequestExtension.ResolutionDescription No 52.0
resolution​LetterSentDate String Date and time when a resolution letter was sent to the requester. Maps to: CareRequest.ResolutionLetterSentDate No 46.0
resolutionNotes String Resolution notes for the request. Maps to: CareRequest.ResolutionNotes No 46.0
reviewDate String Date the review was completed. Maps to: CareRequest.ReviewDate No 46.0
rootCauseNotes String Field for notes related to the root cause for the request. Maps to: CareRequest.RootCauseNotes No 46.0
scheduled​AdmissionDate String Anticipated admission date for the patient. Maps to: CareRequest.ScheduledAdmissionDate No 46.0
scheduled​DischargeDate String Scheduled discharge date for the patient. Maps to: CareRequest.ScheduledDischargeDate No 46.0
serviceDate String Date when patient received the service. Maps to: CareRequest.ServiceDate No 46.0
serviceLevel String The level of service rendered. Maps to: CareRequestExtension.ServiceLevel No 46.0
serviceType String Classification of the type of service. Maps to: CareRequestExtension.ServiceType No 46.0
serviceor​MedicationReceived Boolean Indicates whether the member has already received the medial service or medication. Maps to: CareRequest.IsServiceOrMedicationReceived No 46.0
servicingFacility Servicing Facility Input Facility where the service is being provided. No 46.0
servicingPractitioner Servicing Practitioner Input Practitioner administering the service. No 46.0
servicingPractitioner​License String License type of the practitioner. Maps to: CareRequest.ServicingPractitionerLicense No 46.0
servicingPractitioner​Specialty String Specialty of the practitioner. Maps to: CareRequest.ServicingPractitionerSpecialty No 46.0
sourceSystem String System from which this request was sourced. Maps to: CareRequest.SourceSystem No 46.0
sourceSystem​Identifier String ID of the system from which the request was sourced. Maps to: CareRequest.SourceSystemIdentifier No 46.0
sourceSystem​Modified String The timestamp of the most recent update from the source system. Maps to: CareRequest.SourceSystemModified No 46.0
supportingDocUrl String The URL of supporting documentation such as a questionnaire. This is unavailable for PATCH requests. No 63.0
unitOfMeasure String The unit of measure associated with the prior authorization request. Maps to: CareRequestExtention.UnitOfMeasure

This field is a lookup to UnitOfMeasure.

 No 55.0