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CareRequest

Represents 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, services, or drugs. Care requests include preauthorizations for drugs and services, admission notifications, concurrent review of admissions, appeals, complaints, and grievances.

Supported Calls

create(), delete(), describeLayout(), describeSObjects(), getDeleted(), getUpdated(), query(), retrieve(), search(), undelete(), update(), upsert()

Fields

AcknowledgementLetterSentDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date and time when an acknowledgment letter was sent to the requester.

ActualAdmissionDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Actual admission date for the patient.

ActualDischargeDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Actual discharge date for the patient.

AdmissionNotes

  • Type: textarea
  • Properties: Create, Nillable, Update
  • Description: Notes related to the admission.

AdmissionSource

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Where the patient was admitted from, for example, a clinic or an emergency room.

AdmissionType

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Type of admission, for example, emergency or elective.

AorReceivedDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date and time when the Appointment of Representative (AOR) form was received.

AorRequestedDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date and time when the AOR form was requested.

AppealRequestReasonType

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Restricted picklist, Sort, Update
  • Description: The type of reason associated with the appeal request.
  • Possible values:
    • Service Request Rejected
    • Service Claim Unpaid
    • Rejected - Service Not Required
    • Rejected - No Coverage Benefit
    • Notification Delayed
    • Specialist Referral Rejected

AppointedRepresentativeId

  • Type: reference
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: ID of the appointed representative for the member.

    This is a relationship field.

  • Relationship Name: AppointedRepresentative
  • Relationship Type: Lookup
  • Refers To: Account

AppointedRepVerbalContactDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date and time of verbal contact with the member's appointed representative.

AppointedRepWrittenContactDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date and time correspondence was sent to the member's appointed representative.

ApprovedLengthOfStay

  • Type: int
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Approved number of days for the admission.

ApprovedLevelOfCare

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Approved level of care for the patient, for example, Hospital-Observaton or SNF-Rehabilitation.

CareRequestCaseId

  • Type: reference
  • Properties: Create, Filter, Group, Sort
  • Description: Case related to the care request.
    Note

    Note

    A case record can only be related to a single care request record. Therefore, ensure that the Case record you specify in this field isn’t already associated with another care request.

    This is a relationship field.

  • Relationship Name: CareRequestCase
  • Relationship Type: Lookup
  • Refers To: Case

ClaimNumber

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Claim number for the medical service or medication, if one exists.

ClinicalCaseType

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Clinical case type for the patient, for example, High Risk Fall or Adult Diabetes.

CriteriaMet

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Indicates whether criteria for care was met.

CumulativeLengthOfStay

  • Type: int
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Total number of days for the admission.

CurrentLevelOfCare

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Level of care that the patient is receiving.

DecisionDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date by which the decision must be made for the request.

DecisionDaysRemaining

  • Type: int
  • Properties: Filter, Group, Nillable, Sort
  • Description: Number of days remaining for a decision or resolution.

DecisionLetter

  • Type: textarea
  • Properties: Create, Nillable, Update
  • Description: The text of the determination letter sent to the member and provider.

DecisionNotes

  • Type: textarea
  • Properties: Create, Nillable, Update
  • Description: Notes related to the decision.

DecisionReason

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Reason for the decision.

DecisionReasonDescription

  • Type: textarea
  • Properties: Create, Nillable, Update
  • Description: Text describing the reason for the decision.

DeniedLengthOfStay

  • Type: int
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Number of days denied for the admission.

DeniedLevelOfCare

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Level of care denied for the patient.

DispositionNotes

  • Type: textarea
  • Properties: Create, Nillable, Update
  • Description: Notes related to the disposition of the request.

DueDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date the request is due for completion.

EffectiveFrom

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: The start date for an effective-date range.

EffectiveTo

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: The end date for an effective-date range.

ExpirationDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Expiration date for the request.

ExtensionRequestReceivedDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date and time an extension was requested.

ExternalComplaintIdentifier

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Complaint ID number.

FacilityRecordNumber

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: The medical record number used to identify a patient.

FacilityRoomBedType

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Type of facility bed for the patient.

FacilityRoomNumber

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: The facility room number for the patient.

FinalLevelOfCare

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Final level of care the patient.

FirstReviewerId

  • Type: reference
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: The name of the person who reviewed the request.

    This is a relationship field.

  • Relationship Name: FirstReviewer
  • Relationship Type: Lookup
  • Refers To: User

FirstReviewerNotes

  • Type: textarea
  • Properties: Create, Nillable, Update
  • Description: Notes from the first reviewer related to the case.

GeneralPractitionerId

  • Type: reference
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Member's primary or general care practitioner.

    This is a relationship field.

  • Relationship Name: GeneralPractitioner
  • Relationship Type: Lookup
  • Refers To: Contact

GeneralPractitionerVerbalNotifiedDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date when the primary care practitioner was verbally notified of the decision

GeneralPractitionerWrittenNotifiedDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date when the primary care practitioner was notified of the decision by written correspondence.

GrievanceType

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Specifies the type of grievance.

InfoReceivedDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date and time when additional information was received from the provider or member.

InfoRequestedDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date and time when additional information was requested from the provider or member.

InitialDenialNotificationDate

  • Type: date
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Date of initial denial notification.

InitialDenialNotificationTime

  • Type: time
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: The time when the initial care request was denied.

IsExtendedRequest

  • Type: boolean
  • Properties: Create, Defaulted on create, Filter, Group, Sort, Update
  • Description: Indicates whether a request was extended.

IsReadmission

  • Type: boolean
  • Properties: Create, Defaulted on create, Filter, Group, Sort, Update
  • Description: Indicates whether the care request is for a readmission.
  • Default value: false

IsServiceOrMedicationReceived

  • Type: boolean
  • Properties: Create, Defaulted on create, Filter, Group, Sort, Update
  • Description: Indicates whether the member has already received the medial service or medication.

LastReferencedDate

  • Type: dateTime
  • Properties: Filter, Nillable, Sort
  • Description: The timestamp for when the current user last viewed a record related to this record.

LastViewedDate

  • Type: dateTime
  • Properties: Filter, Nillable, Sort
  • Description: The timestamp for when the current user last viewed this record. If this value is null, it’s possible that this record was referenced (LastReferencedDate) and not viewed.

MedicalDirectorId

  • Type: reference
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Name of the medical director who reviewed the request.

    This is a relationship field.

  • Relationship Name: MedicalDirector
  • Relationship Type: Lookup
  • Refers To: User

MedicalDirectorNotes

  • Type: textarea
  • Properties: Create, Nillable, Update
  • Description: Notes from the medical director related to the request.

MemberCondition

  • Type: textarea
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Free-form description of the member's condition.

MemberContactDateTime

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date and time when the member was contacted.

MemberDateOfBirth

  • Type: date
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Date of birth of the member.

MemberFirstName

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: First name of the member.

MemberGender

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Gender of the member.

MemberGroupNumber

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Insurance group number for the member.

MemberId

  • Type: reference
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Insurance identifier for the member.

    This is a relationship field.

  • Relationship Name: Member
  • Relationship Type: Lookup
  • Refers To: Account

MemberIdentificationNumber

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Insurance identification number for the member.

MemberLastName

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Last name of the member.

MemberPrimaryPlanId

  • Type: reference
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: The primary insurance plan of a member associated with the care request when the member is insured under multiple plans.

    This is a relationship field.

  • Relationship Name: MemberPrimaryPlan
  • Relationship Type: Lookup
  • Refers To: MemberPlan

MemberPrognosis

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Indicator of the provider's prognosis for the member.

MemberSecondaryPlanId

  • Type: reference
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: The secondary insurance plan of a member associated with the care request when the member is insured under multiple plans.

    This is a relationship field.

  • Relationship Name: MemberSecondaryPlan
  • Relationship Type: Lookup
  • Refers To: MemberPlan

MemberStatus

  • Type: textarea
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: The member's status at admission, date of outpatient service, or start of care.

MemberVerbalNotificationDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date when the member was verbally notified of the decision.

MemberWrittenNotificationDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date when the member was notified of the decision by written correspondence.

ModificationDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date the case was modified.

ModifiedLengthOfStay

  • Type: int
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Modified number of days for the admission.

ModifiedLevelOfCare

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Modified level of care for the patient.

Name

  • Type: string
  • Properties: Create, Filter, Group, idLookup, Sort, Update
  • Description: Name of the care request.

NextReviewDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date the next review is scheduled for completion.

OriginalDenialMedicalDirectorId

  • Type: reference
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: The name of the medical director who denied the original request.

    This is a relationship field.

  • Relationship Name: OriginalDenialMedicalDirector
  • Relationship Type: Lookup
  • Refers To: User

ParProvider

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Indicator of whether this provider has entered into an agreement with the insurance carrier.

PlaceOfService

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Place of service for the member's care such as an inpatient hospital or an ambulatory surgery center.

PractitionerContactDateTime

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date and time when the provider was contacted.

QuantityType

  • Type: picklist
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Quantity type for the request such as days, units, or visits.

ReceivedDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date the request was received.

ReconsiderationDenialNotificationDate

  • Type: date
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: The date when the reconsidered care request was denied.

ReconsiderationDenialNotificationTime

  • Type: time
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: The time when the reconsidered care request was denied.

ReferenceCareRequestCaseId

  • Type: reference
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: The reference care request case number associated with the care request.

    This is a relationship field.

  • Relationship Name: ReferenceCareRequestCase
  • Relationship Type: Lookup
  • Refers To: Case

ReferenceCaseNumber

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Reference authorization number for an appeal, complaint, or grievance.

ReopenedDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date the request was reopened.

ReopenReason

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Reason the request was reopened.

    The possible values are:

    • Administrative Error
    • Original Decision Overturned

ReopenReasonDescription

  • Type: textarea
  • Properties: Create, Nillable, Update
  • Description: Description of why the request was reopened.

RequestedDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date the request was originally requested.

RequestedLengthOfStay

  • Type: int
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Requested number of days for the admission.

RequestedLevelOfCare

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Requested level of care for the patient.

RequesterType

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Indicates the role of the individual initiating the request.

RequestingPractitionerId

  • Type: reference
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Ordering or referring practitioner for the request.

    This is a relationship field.

  • Relationship Name: RequestingPractitioner
  • Relationship Type: Lookup
  • Refers To: Contact

RequestingPractitionerLicense

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: License type of the practitioner.

RequestingPractitionerSpecialty

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Specialty of the practitioner, for example, Family Practice or General Surgery.

RequestingPractitionerVerbalNotifiedDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date when the practitioner was verbally notified of the decision.

RequestingPractitionerWrittenNotifiedDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date when the practitioner was notified of the decision by written correspondence.

ResolutionDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date when the complaint, appeal, or grievance was resolved.

ResolutionLetterSentDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date and time when a resolution letter was sent to the requester.

ResolutionNotes

  • Type: textarea
  • Properties: Create, Nillable, Update
  • Description: Resolution notes for the request.

ReviewDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Date the review was completed.

RootCauseNotes

  • Type: textarea
  • Properties: Create, Nillable, Update
  • Description: Field for notes related to the root cause for the request.

ScheduledAdmissionDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Anticipated admission date for the patient.

ScheduledDischargeDate

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Scheduled discharge date for the patient.

ServiceDate

  • Type: date
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Date when patient received the service.

ServicingFacilityId

  • Type: reference
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Facility where the service is being provided.

    This is a relationship field.

  • Relationship Name: ServicingFacility
  • Relationship Type: Lookup
  • Refers To: Account

ServicingPractitionerId

  • Type: reference
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Practitioner administering the service.

    This is a relationship field.

  • Relationship Name: ServicingPractitioner
  • Relationship Type: Lookup
  • Refers To: Contact

ServicingPractitionerLicense

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: License type of the practitioner.

ServicingPractitionerSpecialty

  • Type: picklist
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: Specialty of the practitioner.

SourceSystem

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: System from which this request was sourced.

SourceSystemIdentifier

  • Type: string
  • Properties: Create, Filter, Group, Nillable, Sort, Update
  • Description: ID of the system from which the request was sourced.

SourceSystemModified

  • Type: dateTime
  • Properties: Create, Filter, Nillable, Sort, Update
  • Description: Timestamp of the most recent update from the source system.

Associated Objects

This object has the following associated objects. If the API version isn’t specified, they’re available in the same API versions as this object. Otherwise, they’re available in the specified API version and later.

CareRequestChangeEvent (API version 59.0)
Change events are available for the object.
CareRequestFeed
Feed tracking is available for the object.
CareRequestHistory
History is available for tracked fields of the object.