Retrieve Encounter Information, Patient Information, and Documents for a Claim Using Task Endpoint (FHIR)

This topic provides information on retrieving encounter and patient information related to a claim using FHIR in Oracle Health Clinical Data Exchange. Additionally, this topic provides information on retrieving clinical documents for a claim as needed.

  1. Log in to Oracle Health Clinical Data Exchange and select View Payer Hub.
  2. Review your Payer Profile ID.
  3. Select Get FHIR Client ID to obtain an OAuth 2.0 client ID.
  4. Obtain the Oracle Health Clinical Data Exchange FHIR endpoint and the OAuth 2.0 Token Provider from the payer profile ID resource.
  5. Configure your application to retrieve the insured patient's documents using the client ID, token provider, Claim ID, National Provider Identifier (NPI), and FHIR endpoint.
The Post Service Clinical Claim Review (PSCCR) workflow in Oracle Health Clinical Data Exchange allows you to retrieve encounter information, patient information, and clinical documents using the following process:
  1. The payer system receives a completed claim through conventional means.
  2. If the payer requires more information related to the claim for adjudication purposes, the payer may create a new POST request in FHIR that includes the OAuth 2.0 client ID, the NPI, and the claim ID.
  3. The system sends a request to query the endpoint that is configured for the service.
  4. If the coverage checks are successful, the system receives a response that includes the encounter and patient information that is related to the claim. Additionally, applicable clinical documents are also retrieved as needed.

Example 4-1 Request Body

See the below example of a request and acknowledgement response for the POST Task request.
https://cell1.query.cdexhub.us-chicago-1.oci.oraclecloud.com/fhir/r4/1234567-1234-1234-1234-123456789101/Task

Example 4-2 Request Body

See the below example of a request and acknowledgement response for the POST Task request.
{
  "resourceType": "Task",
  "status": "requested",
  "intent": "unknown",
  "focus": {
    "reference": "Claim/3214334"
  },
  "input": [
    {
      "type": {
        "coding": [
          {
            "code": "npi"
          }
        ],
        "text": "NPI"
      },
      "valueId": "45687668"
    }
  ]
}

Example 4-3 Response Body

See the below example of a request and acknowledgement response for the POST Task request.
{
  "resourceType": "Task",
  "id": "99112233",
  "status": "in-progress"
}

Example 4-4 Request URL

See the below example of a request and response for the GET Task request after document retrieval is completed.
https://cell1.query.cdexhub.us-chicago-1.oci.oraclecloud.com/fhir/r4/1234567-1234-1234-1234-123456789101/Task/99112233

Example 4-5 Response Body

See the below example of a request and response for the GET Task request after document retrieval is completed.
{
        "resourceType": "Task",
        "id": "99112233",
        "status": "completed",
        "intent": "unknown",
        "focus": {
          "reference": "Claim/3214334"
        },
        "output": [
          {
            "type": {
              "coding": [
                {
                  "code": "patient",
                  "display": "patient"
                }
              ],
              "text": "Patient"
            },
            "valueReference": {
              "reference": "Patient/12643234",
              "identifier": {
                "system": "123c71549f4a4bb321b4de8a532f321c_1.23.456.1.234567.6.543.21.1.1",
                "value": "2233"
              }
            }
          },
          {
            "type": {
              "coding": [
                {
                  "code": "encounter",
                  "display": "encounter"
                }
              ],
              "text": "Encounter"
            },
            "valueReference": {
              "reference": "https://fhir-ehr.sandboxcerner.com/r4/dacc6494-e336-45ad-8729-b789ff8663c6/Encounter/97841234",
              "type": "Encounter",
              "identifier": {
                "system": "123c71549f4a4bb321b4de8a532f321c_1.23.456.1.234567.6.543.21.1.1",
                "value": "15651"
              }
            }
          },
          {
            "type": {
              "coding": [
                {
                  "code": "binary",
                  "display": "binary"
                }
              ],
              "text": "Binary"
            },
            "valueAttachment": {
              "contentType": "application/xml",
              "language": "en-us",
              "data": "<base64Binary>",
              "url": "https://cell1.query.stage.cdexhub.us-ashburn-1.oci.oraclecloud.com/fhir/r4/{{queryEndpointAlias}}/Binary/<uuid>",
              "size": 32213,
              "hash": "a12bc34d5e6f78987g65h43210i12j34k5l6m789",
              "creation": "2025-06-27T20:05:14Z"
            }
          }
        ]
      }