> ## Documentation Index
> Fetch the complete documentation index at: https://developer.eka.care/llms.txt
> Use this file to discover all available pages before exploring further.

# Submit Claim

> Submits the final claim after discharge. request_type is empty for the first submit, QueryResponse to answer a payer query, FollowUp to resubmit a rejected claim. The claimed amount is the sum of itemized_billing. The payer answers asynchronously: a 2xx means the request was sent, not approved. Track it with the returned request_id on Get Claim Request.



## OpenAPI

````yaml post /abdm/nhcx/v1/claims/{claimId}/claim
openapi: 3.1.0
info:
  description: ABHA Registration and login APIs
  title: Registration
  version: 1.0.0
servers:
  - description: Production
    url: https://api.eka.care
  - description: Stage/Sandbox
    url: https://api.dev.eka.care
security: []
paths:
  /abdm/nhcx/v1/claims/{claimId}/claim:
    post:
      summary: Submit Claim
      description: >-
        Submits the final claim after discharge. request_type is empty for the
        first submit, QueryResponse to answer a payer query, FollowUp to
        resubmit a rejected claim. The claimed amount is the sum of
        itemized_billing. The payer answers asynchronously: a 2xx means the
        request was sent, not approved. Track it with the returned request_id on
        Get Claim Request.
      parameters:
        - description: Eka User ID (OID)
          in: header
          name: X-Pt-Id
          schema:
            type: string
        - description: Partner User ID
          in: header
          name: X-Partner-Pt-Id
          schema:
            type: string
        - description: Partner HIP ID
          in: header
          name: X-Hip-Id
          schema:
            type: string
        - description: claim_id returned by Create Claim
          in: path
          name: claimId
          required: true
          schema:
            description: claim_id returned by Create Claim
            minimum: 0
            type: integer
      requestBody:
        content:
          application/json:
            schema:
              properties:
                admission_date:
                  description: >-
                    Optional: when supplied, each claim item's servicedPeriod
                    spans admission..discharge (the full IPD stay). The case
                    does not currently capture an admission date, so without
                    this the item falls back to the discharge date alone as its
                    serviced date.
                  format: date-time
                  type:
                    - 'null'
                    - string
                auth_type:
                  type: string
                care_team_members:
                  description: >-
                    NOT case-derivable — supplied by the caller (HMIS) per
                    submission.
                  items:
                    $ref: '#/components/schemas/ModelsClaimCareTeamMember'
                  type: array
                consent:
                  $ref: '#/components/schemas/ModelsPreAuthConsent'
                  description: >-
                    Beneficiary authentication. AuthType "consent" (default)
                    sends the Authentication Consent Questionnaire response
                    (Consent) and OMITS the biometric X-Token; "biometric" sends
                    UserToken as the X-Token.
                diagnosis:
                  description: >-
                    The discharge diagnosis — NOT case-derivable (may differ
                    from the pre-auth diagnosis), supplied by the caller.
                  items:
                    $ref: '#/components/schemas/ModelsDiagnosisCoding'
                  type:
                    - array
                    - 'null'
                discharge_date:
                  format: date-time
                  type:
                    - 'null'
                    - string
                discharge_stage:
                  description: 'DIS valueString: "After surgery"(default) | ...'
                  type: string
                discharge_type:
                  description: '"home"(default) | "mortuary" | "lama" | "dama"'
                  type: string
                itemized_billing:
                  description: >-
                    Carries the client-supplied deltas per line item:
                    service_code, quantity, unit_price. Category/display are
                    optionally enriched server-side from the case's catalog
                    (catalog_md5); TotalAmount and the overall ClaimedAmount are
                    always server-computed.
                  items:
                    $ref: '#/components/schemas/ModelsBillingItem'
                  type: array
                remarks:
                  description: >-
                    Free text; mandatory once the claim is submitted >15 days
                    post-discharge. See validateClaimRequest's TAT-band check.
                  type: string
                request_type:
                  description: >-
                    Selects the NHCX workflow for this claim submission,
                    mirroring preauth: "" / "InitialRequest" → first/final claim
                    submit (workflow 15) "QueryResponse" → answer a payer query
                    on this claim (workflow 151) "Resubmission"/"FollowUp" →
                    resubmit a rejected claim (workflow 16) A
                    QueryResponse/Resubmission reuses the SAME Claim.identifier
                    (the payer's CLN, stored on the claim as claim_ref) so the
                    payer links it to the queried/rejected claim — the
                    correlation id is fresh per exchange, linkage is CLN +
                    workflow id (NHCX bundle-anatomy). Empty = initial.
                  type: string
                supporting_docs:
                  items:
                    $ref: '#/components/schemas/ModelsClaimSupportingDoc'
                  type: array
                user_token:
                  type: string
              type: object
      responses:
        '200':
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ModelsRequestIdModel'
          description: OK
        4XX:
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/NhcxError'
          description: ''
        5XX:
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/NhcxError'
          description: ''
      security:
        - authApiKey: []
components:
  schemas:
    ModelsClaimCareTeamMember:
      properties:
        hpr_id:
          description: ABDM HPR id → Practitioner HPID/HPIN
          type: string
        mobile:
          type: string
        name:
          type: string
        qualification_code:
          description: SNOMED code, e.g. "422234006"
          type: string
        qualification_display:
          description: e.g. "Ophthalmologist"
          type: string
        registration_id:
          description: NMC / council reg no.
          type: string
      required:
        - name
      type: object
    ModelsPreAuthConsent:
      properties:
        answers:
          items:
            $ref: '#/components/schemas/ModelsPreAuthQuestionnaireAnswer'
          type:
            - array
            - 'null'
        questionnaire_url:
          type: string
      type: object
    ModelsDiagnosisCoding:
      properties:
        code:
          type: string
        display:
          type: string
        system:
          description: defaults to ICD-10 if empty
          type: string
      required:
        - code
        - display
      type: object
    ModelsBillingItem:
      properties:
        care_team_sequence:
          description: → careTeam sequences
          items:
            type: integer
          type: array
        category:
          $ref: '#/components/schemas/ModelsCodeableConcept'
        cycle_dates:
          description: >-
            The per-cycle session dates ("YYYY-MM-DD", one per cycle) for a
            cyclic line — each becomes one cycle-information supportingInfo unit
            (a dated EDT entry) linked to the item. The distinct per-cycle dates
            matter: same-dated units were not counted by the payer (Experiment
            D); run 27 cleared PAYR-1368 with distinct dates. Optional; falls
            back to the line's serviced period then the admission date. See
            docs/nhcx/nhcx_cyclic_procedures.md.
          items:
            type: string
          type: array
        description:
          type: string
        diagnosis_pointer:
          description: → diagnosis sequences
          items:
            type: integer
          type: array
        information_sequence:
          description: Sequence references into Claim arrays (1-based)
          items:
            type: integer
          type: array
        procedure_code:
          type: string
        procedure_sequence:
          description: → procedure sequences
          items:
            type: integer
          type: array
        quantity:
          type: number
        service_code:
          type: string
        service_date:
          description: Legacy fields (kept for backward compat)
          format: date-time
          type:
            - 'null'
            - string
        serviced_period_end:
          type: string
        serviced_period_start:
          description: Optional servicedPeriod for the line item (YYYY-MM-DD)
          type: string
        total_amount:
          type: number
        unit_price:
          type: number
      required:
        - service_code
      type: object
    ModelsClaimSupportingDoc:
      properties:
        category:
          description: e.g. "HDS"
          type: string
        category_display:
          description: human-readable label
          type: string
        code:
          description: e.g. "MDC"
          type: string
        code_display:
          type: string
        content:
          description: base64 inline payload (PMJAY requires data, not url)
          type: string
        content_type:
          description: '"application/pdf"'
          type: string
        creation:
          description: '"YYYY-MM-DD"'
          type: string
        doc_id:
          description: >-
            References a document the backend ALREADY stores for this case (a
            saved draft's attachment). When set and Content is empty, the
            service hydrates Content from its own store before
            validating/submitting — the client never has to download bytes it
            just asked the server to keep. See hydrateDocsFromDraft.
          type: string
        title:
          type: string
      required:
        - category
        - code
        - content_type
        - title
      type: object
    ModelsRequestIdModel:
      properties:
        estimated_response_time:
          description: e.g., "4-6 hours"
          type: string
        message:
          type: string
        request_id:
          type: string
        status:
          type: string
        workflow_id:
          description: Current workflow state
          type: string
      type: object
    NhcxError:
      properties:
        error:
          type: string
        issues:
          description: >-
            Every validation problem found, when the backend rejects a submit
            before it reaches the payer
          items:
            type: string
          type: array
        updated_at:
          description: 'Only on a 409 from the draft save: the stored draft''s version'
          type: string
      type: object
    ModelsPreAuthQuestionnaireAnswer:
      properties:
        answer: {}
        link_id:
          type: string
        question:
          type: string
        questionnaire_url:
          description: STG questionnaire URL
          type: string
      type: object
    ModelsCodeableConcept:
      properties:
        coding:
          items:
            $ref: '#/components/schemas/ModelsCoding'
          type:
            - array
            - 'null'
        text:
          type: string
      type: object
    ModelsCoding:
      properties:
        code:
          type: string
        display:
          type: string
        system:
          type: string
      type: object
  securitySchemes:
    authApiKey:
      description: The API requires a Bearer token (JWT) for authentication.
      scheme: bearer
      type: http

````

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