Before you start
- FHIR organizes information into defined resources such as Patient, Practitioner, Observation, Coverage, Claim, and many others that can be combined through profiles and implementation guides.
- FHIR can carry claim-related information, but a FHIR resource is not automatically an X12 837 claim transaction or a CMS-1500 paper claim.
- Real-world FHIR exchanges usually follow profiles, value sets, security requirements, and implementation guides for a specific use case.
Resources are the building blocks
FHIR organizes information into defined resources such as Patient, Practitioner, Observation, Coverage, Claim, and many others that can be combined through profiles and implementation guides.
FHIR is broader than billing
FHIR can carry claim-related information, but a FHIR resource is not automatically an X12 837 claim transaction or a CMS-1500 paper claim.
Implementation guides matter
Real-world FHIR exchanges usually follow profiles, value sets, security requirements, and implementation guides for a specific use case.
Keep FHIR separate from claim transactions
- FHIR is an HL7 standard for exchanging health information electronically using modular resources and APIs.
- FHIR can support clinical and administrative interoperability, but it is not the same thing as the X12 837 claim transaction or a CMS-1500/UB-04 paper claim.
- Implementation guides and version choices matter; a generic “supports FHIR” statement is not enough to define an interface.
Sources and verification
Use the primary source below for the code set, identifier, security standard, or interoperability topic, and apply current payer/organizational rules to the actual workflow.
Related guides
Try the software
MedClaimSoftware provides Windows tools for CMS-1500/UB-04, OWCP, ADA Dental, CMS-485, I-693, DOT, and occupational medical forms. Trials are limited-use downloads and do not require a credit card. MedClaimSoftware free trials.