---
title: "NHCX Claim"
description: "How to submit a claim for reimbursement after treatment, including enhancement of a pre-authorization and discharge details."
date: 2026-08-21
lastModified: 2026-08-21
category: "nhcx"
author: "Dr. Umesh Bilagi"
beta: true
---

## Overview

A **claim** is the formal request for reimbursement sent to the payer after treatment. The NHCX claim form collects the items, diagnoses, and discharge details, builds a FHIR `Claim` bundle, and submits it to the payer.

Claims build on the earlier steps in the workflow: the eligibility check and pre-authorization provide the policy identity and approved items, which the claim references.

## Where to find it

Open the patient's NHCX page, find the relevant workflow, and choose **Claim**. The form is pre-populated from the pre-authorization and eligibility data already recorded for that workflow.

## What the claim form captures

The claim form includes:

- **Claim items** — the procedures/services performed, with their codes, quantities, and amounts.
- **Diagnosis** — the diagnoses tied to the claim, referenced by the items.
- **Discharge disposition** and **discharge status** — how the patient left (relevant for IPD claims).
- **Questionnaire answers** — payer-specific discharge/plan questions.
- **Biometric verification** — for admission and discharge capture (see [NHCX Biometric](/docs/nhcx-biometric)).

For a newborn claim, the parent relation and proof-of-birth documents are carried in automatically. See [NHCX Newborn Claim](/docs/nhcx-newborn-claim).

## Enhancement

If the treatment requires more than what was pre-authorized, the claim can be submitted as an **enhancement**. This adds new items on top of the existing pre-authorization. The system maps the pre-authorized items to the new claim items so only the additional work is charged.

## Common Issues

- **Serialization error when loading the claim** — this is typically a malformed value in the pre-authorization data; re-check the workflow for any failed/partial rows before retrying.
- **Items not showing** — the claim reads from the pre-authorization; ensure the pre-auth was submitted successfully first.

## FAQ

**Q: What is the difference between a pre-auth and a claim?**
A: A pre-auth is approval sought *before* treatment. A claim is the request for payment submitted *after* treatment.

**Q: What is an enhancement?**
A: An enhancement adds extra procedures/items to an already-approved pre-authorization, so the claim reflects the full treatment while only charging for the additional work.

**Q: When is a claim for a newborn filed under the parent?**
A: When the eligibility check linked a parent UHID, the claim automatically uses the parent's policy identity. See [NHCX Newborn Claim](/docs/nhcx-newborn-claim).