Claims Lifecycle Journey

A member creates a care episode by submitting a prior authorisation and a claim after receiving treatment. The claim is reviewed by the adjudication engine (not yet built — claims remain at SUBMITTED status until then).

Sequence Diagram

State Machine

Prior Auth

Claim

API Reference

Step	Service	Method	Path	Auth	Response
Get token	Keycloak	POST	/realms/olly/protocol/openid-connect/token	None	access_token
Submit prior auth	claims	POST	/prior-auth	Member JWT	202 {Locator, Status:"SUBMITTED"}
Get prior auth	claims	GET	/prior-auth/{locator}	Member JWT	200 {Locator, Status}
Submit claim	claims	POST	/claims	Member JWT	202 {Locator, Status}
Get claim	claims	GET	/claims/{locator}	Member JWT	200 {Locator, Status}
List claims	claims	GET	/claims	Member JWT	200 list; filter with ?status=SUBMITTED

Notes

• Prior auth providerId, policyId, memberPartyId are UUIDs; procedureCode is a string (e.g. "99213").
• Claims policyLocator and memberLocator are string locators; claimantPartyId is a UUID.
• Both prior auth and claims return HTTP 202 Accepted on creation (not 201).
• Initial prior auth status is "SUBMITTED" — not "PENDING".
• Claim adjudication (moving beyond SUBMITTED) requires the adjudication engine (not yet built).