Emergency Claims

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Emergency Case Claims Process Guide: Resend Doctor Consent Workflow

1. Overview: Re-sending the Doctor Consent Request

This guide focuses on the Resend Doctor Consent workflow for emergency claims. When you provide the attending practitioner's details - at claim creation or when adding a doctor - a doctor consent request is sent to that doctor via SMS with an approval code. If the doctor does not see the request, the provider can re-send it with this workflow.

1.1. What This Workflow Does

The Resend Doctor Consent workflow re-initiates a doctor consent request via POST /api/v1/claims/doctor-consent. For emergency claims, the request_type is EMERGENCY_CLAIM_DOCTOR_APPROVAL_REQUEST. It identifies the claim by emergency_claim_id (with its created timestamp) and consent_token, the service by intervention_code, and the doctor by identification_type, identification_number, and regulation_body.

1.2. Why This Workflow Is Critical (The "Why It Matters")

Doctor consent is a prerequisite for the emergency claim:

• Unblocks the Claim: If the doctor missed the original OTP request, re-sending lets them act on it.
• Avoids Re-work: It re-sends the request without recreating the claim or re-adding the doctor.
• Keeps Care Moving: In time-critical emergencies, a quick resend keeps the claim on track for the 24-hour submission window.

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2. Workflow Details: Resend Doctor Consent

2.1. Workflow Description: Step-by-Step System Behavior

When a resend request comes into the system, here is what unfolds:

1. Input Reception: The system receives the emergency_claim_id and its created timestamp, the claim's consent_token, the intervention_code, the request_type, and the doctor's identification details (identification_type, identification_number, regulation_body).
2. Authorization Validation: The system confirms the consent_token resolves to an active (authorized or emergency-authorized) authorization owned by the requesting facility, and that the intervention_code exists on it.
3. Doctor Resolution: The doctor is looked up in the Health Worker Registry using the identification details, with a check that they can perform the intervention.
4. Resend: A fresh doctor consent request is sent to the doctor via SMS, carrying an approval code linked to the emergency_claim_id.

2.2. Key Validations: Our System's Essential Checks

• Emergency Shape Selection:
  • What it means: The request must carry emergency_claim_id and must NOT carry service_type (that field selects the EMT shape). request_type must be EMERGENCY_CLAIM_DOCTOR_APPROVAL_REQUEST.
  • Why it's important: Without emergency_claim_id the system cannot classify the request and rejects it with "Kindly provide valid service type, emergency case unique identifier or request type for a valid doctor request."
• Valid Authorization and Intervention:
  • What it means: The consent_token must resolve to an active authorization owned by your facility, and the intervention_code must exist on it.
  • Why it's important: The request is re-sent for the correct case and service.
• Doctor Resolvable in the Health Worker Registry:
  • What it means: The identification_type, identification_number, and regulation_body must match a registered practitioner permitted to perform the intervention.
  • Why it's important: The consent request reaches a verified practitioner.

2.3. Workflow Data Dictionary: What Information We Work With

Field Name	Description	Data Type	Required	Purpose
request_type	The type of consent request. For emergency claims use EMERGENCY_CLAIM_DOCTOR_APPROVAL_REQUEST.	string (enum)	Yes	Declares the request context.
emergency_claim_id	The identifier of the emergency claim, as returned when the claim was created.	string	Yes	Selects the emergency shape and links the doctor's approval response back to the claim.
created	ISO 8601 timestamp of when the emergency claim was created.	string (date-time)	Yes	Shown to the doctor in the consent request.
consent_token	The token returned when the emergency claim was created.	string	Yes	Identifies the claim's authorization.
intervention_code	The intervention on the emergency claim.	string	Yes	Identifies the service the consent applies to.
identification_type	Type of doctor identifier: registration_number, National ID, Alien ID, or Refugee ID.	string (enum)	Yes	Identifies the doctor in the Health Worker Registry.
identification_number	The doctor's identification number, matching the identification type.	string	Yes	Identifies the doctor in the Health Worker Registry.
regulation_body	The doctor's regulatory body: KMPDC, COC, NCK, or PPB.	string (enum)	Yes	Identifies the doctor in the Health Worker Registry.
practitioner_registration_number	The doctor's registration number.	string	No	Not used to resolve the doctor in the emergency flow - the identification fields above are.

2.4. Expected Outcomes from this Workflow

• Success: A fresh doctor consent request is sent to the doctor via SMS.
• Failure: Missing emergency_claim_id - the system cannot classify the request as an emergency resend and rejects it.
• Failure: Invalid authorization or intervention - the consent_token or intervention_code does not match an active emergency claim owned by your facility.
• Failure: Doctor not resolvable - the identification details do not match a practitioner in the Health Worker Registry who can perform the intervention.

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3. Critical Success Factors for Resend Doctor Consent Integration

• Always Include the Claim Identifier: Send the emergency_claim_id and created returned when the claim was created - without them the request is rejected.
• Use the Emergency Request Type, Without a Service Type: Set request_type to EMERGENCY_CLAIM_DOCTOR_APPROVAL_REQUEST and omit service_type (it is only for EMT claims).
• Identify the Doctor by Identification Details: Provide identification_type, identification_number, and regulation_body for the doctor already on the claim - practitioner_registration_number alone is not used in the emergency flow.
• Match the Claim: Provide the same consent_token and intervention_code as the claim.
• Mind the 24-Hour Window: Re-send promptly so doctor consent does not delay submission.

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4. Related Resources

• Emergency Case Claims Process Overview
• Create an Emergency Case Claim
• Add a Doctor to an Emergency Case Claim
• Claims & Preauths API Reference