A patient presents at a facility for emergency care and can be identified at the point of care. The claim is created under SHA's Emergency, Chronic and Critical Illness Fund (ECCIF), billed by approved protocols, and submitted within 24 hours. Emergency claims do not use the normal eligibility/preauth gating - care is initiated first and reconciled through the emergency flow.
Claim Properties
Property
Value
Fund
ECCIF (Emergency, Chronic and Critical Illness Fund)
Access Point
Outpatient (OP) and Inpatient (IP)
Payment Mechanism
Fee for Service / Fixed Fee for Service (billed against approved protocol tariffs)
Needs Preauth
No (doctor consent is requested instead)
Patient Identity
Identified (beneficiary_cr_id + patient OTP)
Interventions
Exactly one per emergency claim
Consent
OTP only (no biometrics, no discharge OTP)
Claim Dispatch
Submit, within 24 hours
How to identify this scenario: Emergency interventions are identifiable by the SHA-01 intervention-code prefix (for example SHA-01-005, Shock states). The patient's identity is confirmed at presentation, so the emergency claim can be created with beneficiary_cr_id and a patient otp.
An emergency claim covers exactly one intervention, and per SHA rules it must be submitted within 24 hours. The discharge_reason (one of RECOVERED, REFERRED, DECEASED, ABSCONDED, OTHER) is required at submission.
OTP Only - No Biometrics, No Discharge OTP
Emergency consent uses OTP only. There is no biometrics path and no inpatient-style discharge OTP in the emergency flow.
Practitioner Details Trigger Doctor Consent
The attending practitioner details sent at claim creation cause a doctor consent request to be delivered by OTP (request_type: EMERGENCY_CLAIM_DOCTOR_APPROVAL_REQUEST). If the doctor misses it, resend with POST /api/v1/claims/doctor-consent; to change the doctor, remove and re-add via POST / DELETE /api/v1/claims/doctors.
Protocol-Based Billing
Emergency interventions are billed by protocol, not free-form line items. Always fetch the approved protocols and their applicableTariff first, then bill within the approved amount. Attachments are at the intervention level and must use the intervention's applicableDocumentTypes.
