A patient presents for emergency care but cannot be identified at the point of care (for example, brought in unconscious and alone). The claim is created under SHA's Emergency, Chronic and Critical Illness Fund (ECCIF) as an unidentified patient, care is billed by protocol, and the patient may be identified later when they are recognised. The claim is submitted within 24 hours - either as an identified patient or, if still unknown, with a reason_for_unknown_patient.
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
Unidentified at creation; may be identified later
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 cannot be identified at presentation, so the emergency claim is created withoutbeneficiary_cr_id or a patient otp.
consent_token, discharge_reason, invoice_number, reason_for_unknown_patient (only if still unidentified)
Emergency claim submitted to SHA under ECCIF
Field Flow Between Steps
Output Field
Step It Comes From
Used In
access_token
Step 1
Authorization header - all requests
authorization_code (consent_token)
Step 2
Steps 3b, 5, 8, 9, 10
intervention_code
Chosen for the emergency case
Steps 2, 3b, 4, 5
protocolCode + applicableTariff
Step 4
protocol_code and unit_price in Step 5
beneficiary_cr_id
Step 6 (if identified later)
beneficiary_cr_id in Step 8
OTP
Patient receives via SMS (Step 7)
otp in Step 8
Two Submission Paths
Identified Later vs Still Unknown
By the time you submit, the patient is in one of two states:
State
What you did
Submission field
Identified later
Ran Phase 5 to link the patient (unknown to known)
Omit reason_for_unknown_patient
Still unknown
Could not identify the patient during the visit
Include reason_for_unknown_patient - one of SHA_UNREGISTERED or DECEASED
In both cases discharge_reason (RECOVERED, REFERRED, DECEASED, ABSCONDED, OTHER) is required.
Important Notes
One Intervention, Submit Within 24 Hours
An emergency claim covers exactly one intervention and must be submitted within 24 hours of the emergency, whether or not the patient was identified.
Identification Re-uses the Create Endpoint
Identifying an unknown patient re-hits POST /api/v1/claims/emergency with the original unidentified payload plus beneficiary_cr_id, otp, and the consent_token of the unknown claim. It updates the same claim - the protocols already added are retained.
OTP Only - No Biometrics
Emergency consent uses OTP only, including the identification step. There is no biometrics path and no discharge OTP in the emergency flow.
