Candidate Standard

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The architecture for all messages in this standard are defined herein. The Record Types used in all messages formatted in accordance with this standard can be found in Part 2 of the Claim Detail Message Suite Standard.

These Record Types are used in Profile-specific standards which are, in turn, built upon this standard. At the time of writing this Part, the following Profiles have been defined by DDEX as:

  1. Profile for Post-usage Reporting of New Claims and/or Invoice Details (Part 3);
  2. Profile for Correcting Post-usage Reports of New Claims and/or Invoice Details (Part 3);
  3. Profile for Pre-usage Reporting of New Claims (Part 3);
  4. Profile for Correcting Pre-usage Reports of New Claims (Part 3);
  5. Notification of Record Discrepancies (Part 4); and
  6. Notification of Over-Claim Discrepancies (Part 5).

DDEX expects to add further Profile standards over time. They will be published on the DDEX Knowledge Base where a complete list of Profiles of the Claim Detail Message Suite Standard can be found.

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