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Resource "100154" Version "1" (Claim)

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XML or JSON representation . provenance for this resource

This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.

{
  "resourceType" : "Claim",
  "id" : "100154",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2018-12-14T02:01:33.692Z"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.</div>"
  },
  "identifier" : [
    {
      "system" : "http://happyvalley.com/claim",
      "value" : "12347"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "oral"
      }
    ]
  },
  "use" : "claim",
  "patient" : {
    "identifier" : {
      "system" : "http://www.jurisdiction.com/nationalId",
      "value" : "123AB345"
    }
  },
  "created" : "2014-08-16",
  "insurer" : {
    "identifier" : {
      "system" : "http://www.jurisdiction.com/insurers",
      "value" : "123456"
    }
  },
  "provider" : {
    "identifier" : {
      "system" : "http://www.jurisdiction.com/careorganizations",
      "value" : "HOSP12345"
    }
  },
  "priority" : {
    "coding" : [
      {
        "code" : "normal"
      }
    ]
  },
  "payee" : {
    "type" : {
      "coding" : [
        {
          "code" : "provider"
        }
      ]
    }
  },
  "careTeam" : [
    {
      "sequence" : 1,
      "provider" : {
        "identifier" : {
          "system" : "http://www.jurisdiction.com/providerId",
          "value" : "MD98765"
        }
      }
    }
  ],
  "diagnosis" : [
    {
      "sequence" : 1,
      "diagnosisCodeableConcept" : {
        "coding" : [
          {
            "code" : "123456"
          }
        ]
      }
    }
  ],
  "insurance" : [
    {
      "sequence" : 1,
      "focal" : true,
      "coverage" : {
        "identifier" : {
          "system" : "http://www.jurisdiction.com/nationalplan",
          "value" : "123AB345"
        }
      }
    }
  ],
  "item" : [
    {
      "sequence" : 1,
      "careTeamSequence" : [
        "1"
      ],
      "productOrService" : {
        "coding" : [
          {
            "code" : "1200"
          }
        ]
      },
      "servicedDate" : "2014-08-16",
      "unitPrice" : {
        "value" : 135.57,
        "currency" : "USD"
      },
      "net" : {
        "value" : 135.57,
        "currency" : "USD"
      }
    }
  ]
}