FHIR © HL7.org  |  Server Home  |  Health Intersections FHIR Server v1.0.287  |  FHIR Version 4.0.0  | User: ANONYMOUS (Unknown)  

Resource "960150" Version "1" (Claim)

Tags:

XML or JSON representation . provenance for this resource

A human-readable rendering of the Claim

{
  "resourceType" : "Claim",
  "id" : "960150",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2018-12-14T02:01:34.036Z"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Claim</div>"
  },
  "identifier" : [
    {
      "system" : "http://happyhospital.com/claim",
      "value" : "9612345"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "institutional"
      }
    ]
  },
  "subType" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/ex-claimsubtype",
        "code" : "emergency"
      }
    ]
  },
  "use" : "claim",
  "patient" : {
    "reference" : "Patient/1"
  },
  "created" : "2014-08-16",
  "enterer" : {
    "identifier" : {
      "system" : "http://jurisdiction.org/facilities/HOSP1234/users",
      "value" : "UC1234"
    }
  },
  "insurer" : {
    "reference" : "Organization/2"
  },
  "provider" : {
    "reference" : "Organization/1"
  },
  "priority" : {
    "coding" : [
      {
        "code" : "normal"
      }
    ]
  },
  "payee" : {
    "type" : {
      "coding" : [
        {
          "code" : "provider"
        }
      ]
    }
  },
  "facility" : {
    "identifier" : {
      "system" : "http://jurisdiction.org/facilities",
      "value" : "HOSP1234"
    }
  },
  "careTeam" : [
    {
      "sequence" : 1,
      "provider" : {
        "reference" : "Practitioner/example"
      }
    }
  ],
  "diagnosis" : [
    {
      "sequence" : 1,
      "diagnosisCodeableConcept" : {
        "coding" : [
          {
            "code" : "654456"
          }
        ]
      }
    }
  ],
  "procedure" : [
    {
      "sequence" : 1,
      "type" : [
        {
          "coding" : [
            {
              "code" : "primary"
            }
          ]
        }
      ],
      "date" : "2014-08-16",
      "procedureCodeableConcept" : {
        "coding" : [
          {
            "code" : "SDI9901"
          }
        ],
        "text" : "Subcutaneous diagnostic implant"
      },
      "udi" : [
        {
          "reference" : "Device/example"
        }
      ]
    }
  ],
  "insurance" : [
    {
      "sequence" : 1,
      "focal" : true,
      "coverage" : {
        "reference" : "Coverage/9876B1"
      }
    }
  ],
  "item" : [
    {
      "sequence" : 1,
      "careTeamSequence" : [
        "1"
      ],
      "productOrService" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/ex-serviceproduct",
            "code" : "exam"
          }
        ]
      },
      "servicedDate" : "2014-08-16",
      "unitPrice" : {
        "value" : 125.00,
        "currency" : "USD"
      },
      "net" : {
        "value" : 125.00,
        "currency" : "USD"
      },
      "encounter" : [
        {
          "reference" : "Encounter/example"
        }
      ]
    }
  ],
  "total" : {
    "value" : 125.00,
    "currency" : "USD"
  }
}