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Resource "960151" Version "1" (Claim)

Tags:

XML or JSON representation . provenance for this resource

A human-readable rendering of the Claim

{
  "resourceType" : "Claim",
  "id" : "960151",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2018-12-14T02:01:34.067Z"
  },
  "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" : "96123451"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "institutional"
      }
    ]
  },
  "use" : "claim",
  "patient" : {
    "reference" : "Patient/1"
  },
  "billablePeriod" : {
    "start" : "2014-08-15",
    "end" : "2014-08-16"
  },
  "created" : "2014-08-16",
  "enterer" : {
    "identifier" : {
      "system" : "http://jurisdiction.org/facilities/HOSP1234/users",
      "value" : "UC1234"
    }
  },
  "insurer" : {
    "reference" : "Organization/2"
  },
  "provider" : {
    "identifier" : {
      "system" : "http://npid.org/providerid",
      "value" : "NJ12345"
    }
  },
  "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"
      },
      "responsible" : true,
      "role" : {
        "coding" : [
          {
            "system" : "http://example.org/fhir/CodeSystem/claim-careteamrole",
            "code" : "primary"
          }
        ]
      },
      "qualification" : {
        "coding" : [
          {
            "system" : "http://example.org/fhir/CodeSystem/provider-qualification",
            "code" : "physician"
          }
        ]
      }
    }
  ],
  "supportingInfo" : [
    {
      "sequence" : 1,
      "category" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code" : "employmentimpacted"
          }
        ]
      },
      "timingPeriod" : {
        "start" : "2014-08-16",
        "end" : "2014-08-16"
      }
    },
    {
      "sequence" : 2,
      "category" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code" : "hospitalized"
          }
        ]
      },
      "timingPeriod" : {
        "start" : "2014-08-15",
        "end" : "2014-08-16"
      }
    }
  ],
  "diagnosis" : [
    {
      "sequence" : 1,
      "diagnosisCodeableConcept" : {
        "coding" : [
          {
            "code" : "654456"
          }
        ]
      },
      "type" : [
        {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
              "code" : "admitting"
            }
          ]
        }
      ],
      "packageCode" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup",
            "code" : "400",
            "display" : "Head trauma - concussion"
          }
        ]
      }
    }
  ],
  "insurance" : [
    {
      "sequence" : 1,
      "focal" : true,
      "coverage" : {
        "reference" : "Coverage/9876B1"
      },
      "businessArrangement" : "BA987123",
      "preAuthRef" : [
        "PA2014G56473"
      ]
    }
  ],
  "accident" : {
    "date" : "2014-07-09",
    "type" : {
      "coding" : [
        {
          "system" : "http://terminology.hl7.org/CodeSystem/v3-ActIncidentCode",
          "code" : "SPT",
          "display" : "Sporting Accident"
        }
      ]
    },
    "locationAddress" : {
      "text" : "Grouse Mountain Ski Hill"
    }
  },
  "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"
      }
    }
  ],
  "total" : {
    "value" : 125.00,
    "currency" : "USD"
  }
}