FHIR IG analytics| Package | hie-fhir-ig-profile |
| Resource Type | Claim |
| Id | Claim-HIEClaim-example.json |
| FHIR Version | R4B |
No resources found
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Note: links and images are rebased to the (stated) source
HIE Claim
Outpatient professional claim for Jane Patient, created 2025-11-12. Billed by Acme Health Center to PayerOne Insurance.
| Section | Details |
|---|---|
| Identifiers | Claim Number: CLM-2025-0001 |
| Claim | Status: active, Use: claim, Type: professional, Priority: routine |
| Patient | Jane Patient (Patient/p-001) |
| Billable period | 2025-11-10 to 2025-11-10 |
| Provider | Acme Health Center (Organization/org-001) |
| Insurer | PayerOne Insurance (Organization/org-payer-001), Coverage cov-001, Focal: true |
| Diagnosis | Primary: Headache (R51.9 ICD-10-CM) |
| Items | 1 x 99213, Office/outpatient visit est, UnitPrice 75.00 USD, Net 75.00 USD |
| Total | Category: submitted, Amount: 75.00 USD |
FHIR
FHIRsmith{
"resourceType": "Claim",
"id": "HIEClaim-example",
"meta": {
"profile": [
"https://nshr.dha.go.ke/fhir/StructureDefinition/claim"
]
},
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"identifier": [
{
"use": "official",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "ACSN",
"display": "Accession ID"
}
]
},
"system": "http://example.org/claims",
"value": "CLM-2025-0001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional",
"display": "Professional"
}
]
},
"use": "claim",
"patient": {
"reference": "Patient/p-001",
"display": "Jane Patient"
},
"billablePeriod": {
"start": "2025-11-10",
"end": "2025-11-10"
},
"created": "2025-11-12T10:15:00+03:00",
"insurer": {
"reference": "Organization/org-payer-001",
"display": "PayerOne Insurance"
},
"provider": {
"reference": "Organization/org-001",
"display": "Acme Health Center"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "routine",
"display": "Routine"
}
]
},
"diagnosis": [
{
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/icd-10-cm",
"code": "R51.9",
"display": "Headache, unspecified"
}
]
},
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-diagnosis-type",
"code": "principal",
"display": "Principal Diagnosis"
}
]
}
]
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/cov-001",
"display": "Primary PPO Plan"
}
}
],
"item": [
{
"sequence": 1,
"revenue": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-revenue-center",
"code": "100",
"display": "General Medical"
}
]
},
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code": "professional-visit",
"display": "Professional Visit"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99213",
"display": "Office or other outpatient visit, established patient"
}
]
},
"quantity": {
"value": 1
},
"unitPrice": {
"value": 75,
"currency": "USD"
},
"net": {
"value": 75,
"currency": "USD"
},
"encounter": [
{
"reference": "Encounter/enc-001",
"display": "Ambulatory visit 2025-11-10"
}
],
"detail": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99213",
"display": "Office or other outpatient visit, established patient"
}
]
},
"quantity": {
"value": 1
},
"unitPrice": {
"value": 75,
"currency": "USD"
},
"net": {
"value": 75,
"currency": "USD"
},
"subDetail": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99070",
"display": "Supplies and materials"
}
]
},
"quantity": {
"value": 1
},
"unitPrice": {
"value": 5,
"currency": "USD"
},
"net": {
"value": 5,
"currency": "USD"
}
}
]
}
]
}
],
"total": {
"value": 75,
"currency": "USD"
}
}