FHIR IG analytics| Package | hl7.fhir.us.davinci-pas |
| Resource Type | Claim |
| Id | Claim-HomecareAuthorizationUpdateExample.json |
| FHIR Version | R4 |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: Claim HomecareAuthorizationUpdateExample
Language: en
Profile: PAS Claim Update
identifier: http://example.org/PATIENT_EVENT_TRACE_NUMBER/111099-UPDATE
status: Active
type: Professional
use: Preauthorization
patient: JOE SMITH Male, DoB Unknown ( http://example.org/MIN#12345678901)
created: 2019-07-20 11:01:00+0500
insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY
provider: Organization DR. JOE SMITH CORPORATION
priority: Normal
| Sequence | Focal | Coverage |
| 1 | true | Coverage: status = active; subscriberId = 1122334455; relationship = Self |
item
ServiceItemRequestType: Health Services Review
CertificationType: Initial
sequence: 1
category: Home Health Care
productOrService: G0154
location: Office
item
ServiceItemRequestType: Health Services Review
CertificationType: Cancel
InfoCancelledFlag: true
sequence: 2
category: Home Health Care
productOrService: B4184
location: Office
item
ServiceItemRequestType: Health Services Review
CertificationType: Initial
InfoChanged: added
sequence: 3
category: Home Health Care
productOrService: B4185
location: Office
FHIR
FHIRsmith{
"resourceType": "Claim",
"id": "HomecareAuthorizationUpdateExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update"
]
},
"language": "en",
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"identifier": [
{
"system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
"value": "111099-UPDATE",
"assigner": {
"identifier": {
"system": "http://example.org/USER_ASSIGNED",
"value": "9012345678"
}
}
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "professional"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "Patient/SubscriberExample"
},
"created": "2019-07-20T11:01:00+05:00",
"insurer": {
"reference": "Organization/InsurerExample"
},
"provider": {
"reference": "Organization/UMOExample"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"related": [
{
"claim": {
"reference": "Claim/HomecareAuthorizationExample"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship",
"code": "prior"
}
]
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/InsuranceExample"
}
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1525",
"code": "HS",
"display": "Health Services Review"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1322",
"code": "I",
"display": "Initial"
}
]
}
}
],
"sequence": 1,
"category": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1365",
"code": "42",
"display": "Home Health Care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
"code": "G0154"
}
]
},
"locationCodeableConcept": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set",
"code": "11"
}
]
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1525",
"code": "HS",
"display": "Health Services Review"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1322",
"code": "3",
"display": "Cancel"
}
]
}
}
],
"modifierExtension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled",
"valueBoolean": true
}
],
"sequence": 2,
"category": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1365",
"code": "42",
"display": "Home Health Care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
"code": "B4184"
}
]
},
"locationCodeableConcept": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set",
"code": "11"
}
]
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1525",
"code": "HS",
"display": "Health Services Review"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType",
"valueCodeableConcept": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1322",
"code": "I",
"display": "Initial"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged",
"valueCode": "added"
}
],
"sequence": 3,
"category": {
"coding": [
{
"system": "https://codesystem.x12.org/005010/1365",
"code": "42",
"display": "Home Health Care"
}
]
},
"productOrService": {
"coding": [
{
"system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
"code": "B4185"
}
]
},
"locationCodeableConcept": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set",
"code": "11"
}
]
}
}
]
}