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Narrative

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Source1

{
  "resourceType": "ClaimResponse",
  "id": "PractitionerRequestorResponseExample",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "identifier": [
    {
      "system": "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
      "value": "111099",
      "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": "2005-05-02T11:02:00+05:00",
  "insurer": {
    "reference": "Organization/InsurerExample"
  },
  "requestor": {
    "reference": "PractitionerRole/ReferralPractitionerRoleExample"
  },
  "request": {
    "reference": "Claim/ReferralAuthorizationExample"
  },
  "outcome": "complete",
  "item": [
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemRequestedServiceDate",
          "valuePeriod": {
            "start": "2005-05-02",
            "end": "2005-06-02"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
          "valueDate": "2005-05-02"
        },
        {
          "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod",
          "valuePeriod": {
            "start": "2005-05-02",
            "end": "2005-06-02"
          }
        },
        {
          "extension": [
            {
              "url": "provider",
              "valueReference": {
                "reference": "Practitioner/ReferralPractitionerExample"
              }
            }
          ],
          "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedProvider"
        },
        {
          "extension": [
            {
              "url": "productOrServiceCode",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "https://codesystem.x12.org/005010/1365",
                    "code": "3",
                    "display": "Consultation"
                  }
                ]
              }
            },
            {
              "url": "unitPrice",
              "valueMoney": {
                "value": 100,
                "currency": "USD"
              }
            },
            {
              "url": "quantity",
              "valueQuantity": {
                "value": 1
              }
            }
          ],
          "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
        }
      ],
      "itemSequence": 1,
      "adjudication": [
        {
          "extension": [
            {
              "extension": [
                {
                  "url": "number",
                  "valueString": "AUTH0001"
                },
                {
                  "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "https://codesystem.x12.org/005010/306",
                        "code": "A1",
                        "display": "Certified in total"
                      }
                    ]
                  }
                }
              ],
              "url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
            }
          ],
          "category": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                "code": "submitted"
              }
            ]
          }
        }
      ]
    }
  ]
}