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Packagehl7.fhir.us.eltss.r4b
Resource TypeClaim
IdClaim-claim2.json
FHIR VersionR4B

Resources that use this resource

No resources found

Resources that this resource uses

No resources found

Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: Claim

Resource Claim "claim2" Version "1" Updated "2020-09-03 10:16:03-0400"

Information Source: #KZ0jzPjXDrhCiMif!

Profile: Claim_eltss

status: active

type: Professional (Claim Type Codes#professional)

use: claim

patient: Patient/patientBSJ1 " SMITH-JOHNSON"

created: 2020-05-01

provider: Organization/funding1 "Texas Department of Community Health"

priority: Normal (Process Priority Codes#normal)

Insurances

-SequenceFocalCoverage
*1trueCoverage/coverage1

item

sequence: 1

productOrService: G0108 (HCFA Procedure Codes (HCPCS)#G0108)

UnitPrices

-Value
*55

Nets

-Value
*660

Source1

{
  "resourceType": "Claim",
  "id": "claim2",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2020-09-03T10:16:03.512-04:00",
    "source": "#KZ0jzPjXDrhCiMif",
    "profile": [
      "http://hl7.org/fhir/us/eltss/StructureDefinition/Claim-eltss"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "professional"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/patientBSJ1"
  },
  "created": "2020-05-01",
  "provider": {
    "reference": "Organization/funding1"
  },
  "priority": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/processpriority",
        "code": "normal"
      }
    ]
  },
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/coverage1"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "productOrService": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/HCPCS-all-codes",
            "code": "G0108"
          }
        ]
      },
      "unitPrice": {
        "value": 55
      },
      "net": {
        "value": 660
      }
    }
  ]
}