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Packagehl7.fhir.us.qicore
Resource TypeClaimResponse
IdClaimResponse-example.json
FHIR VersionR4

Resources that use this resource

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Resources that this resource uses

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Narrative

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

Generated Narrative: ClaimResponse example

Language: en

Profile: QICore ClaimResponse

status: Active

type: Vision

use: Preauthorization

patient: Jim Chalmers Male, DoB: 1974-12-25 ( Medical record number (use: usual, period: 2001-05-06 --> (ongoing)))

created: 2018-02-24

insurer: Organization Health Level Seven International

requestor: Practitioner Adam Careful

request: Claim: identifier = http://example.org/claim#6612346; status = active; type = Vision; use = claim; created = 2014-08-16; priority = Normal

outcome: Queued

item

itemSequence: 1

adjudication

category: Submitted Amount

Amounts

-ValueCurrency
*235.40United States dollar

Source1

{
  "resourceType": "ClaimResponse",
  "id": "example",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse"
    ]
  },
  "language": "en",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "vision"
      }
    ]
  },
  "use": "preauthorization",
  "patient": {
    "reference": "Patient/example"
  },
  "created": "2018-02-24",
  "insurer": {
    "reference": "Organization/example"
  },
  "requestor": {
    "reference": "Practitioner/example"
  },
  "request": {
    "reference": "Claim/example"
  },
  "outcome": "queued",
  "item": [
    {
      "itemSequence": 1,
      "adjudication": [
        {
          "category": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                "code": "submitted"
              }
            ]
          },
          "amount": {
            "value": 235.4,
            "currency": "USD"
          }
        }
      ]
    }
  ]
}