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FHIR IG analytics

Packagehl7.fhir.us.qicore.r4
Resource TypeClaim
IdClaim-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: Claim example

Profile: QICore Claim

identifier: http://example.org/claim/6612346

status: Active

type: Vision

use: Claim

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

created: 2014-08-16

insurer: Organization Health Level Seven International

provider: Practitioner Adam Careful

priority: Normal

prescription: MedicationRequest: status = active; intent = order; medication[x] = ->Medication alemtuzumab 10 MG/ML [Lemtrada]; authoredOn = 2015-03-25 19:32:52-0500

Payees

-TypeParty
*ProviderPractitioner Adam Careful

CareTeams

-SequenceProvider
*1Practitioner Adam Careful

Diagnoses

-SequenceDiagnosis[x]
*1Degenerative myopia, bilateral

Insurances

-SequenceFocalCoverage
*1trueCoverage: identifier = Member Number; status = active; type = Other Private Insurance; dependent = 0; relationship = Self; period = 2011-05-23 --> 2012-05-23; order = 9

item

sequence: 1

careTeamSequence: 1

productOrService: glasses

serviced: 2014-08-16

UnitPrices

-ValueCurrency
*214.00United States dollar

detail

sequence: 1

productOrService: frame

UnitPrices

-ValueCurrency
*100.00United States dollar

Nets

-ValueCurrency
*100.00United States dollar

detail

sequence: 2

productOrService: lens

quantity: 2

UnitPrices

-ValueCurrency
*50.00United States dollar

Nets

-ValueCurrency
*100.00United States dollar

detail

sequence: 3

productOrService: fst

UnitPrices

-ValueCurrency
*200.00United States dollar

factor: 0.07

Nets

-ValueCurrency
*14.00United States dollar

Source1

{
  "resourceType": "Claim",
  "id": "example",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "identifier": [
    {
      "system": "http://example.org/claim",
      "value": "6612346"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "vision"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/example"
  },
  "created": "2014-08-16",
  "insurer": {
    "reference": "Organization/example"
  },
  "provider": {
    "reference": "Practitioner/example"
  },
  "priority": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/processpriority",
        "code": "normal"
      }
    ]
  },
  "prescription": {
    "reference": "MedicationRequest/example"
  },
  "payee": {
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/payeetype",
          "code": "provider"
        }
      ]
    },
    "party": {
      "reference": "Practitioner/example"
    }
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/example"
      }
    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/sid/icd-10-cm",
            "code": "H44.23"
          }
        ]
      }
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/example"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://example.org/fhir/CodeSystem/ex-visionservice",
            "code": "glasses"
          }
        ]
      },
      "servicedDate": "2014-08-16",
      "unitPrice": {
        "value": 214,
        "currency": "USD"
      },
      "detail": [
        {
          "sequence": 1,
          "productOrService": {
            "coding": [
              {
                "system": "http://example.org/fhir/CodeSystem/ex-visionservice",
                "code": "frame"
              }
            ]
          },
          "unitPrice": {
            "value": 100,
            "currency": "USD"
          },
          "net": {
            "value": 100,
            "currency": "USD"
          }
        },
        {
          "sequence": 2,
          "productOrService": {
            "coding": [
              {
                "system": "http://example.org/fhir/CodeSystem/ex-visionservice",
                "code": "lens"
              }
            ]
          },
          "quantity": {
            "value": 2
          },
          "unitPrice": {
            "value": 50,
            "currency": "USD"
          },
          "net": {
            "value": 100,
            "currency": "USD"
          }
        },
        {
          "sequence": 3,
          "productOrService": {
            "coding": [
              {
                "system": "http://example.org/fhir/CodeSystem/ex-visionservice",
                "code": "fst"
              }
            ]
          },
          "unitPrice": {
            "value": 200,
            "currency": "USD"
          },
          "factor": 0.07,
          "net": {
            "value": 14,
            "currency": "USD"
          }
        }
      ]
    }
  ]
}