FHIR IG analytics| Package | ihe.iti.fais |
| Resource Type | Bundle |
| Id | Bundle-ex-claim-response-acc-bundle-3.json |
| FHIR Version | R4 |
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FHIR
FHIRsmith{
"resourceType": "Bundle",
"id": "ex-claim-response-acc-bundle-3",
"meta": {
"profile": [
"https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse.Bundle"
]
},
"type": "collection",
"entry": [
{
"fullUrl": "https://profiles.ihe.net/ITI/FAIS/ClaimResponse/ex-claim-response-acc-3",
"resource": {
"resourceType": "ClaimResponse",
"id": "ex-claim-response-acc-3",
"meta": {
"profile": [
"https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_ex-claim-response-acc-3\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse ex-claim-response-acc-3</b></p><a name=\"ex-claim-response-acc-3\"> </a><a name=\"hcex-claim-response-acc-3\"> </a><a name=\"ex-claim-response-acc-3-en-US\"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno Female, DoB: 2000-05-04</a></p><p><b>created</b>: 2024-07-16 03:00:00+0000</p><p><b>insurer</b>: <a href=\"Organization-ex-insurer-1.html\">Organization National Health Insurance Scheme</a></p><p><b>request</b>: <a href=\"Claim-ex-claim-3.html\">Claim: status = active; type = Institutional; use = claim; created = 2024-07-15 03:00:00+0000; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Accepted</p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-ex-coverage-1.html\">Coverage: status = active; type = public healthcare; subscriberId = 05710b56-4448-11ef-b676-774a043da147; relationship = Self; period = 2024-01-01 --> 2024-12-31</a></td></tr></table></div>"
},
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "Patient/ex-beneficiary-1"
},
"created": "2024-07-16T03:00:00Z",
"insurer": {
"reference": "Organization/ex-insurer-1"
},
"request": {
"reference": "Claim/ex-claim-3"
},
"outcome": "complete",
"disposition": "Accepted",
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/ex-coverage-1"
}
}
]
}
},
{
"fullUrl": "https://profiles.ihe.net/ITI/FAIS/Patient/ex-beneficiary-1",
"resource": {
"resourceType": "Patient",
"id": "ex-beneficiary-1",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_ex-beneficiary-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient ex-beneficiary-1</b></p><a name=\"ex-beneficiary-1\"> </a><a name=\"hcex-beneficiary-1\"> </a><a name=\"ex-beneficiary-1-en-US\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Purity Atieno Female, DoB: 2000-05-04</p><hr/></div>"
},
"name": [
{
"family": "Atieno",
"given": [
"Purity"
]
}
],
"gender": "female",
"birthDate": "2000-05-04"
}
},
{
"fullUrl": "https://profiles.ihe.net/ITI/FAIS/Claim/ex-claim-3",
"resource": {
"resourceType": "Claim",
"id": "ex-claim-3",
"meta": {
"profile": [
"https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_ex-claim-3\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim ex-claim-3</b></p><a name=\"ex-claim-3\"> </a><a name=\"hcex-claim-3\"> </a><a name=\"ex-claim-3-en-US\"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno Female, DoB: 2000-05-04</a></p><p><b>created</b>: 2024-07-15 03:00:00+0000</p><p><b>enterer</b>: <a href=\"Practitioner-ex-doctor-2.html\">Practitioner Kalu Kalu </a></p><p><b>insurer</b>: <a href=\"Organization-ex-insurer-1.html\">Organization National Health Insurance Scheme</a></p><p><b>provider</b>: <a href=\"Practitioner-ex-doctor-2.html\">Practitioner Kalu Kalu </a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td><td><a href=\"Organization-ex-network-1.html\">Organization National Health Hospital System</a></td></tr></table><p><b>facility</b>: <a href=\"Location-ex-hospital-2.html\">Location Local Hospital</a></p><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://id.who.int/icd/release/11/mms XH1VB1}\">Hybrid oncocytic chromophobe tumour</span></td></tr></table><h3>Procedures</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Procedure[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://loinc.org 21946-9}\">Chemotherapy treatment Cancer</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-ex-coverage-1.html\">Coverage: status = active; type = public healthcare; subscriberId = 05710b56-4448-11ef-b676-774a043da147; relationship = Self; period = 2024-01-01 --> 2024-12-31</a></td></tr></table></div>"
},
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "Patient/ex-beneficiary-1"
},
"created": "2024-07-15T03:00:00Z",
"enterer": {
"reference": "Practitioner/ex-doctor-2"
},
"insurer": {
"reference": "Organization/ex-insurer-1"
},
"provider": {
"reference": "Practitioner/ex-doctor-2"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"payee": {
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/payeetype",
"code": "provider"
}
]
},
"party": {
"reference": "Organization/ex-network-1"
}
},
"facility": {
"reference": "Location/ex-hospital-2"
},
"diagnosis": [
{
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://id.who.int/icd/release/11/mms",
"code": "XH1VB1",
"display": "Hybrid oncocytic chromophobe tumour"
}
]
}
}
],
"procedure": [
{
"sequence": 1,
"procedureCodeableConcept": {
"coding": [
{
"system": "http://loinc.org",
"code": "21946-9",
"display": "Chemotherapy treatment Cancer"
}
]
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/ex-coverage-1"
}
}
]
}
},
{
"fullUrl": "https://profiles.ihe.net/ITI/FAIS/Organization/ex-insurer-1",
"resource": {
"resourceType": "Organization",
"id": "ex-insurer-1",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_ex-insurer-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization ex-insurer-1</b></p><a name=\"ex-insurer-1\"> </a><a name=\"hcex-insurer-1\"> </a><a name=\"ex-insurer-1-en-US\"> </a><p><b>name</b>: National Health Insurance Scheme</p></div>"
},
"name": "National Health Insurance Scheme"
}
},
{
"fullUrl": "https://profiles.ihe.net/ITI/FAIS/Coverage/ex-coverage-1",
"resource": {
"resourceType": "Coverage",
"id": "ex-coverage-1",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_ex-coverage-1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage ex-coverage-1</b></p><a name=\"ex-coverage-1\"> </a><a name=\"hcex-coverage-1\"> </a><a name=\"ex-coverage-1-en-US\"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode PUBLICPOL}\">public healthcare</span></p><p><b>policyHolder</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno Female, DoB: 2000-05-04</a></p><p><b>subscriber</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno Female, DoB: 2000-05-04</a></p><p><b>subscriberId</b>: 05710b56-4448-11ef-b676-774a043da147</p><p><b>beneficiary</b>: <a href=\"Patient-ex-beneficiary-1.html\">Purity Atieno Female, DoB: 2000-05-04</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: 2024-01-01 --> 2024-12-31</p><p><b>payor</b>: <a href=\"Organization-ex-insurer-1.html\">Organization National Health Insurance Scheme</a></p></div>"
},
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "PUBLICPOL",
"display": "public healthcare"
}
]
},
"policyHolder": {
"reference": "Patient/ex-beneficiary-1"
},
"subscriber": {
"reference": "Patient/ex-beneficiary-1"
},
"subscriberId": "05710b56-4448-11ef-b676-774a043da147",
"beneficiary": {
"reference": "Patient/ex-beneficiary-1"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "Self"
}
]
},
"period": {
"start": "2024-01-01",
"end": "2024-12-31"
},
"payor": [
{
"reference": "Organization/ex-insurer-1"
}
]
}
}
]
}