FHIR IG analytics| Package | ndhm.in |
| Resource Type | Bundle |
| Id | Bundle-ClaimResponseBundle-enhancement-example-01.json |
| FHIR Version | R4 |
No resources found
No resources found
No narrative content found in resource
FHIR
FHIRsmith{
"resourceType": "Bundle",
"id": "ClaimResponseBundle-enhancement-example-01",
"meta": {
"profile": [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponseBundle"
],
"security": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-Confidentiality",
"code": "V",
"display": "very restricted"
}
]
},
"identifier": {
"value": "bc3c6c57-2053-4d0e-ac40-139ccccff645"
},
"type": "collection",
"timestamp": "2025-03-13T15:32:26.605+05:30",
"entry": [
{
"fullUrl": "urn:uuid:b56a1f6e-c46e-4d06-95e4-aeaf9ecf5562",
"resource": {
"resourceType": "ClaimResponse",
"id": "b56a1f6e-c46e-4d06-95e4-aeaf9ecf5562",
"meta": {
"profile": [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_b56a1f6e-c46e-4d06-95e4-aeaf9ecf5562\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse b56a1f6e-c46e-4d06-95e4-aeaf9ecf5562</b></p><a name=\"b56a1f6e-c46e-4d06-95e4-aeaf9ecf5562\"> </a><a name=\"hcb56a1f6e-c46e-4d06-95e4-aeaf9ecf5562\"> </a><a name=\"b56a1f6e-c46e-4d06-95e4-aeaf9ecf5562-hi-IN\"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 737481003}\">Inpatient care management (procedure)</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-d16be93a-0881-422f-a9f1-b49808449395\">Patient</a></p><p><b>created</b>: 2025-03-07 15:32:26+0530</p><p><b>insurer</b>: <a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-344de91a-0662-43a5-b88e-c2cd00887244\">Organization</a></p><p><b>requestor</b>: <a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-de3a873e-3d69-44de-bf2b-4cb18384b07d\">Organization</a></p><p><b>request</b>: <a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-cd1e58c5-08fa-4cac-8a46-c12d26d57f21\">Claim-enhancement</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: The enclosed services are authorized for your provision within 30 days of this notice.</p><p><b>preAuthRef</b>: 98765432</p><p><b>preAuthPeriod</b>: 2025-03-12 15:32:26+0530 --> 2025-04-12 15:32:26+0530</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligpercent}\">Eligible %</span></p><p><b>reason</b>: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-adjudication-reason covered}\">Product or Service requested is covered by the policy.</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000</td><td>Indian rupee</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 2</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligpercent}\">Eligible %</span></p><p><b>reason</b>: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-adjudication-reason covered}\">Product or Service requested is covered by the policy.</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000</td><td>Indian rupee</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligpercent}\">Eligible %</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20000</td><td>Indian rupee</td></tr></table></blockquote><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=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-02461bcb-aeaa-45ad-b24c-66b94272103c\">Coverage</a></td></tr></table></div>"
},
"status": "active",
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "737481003",
"display": "Inpatient care management (procedure)"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "urn:uuid:d16be93a-0881-422f-a9f1-b49808449395",
"display": "Patient"
},
"created": "2025-03-07T15:32:26.605+05:30",
"insurer": {
"reference": "urn:uuid:344de91a-0662-43a5-b88e-c2cd00887244",
"display": "Organization"
},
"requestor": {
"reference": "urn:uuid:de3a873e-3d69-44de-bf2b-4cb18384b07d",
"display": "Organization"
},
"request": {
"reference": "urn:uuid:cd1e58c5-08fa-4cac-8a46-c12d26d57f21",
"display": "Claim-enhancement"
},
"outcome": "complete",
"disposition": "The enclosed services are authorized for your provision within 30 days of this notice.",
"preAuthRef": "98765432",
"preAuthPeriod": {
"start": "2025-03-12T15:32:26.605+05:30",
"end": "2025-04-12T15:32:26.605+05:30"
},
"item": [
{
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
]
},
"amount": {
"value": 10000,
"currency": "INR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligpercent",
"display": "Eligible %"
}
]
},
"reason": {
"coding": [
{
"system": "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-adjudication-reason",
"code": "covered",
"display": "Product or Service requested is covered by the policy."
}
]
},
"amount": {
"value": 10000,
"currency": "INR"
}
}
]
},
{
"itemSequence": 2,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
]
},
"amount": {
"value": 10000,
"currency": "INR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligpercent",
"display": "Eligible %"
}
]
},
"reason": {
"coding": [
{
"system": "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-adjudication-reason",
"code": "covered",
"display": "Product or Service requested is covered by the policy."
}
]
},
"amount": {
"value": 10000,
"currency": "INR"
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
]
},
"amount": {
"value": 20000,
"currency": "INR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligpercent",
"display": "Eligible %"
}
]
},
"amount": {
"value": 20000,
"currency": "INR"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "urn:uuid:02461bcb-aeaa-45ad-b24c-66b94272103c",
"display": "Coverage"
}
}
]
}
},
{
"fullUrl": "urn:uuid:cd1e58c5-08fa-4cac-8a46-c12d26d57f21",
"resource": {
"resourceType": "Claim",
"id": "cd1e58c5-08fa-4cac-8a46-c12d26d57f21",
"meta": {
"profile": [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_cd1e58c5-08fa-4cac-8a46-c12d26d57f21\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim cd1e58c5-08fa-4cac-8a46-c12d26d57f21</b></p><a name=\"cd1e58c5-08fa-4cac-8a46-c12d26d57f21\"> </a><a name=\"hccd1e58c5-08fa-4cac-8a46-c12d26d57f21\"> </a><a name=\"cd1e58c5-08fa-4cac-8a46-c12d26d57f21-hi-IN\"> </a><p><b>identifier</b>: 7612345, 96785763</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 737481003}\">Inpatient care management (procedure)</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-d16be93a-0881-422f-a9f1-b49808449395\">Patient</a></p><p><b>billablePeriod</b>: 2025-03-07 11:01:00+0500 --> 2025-04-07 11:01:00+0500</p><p><b>created</b>: 2025-03-13 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-344de91a-0662-43a5-b88e-c2cd00887244\">Organization</a></p><p><b>provider</b>: <a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-de3a873e-3d69-44de-bf2b-4cb18384b07d\">Organization</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Relateds</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Claim</b></td><td><b>Relationship</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-66748b1f-0dac-47da-9ded-d8908ef42338\">Claim-preauth</a></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship prior}\">Prior Claim</span></td></tr></table><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td><td><b>Role</b></td><td><b>Qualification</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-04c47993-b2bc-4912-849b-65ee63883f2e\">Practitioner</a></td><td><span title=\"Codes:{http://snomed.info/sct 223366009}\">Healthcare professional (occupation)</span></td><td><span title=\"Codes:{http://snomed.info/sct 394658006}\">Clinical specialty (qualifier value)</span></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10 I46.9}\">Cardiac arrest, unspecified</span></td><td><span title=\"Codes:{http://snomed.info/sct 89100005}\">Final diagnosis (discharge) (contextual qualifier) (qualifier value)</span></td></tr></table><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 1</p><p><b>procedure</b>: <span title=\"Codes:{http://snomed.info/sct 77343006}\">Angiography</span></p></blockquote><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 2</p><p><b>procedure</b>: <span title=\"Codes:{http://snomed.info/sct 418285008}\">Angioplasty of blood vessel</span></p></blockquote><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><td><b>PreAuthRef</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-02461bcb-aeaa-45ad-b24c-66b94272103c\">Coverage</a></td><td>123456</td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 77343006}\">Angiography</span></p><p><b>serviced</b>: 2023-12-09</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000</td><td>Indian rupee</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 2</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 418285008}\">Angioplasty of blood vessel</span></p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000</td><td>Indian rupee</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000</td><td>Indian rupee</td></tr></table></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20000</td><td>Indian rupee</td></tr></table></div>"
},
"identifier": [
{
"value": "7612345"
},
{
"value": "96785763"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "737481003",
"display": "Inpatient care management (procedure)"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "urn:uuid:d16be93a-0881-422f-a9f1-b49808449395",
"display": "Patient"
},
"billablePeriod": {
"start": "2025-03-07T11:01:00+05:00",
"end": "2025-04-07T11:01:00+05:00"
},
"created": "2025-03-13T11:01:00+05:00",
"insurer": {
"reference": "urn:uuid:344de91a-0662-43a5-b88e-c2cd00887244",
"display": "Organization"
},
"provider": {
"reference": "urn:uuid:de3a873e-3d69-44de-bf2b-4cb18384b07d",
"display": "Organization"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"related": [
{
"claim": {
"reference": "urn:uuid:66748b1f-0dac-47da-9ded-d8908ef42338",
"display": "Claim-preauth"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship",
"code": "prior",
"display": "Prior Claim"
}
]
}
}
],
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:04c47993-b2bc-4912-849b-65ee63883f2e",
"display": "Practitioner"
},
"role": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "223366009",
"display": "Healthcare professional (occupation)"
}
]
},
"qualification": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "394658006",
"display": "Clinical specialty (qualifier value)"
}
]
}
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/icd-10",
"code": "I46.9",
"display": "Cardiac arrest, unspecified"
}
]
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "89100005",
"display": "Final diagnosis (discharge) (contextual qualifier) (qualifier value)"
}
]
}
]
}
],
"procedure": [
{
"sequence": 1,
"procedureCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "77343006",
"display": "Angiography"
}
]
}
},
{
"sequence": 2,
"procedureCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "418285008",
"display": "Angioplasty of blood vessel"
}
]
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "urn:uuid:02461bcb-aeaa-45ad-b24c-66b94272103c",
"display": "Coverage"
},
"preAuthRef": [
"123456"
]
}
],
"item": [
{
"sequence": 1,
"careTeamSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "77343006",
"display": "Angiography"
}
]
},
"servicedDate": "2023-12-09",
"unitPrice": {
"value": 10000,
"currency": "INR"
},
"net": {
"value": 10000,
"currency": "INR"
}
},
{
"sequence": 2,
"careTeamSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "418285008",
"display": "Angioplasty of blood vessel"
}
]
},
"unitPrice": {
"value": 10000,
"currency": "INR"
},
"net": {
"value": 10000,
"currency": "INR"
}
}
],
"total": {
"value": 20000,
"currency": "INR"
}
}
},
{
"fullUrl": "urn:uuid:d16be93a-0881-422f-a9f1-b49808449395",
"resource": {
"resourceType": "Patient",
"id": "d16be93a-0881-422f-a9f1-b49808449395",
"meta": {
"profile": [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_d16be93a-0881-422f-a9f1-b49808449395\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient d16be93a-0881-422f-a9f1-b49808449395</b></p><a name=\"d16be93a-0881-422f-a9f1-b49808449395\"> </a><a name=\"hcd16be93a-0881-422f-a9f1-b49808449395\"> </a><a name=\"d16be93a-0881-422f-a9f1-b49808449395-hi-IN\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Adarsh Agrawal Male, DoB: 1981-01-12 ( Adhaar number: 7225-4829-5255)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Detail</td><td colspan=\"3\"><a href=\"tel:+919818512600\">+919818512600</a></td></tr></table></div>"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code",
"code": "ADN",
"display": "Adhaar number"
}
]
},
"system": "https://uidai.gov.in/",
"value": "7225-4829-5255"
}
],
"name": [
{
"text": "Adarsh Agrawal"
}
],
"telecom": [
{
"system": "phone",
"value": "+919818512600",
"use": "home"
}
],
"gender": "male",
"birthDate": "1981-01-12"
}
},
{
"fullUrl": "urn:uuid:344de91a-0662-43a5-b88e-c2cd00887244",
"resource": {
"resourceType": "Organization",
"id": "344de91a-0662-43a5-b88e-c2cd00887244",
"meta": {
"profile": [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_344de91a-0662-43a5-b88e-c2cd00887244\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization 344de91a-0662-43a5-b88e-c2cd00887244</b></p><a name=\"344de91a-0662-43a5-b88e-c2cd00887244\"> </a><a name=\"hc344de91a-0662-43a5-b88e-c2cd00887244\"> </a><a name=\"344de91a-0662-43a5-b88e-c2cd00887244-hi-IN\"> </a><p><b>identifier</b>: Registry of Hospitals in Network of Insurance (ROHINI) ID/4567878</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type ins}\">Insurance Company</span></p><p><b>name</b>: XYZ Insurance Co. Ltd.</p><p><b>telecom</b>: <a href=\"tel:+9124326341234\">+91 243 2634 1234</a>, <a href=\"mailto:contact@xyz.org\">contact@xyz.org</a></p></div>"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code",
"code": "ROHINI",
"display": "Registry of Hospitals in Network of Insurance (ROHINI) ID"
}
]
},
"system": "https://rohini.iib.gov.in/",
"value": "4567878"
}
],
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "ins",
"display": "Insurance Company"
}
]
}
],
"name": "XYZ Insurance Co. Ltd.",
"telecom": [
{
"system": "phone",
"value": "+91 243 2634 1234",
"use": "work"
},
{
"system": "email",
"value": "contact@xyz.org",
"use": "work"
}
]
}
},
{
"fullUrl": "urn:uuid:de3a873e-3d69-44de-bf2b-4cb18384b07d",
"resource": {
"resourceType": "Organization",
"id": "de3a873e-3d69-44de-bf2b-4cb18384b07d",
"meta": {
"profile": [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_de3a873e-3d69-44de-bf2b-4cb18384b07d\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization de3a873e-3d69-44de-bf2b-4cb18384b07d</b></p><a name=\"de3a873e-3d69-44de-bf2b-4cb18384b07d\"> </a><a name=\"hcde3a873e-3d69-44de-bf2b-4cb18384b07d\"> </a><a name=\"de3a873e-3d69-44de-bf2b-4cb18384b07d-hi-IN\"> </a><p><b>identifier</b>: Provider number/45675454</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span></p><p><b>name</b>: XYZ Hospital Co. Ltd.</p><p><b>telecom</b>: <a href=\"tel:+9124326341278\">+91 243 2634 1278</a>, <a href=\"mailto:contact@xyz.org\">contact@xyz.org</a></p></div>"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "PRN",
"display": "Provider number"
}
]
},
"system": "https://facility.ndhm.gov.in",
"value": "45675454"
}
],
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "prov",
"display": "Healthcare Provider"
}
]
}
],
"name": "XYZ Hospital Co. Ltd.",
"telecom": [
{
"system": "phone",
"value": "+91 243 2634 1278",
"use": "work"
},
{
"system": "email",
"value": "contact@xyz.org",
"use": "work"
}
]
}
},
{
"fullUrl": "urn:uuid:04c47993-b2bc-4912-849b-65ee63883f2e",
"resource": {
"resourceType": "Practitioner",
"id": "04c47993-b2bc-4912-849b-65ee63883f2e",
"meta": {
"profile": [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Practitioner_04c47993-b2bc-4912-849b-65ee63883f2e\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Practitioner 04c47993-b2bc-4912-849b-65ee63883f2e</b></p><a name=\"04c47993-b2bc-4912-849b-65ee63883f2e\"> </a><a name=\"hc04c47993-b2bc-4912-849b-65ee63883f2e\"> </a><a name=\"04c47993-b2bc-4912-849b-65ee63883f2e-hi-IN\"> </a><p><b>identifier</b>: Medical License number/21-1521-3828-3227</p><p><b>name</b>: Dr. Aayush Agrawal</p></div>"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MD",
"display": "Medical License number"
}
]
},
"system": "https://doctor.ndhm.gov.in",
"value": "21-1521-3828-3227"
}
],
"name": [
{
"text": "Dr. Aayush Agrawal"
}
]
}
},
{
"fullUrl": "urn:uuid:02461bcb-aeaa-45ad-b24c-66b94272103c",
"resource": {
"resourceType": "Coverage",
"id": "02461bcb-aeaa-45ad-b24c-66b94272103c",
"meta": {
"profile": [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Coverage"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_02461bcb-aeaa-45ad-b24c-66b94272103c\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage 02461bcb-aeaa-45ad-b24c-66b94272103c</b></p><a name=\"02461bcb-aeaa-45ad-b24c-66b94272103c\"> </a><a name=\"hc02461bcb-aeaa-45ad-b24c-66b94272103c\"> </a><a name=\"02461bcb-aeaa-45ad-b24c-66b94272103c-hi-IN\"> </a><p><b>identifier</b>: <code>https://xyzinsurance.in/policynumber/</code>/235037120</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}\">health insurance plan policy</span></p><p><b>subscriber</b>: <a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-d16be93a-0881-422f-a9f1-b49808449395\">Patient</a></p><p><b>subscriberId</b>: ABC123456BI007</p><p><b>beneficiary</b>: <a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-d16be93a-0881-422f-a9f1-b49808449395\">Patient</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: ?? --> 2026-03-17</p><p><b>payor</b>: <a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-344de91a-0662-43a5-b88e-c2cd00887244\">Organization</a></p></div>"
},
"identifier": [
{
"system": "https://xyzinsurance.in/policynumber/",
"value": "235037120"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "HIP",
"display": "health insurance plan policy"
}
]
},
"subscriber": {
"reference": "urn:uuid:d16be93a-0881-422f-a9f1-b49808449395",
"display": "Patient"
},
"subscriberId": "ABC123456BI007",
"beneficiary": {
"reference": "urn:uuid:d16be93a-0881-422f-a9f1-b49808449395",
"display": "Patient"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self"
}
]
},
"period": {
"end": "2026-03-17"
},
"payor": [
{
"reference": "urn:uuid:344de91a-0662-43a5-b88e-c2cd00887244",
"display": "Organization"
}
]
}
},
{
"fullUrl": "urn:uuid:66748b1f-0dac-47da-9ded-d8908ef42338",
"resource": {
"resourceType": "Claim",
"id": "66748b1f-0dac-47da-9ded-d8908ef42338",
"meta": {
"profile": [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_66748b1f-0dac-47da-9ded-d8908ef42338\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim 66748b1f-0dac-47da-9ded-d8908ef42338</b></p><a name=\"66748b1f-0dac-47da-9ded-d8908ef42338\"> </a><a name=\"hc66748b1f-0dac-47da-9ded-d8908ef42338\"> </a><a name=\"66748b1f-0dac-47da-9ded-d8908ef42338-hi-IN\"> </a><p><b>identifier</b>: 7612345, 96785763</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 737481003}\">Inpatient care management (procedure)</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-d16be93a-0881-422f-a9f1-b49808449395\">Patient</a></p><p><b>billablePeriod</b>: 2025-03-07 11:01:00+0500 --> 2025-04-07 11:01:00+0500</p><p><b>created</b>: 2023-12-11 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-344de91a-0662-43a5-b88e-c2cd00887244\">Organization</a></p><p><b>provider</b>: <a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-de3a873e-3d69-44de-bf2b-4cb18384b07d\">Organization</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td><td><b>Role</b></td><td><b>Qualification</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-04c47993-b2bc-4912-849b-65ee63883f2e\">Practitioner</a></td><td><span title=\"Codes:{http://snomed.info/sct 223366009}\">Healthcare professional (occupation)</span></td><td><span title=\"Codes:{http://snomed.info/sct 394658006}\">Clinical specialty (qualifier value)</span></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10 I46.9}\">Cardiac arrest, unspecified</span></td><td><span title=\"Codes:{http://snomed.info/sct 89100005}\">Final diagnosis (discharge) (contextual qualifier) (qualifier value)</span></td></tr></table><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 1</p><p><b>procedure</b>: <span title=\"Codes:{http://snomed.info/sct 77343006}\">Angiography</span></p></blockquote><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 2</p><p><b>procedure</b>: <span title=\"Codes:{http://snomed.info/sct 418285008}\">Angioplasty of blood vessel</span></p></blockquote><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=\"Bundle-ClaimResponseBundle-enhancement-example-01.html#urn-uuid-02461bcb-aeaa-45ad-b24c-66b94272103c\">Coverage</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 77343006}\">Angiography</span></p><p><b>serviced</b>: 2023-12-09</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000</td><td>Indian rupee</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 2</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 418285008}\">Angioplasty of blood vessel</span></p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>40000</td><td>Indian rupee</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>40000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 3</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 309904001}\">Intensive care unit</span></p><p><b>serviced</b>: 2023-12-11</p><p><b>quantity</b>: 10 day</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>2000</td><td>Indian rupee</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20000</td><td>Indian rupee</td></tr></table></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>70000</td><td>Indian rupee</td></tr></table></div>"
},
"identifier": [
{
"value": "7612345"
},
{
"value": "96785763"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "737481003",
"display": "Inpatient care management (procedure)"
}
]
},
"use": "preauthorization",
"patient": {
"reference": "urn:uuid:d16be93a-0881-422f-a9f1-b49808449395",
"display": "Patient"
},
"billablePeriod": {
"start": "2025-03-07T11:01:00+05:00",
"end": "2025-04-07T11:01:00+05:00"
},
"created": "2023-12-11T11:01:00+05:00",
"insurer": {
"reference": "urn:uuid:344de91a-0662-43a5-b88e-c2cd00887244",
"display": "Organization"
},
"provider": {
"reference": "urn:uuid:de3a873e-3d69-44de-bf2b-4cb18384b07d",
"display": "Organization"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "urn:uuid:04c47993-b2bc-4912-849b-65ee63883f2e",
"display": "Practitioner"
},
"role": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "223366009",
"display": "Healthcare professional (occupation)"
}
]
},
"qualification": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "394658006",
"display": "Clinical specialty (qualifier value)"
}
]
}
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/icd-10",
"code": "I46.9",
"display": "Cardiac arrest, unspecified"
}
]
},
"type": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "89100005",
"display": "Final diagnosis (discharge) (contextual qualifier) (qualifier value)"
}
]
}
]
}
],
"procedure": [
{
"sequence": 1,
"procedureCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "77343006",
"display": "Angiography"
}
]
}
},
{
"sequence": 2,
"procedureCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "418285008",
"display": "Angioplasty of blood vessel"
}
]
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "urn:uuid:02461bcb-aeaa-45ad-b24c-66b94272103c",
"display": "Coverage"
}
}
],
"item": [
{
"sequence": 1,
"careTeamSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "77343006",
"display": "Angiography"
}
]
},
"servicedDate": "2023-12-09",
"unitPrice": {
"value": 10000,
"currency": "INR"
},
"net": {
"value": 10000,
"currency": "INR"
}
},
{
"sequence": 2,
"careTeamSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "418285008",
"display": "Angioplasty of blood vessel"
}
]
},
"unitPrice": {
"value": 40000,
"currency": "INR"
},
"net": {
"value": 40000,
"currency": "INR"
}
},
{
"sequence": 3,
"careTeamSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "309904001",
"display": "Intensive care unit"
}
]
},
"servicedDate": "2023-12-11",
"quantity": {
"value": 10,
"unit": "day"
},
"unitPrice": {
"value": 2000,
"currency": "INR"
},
"net": {
"value": 20000,
"currency": "INR"
}
}
],
"total": {
"value": 70000,
"currency": "INR"
}
}
}
]
}