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Packagendhm.in
Resource TypeClaim
IdClaim-Claim-enhancement-example-01.json
FHIR VersionR4

Resources that use this resource

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Resources that this resource uses

No resources found


Narrative

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

Generated Narrative: Claim Claim-enhancement-example-01

identifier: 7612345

status: Active

type: Inpatient care management (procedure)

subType: Emergency Claim

use: Preauthorization

patient: ABC Male, DoB: 1981-01-12 ( Medical record number: 22-7225-4829-5255)

billablePeriod: 2025-03-07 11:01:00+0500 --> 2025-04-07 11:01:00+0500

created: 2025-03-13 11:01:00+0500

insurer: Organization XYZ Insurance Co. Ltd.

provider: Organization XYZ Hospital Co. Ltd.

priority: Normal

Relateds

-ClaimRelationship
*Claim: identifier = 7612345; status = active; type = Inpatient care management (procedure); subType = Emergency Claim; use = preauthorization; billablePeriod = 2025-03-07 11:01:00+0500 --> 2025-04-07 11:01:00+0500; created = 2025-03-08 11:01:00+0500; priority = NormalPrior Claim

CareTeams

-SequenceProviderRoleQualification
*1Practitioner Dr. DEFHealthcare professional (occupation)Clinical specialty (qualifier value)

Diagnoses

-SequenceDiagnosis[x]Type
*1Cardiac arrest, unspecifiedFinal diagnosis (discharge) (contextual qualifier) (qualifier value)

procedure

sequence: 1

procedure: Angiography

procedure

sequence: 2

procedure: Angioplasty of blood vessel

Insurances

-SequenceFocalCoveragePreAuthRef
*1trueCoverage: identifier = https://xyzinsurance.in/policynumber/#235037120; status = active; type = PAY; subscriberId = ABC123456BI007; relationship = Self; period = (?) --> 2026-03-17123456

item

sequence: 1

careTeamSequence: 1

productOrService: Angiography

UnitPrices

-ValueCurrency
*10000Indian rupee

Nets

-ValueCurrency
*10000Indian rupee

item

sequence: 2

careTeamSequence: 1

productOrService: Angioplasty of blood vessel

UnitPrices

-ValueCurrency
*10000Indian rupee

Nets

-ValueCurrency
*10000Indian rupee

Totals

-ValueCurrency
*20000Indian rupee

Source1

{
  "resourceType": "Claim",
  "id": "Claim-enhancement-example-01",
  "meta": {
    "profile": [
      "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "identifier": [
    {
      "value": "7612345"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "737481003",
        "display": "Inpatient care management (procedure)"
      }
    ]
  },
  "subType": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/ex-claimsubtype",
        "code": "emergency"
      }
    ]
  },
  "use": "preauthorization",
  "patient": {
    "reference": "Patient/example-01"
  },
  "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": "Organization/example-02"
  },
  "provider": {
    "reference": "Organization/example-03"
  },
  "priority": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/processpriority",
        "code": "normal"
      }
    ]
  },
  "related": [
    {
      "claim": {
        "reference": "Claim/Claim-preauthorization-example-01"
      },
      "relationship": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship",
            "code": "prior",
            "display": "Prior Claim"
          }
        ]
      }
    }
  ],
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/example-01"
      },
      "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": "Coverage/example-01"
      },
      "preAuthRef": [
        "123456"
      ]
    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://snomed.info/sct",
            "code": "77343006",
            "display": "Angiography"
          }
        ]
      },
      "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"
  }
}