FHIR IG analytics| Package | org.dhin-hie.sandbox |
| Resource Type | Bundle |
| Id | Bundle-ClaimSubmission-Request.json |
| FHIR Version | R4 |
No resources found
No resources found
No narrative content found in resource
FHIR
FHIRsmith{
"resourceType": "Bundle",
"id": "ClaimSubmission-Request",
"meta": {
"profile": [
"https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-claim-submission-bundle"
]
},
"type": "transaction",
"entry": [
{
"fullUrl": "urn:uuid:aaabbbc2-e5f6-4789-a123-456789abcdef",
"resource": {
"resourceType": "Patient",
"id": "NgPatient-Claim-001",
"meta": {
"lastUpdated": "2025-10-25T14:30:00+01:00",
"profile": [
"https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-patient"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_NgPatient-Claim-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient NgPatient-Claim-001</b></p><a name=\"NgPatient-Claim-001\"> </a><a name=\"hcNgPatient-Claim-001\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Last updated: 2025-10-25 14:30:00+0100</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ng-patient.html\">NG Patient</a></p></div><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Amaka Nwosu Female, DoB: 1992-07-15 ( mobile: 08045678901)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Record is active\">Active:</td><td colspan=\"3\">true</td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Detail</td><td colspan=\"3\">22 River Road Port Harcourt RI </td></tr></table></div>"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "https://sandbox.dhin-hie.org/ig/CodeSystem/patient-identifier-cs",
"code": "MOBILE",
"display": "mobile"
}
]
},
"system": "https://sandbox.dhin-hie.org/ig/CodeSystem/patient-identifier-cs",
"value": "08045678901"
}
],
"active": true,
"name": [
{
"family": "Nwosu",
"given": [
"Amaka"
]
}
],
"gender": "female",
"birthDate": "1992-07-15",
"address": [
{
"line": [
"22 River Road"
],
"city": "Port Harcourt",
"district": "ri-oyigbo",
"state": "RI"
}
]
},
"request": {
"method": "POST",
"url": "Patient"
}
},
{
"fullUrl": "urn:uuid:ccc33344-e5f6-4789-a123-456789abcdef",
"resource": {
"resourceType": "Organization",
"id": "NgOrganization-Provider-Claim-001",
"meta": {
"profile": [
"https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-provider-organization"
]
},
"text": {
"status": "extensions",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_NgOrganization-Provider-Claim-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization NgOrganization-Provider-Claim-001</b></p><a name=\"NgOrganization-Provider-Claim-001\"> </a><a name=\"hcNgOrganization-Provider-Claim-001\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ng-provider-organization.html\">NG Provider Organization</a></p></div><p><b>NG Owner of Facility</b>: <span title=\"Codes:{https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-location-owner-cs public}\">Public Health Institution Location</span></p><p><b>identifier</b>: <code>https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry</code>/HCF-RS-5678</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span></p><p><b>name</b>: Rivers State Teaching Hospital</p><p><b>telecom</b>: ph: 084-234-5678</p><p><b>address</b>: 100 Hospital Boulevard Port Harcourt RI </p></div>"
},
"extension": [
{
"url": "https://sandbox.dhin-hie.org/ig/StructureDefinition/organization-owner",
"valueCodeableConcept": {
"coding": [
{
"system": "https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-location-owner-cs",
"code": "public"
}
]
}
}
],
"identifier": [
{
"system": "https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry",
"value": "HCF-RS-5678"
}
],
"active": true,
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "prov",
"display": "Healthcare Provider"
}
]
}
],
"name": "Rivers State Teaching Hospital",
"telecom": [
{
"system": "phone",
"value": "084-234-5678"
}
],
"address": [
{
"line": [
"100 Hospital Boulevard"
],
"city": "Port Harcourt",
"district": "ri-oyigbo",
"state": "RI"
}
]
},
"request": {
"method": "POST",
"url": "Organization"
}
},
{
"fullUrl": "urn:uuid:ddd44455-e5f6-4789-a123-456789abcdef",
"resource": {
"resourceType": "Organization",
"id": "NgOrganization-Insurer-Claim-001",
"meta": {
"profile": [
"https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-insurer-organization"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_NgOrganization-Insurer-Claim-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization NgOrganization-Insurer-Claim-001</b></p><a name=\"NgOrganization-Insurer-Claim-001\"> </a><a name=\"hcNgOrganization-Insurer-Claim-001\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ng-insurer-organization.html\">NG Insurer Organization</a></p></div><p><b>identifier</b>: <code>https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry</code>/HMO-MC-9988</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type ins}\">Insurance Company</span></p><p><b>name</b>: MediCare Plus HMO</p><p><b>telecom</b>: ph: 0700-MEDICARE</p><p><b>address</b>: 15 Insurance Plaza Port Harcourt RI </p></div>"
},
"identifier": [
{
"system": "https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry",
"value": "HMO-MC-9988"
}
],
"active": true,
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "ins",
"display": "Insurance Company"
}
]
}
],
"name": "MediCare Plus HMO",
"telecom": [
{
"system": "phone",
"value": "0700-MEDICARE"
}
],
"address": [
{
"line": [
"15 Insurance Plaza"
],
"city": "Port Harcourt",
"district": "ri-oyigbo",
"state": "RI"
}
]
},
"request": {
"method": "POST",
"url": "Organization"
}
},
{
"fullUrl": "urn:uuid:eee55566-e5f6-4789-a123-456789abcdef",
"resource": {
"resourceType": "Coverage",
"id": "NgCoverage-Claim-001",
"meta": {
"profile": [
"https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-coverage"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_NgCoverage-Claim-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage NgCoverage-Claim-001</b></p><a name=\"NgCoverage-Claim-001\"> </a><a name=\"hcNgCoverage-Claim-001\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ng-coverage.html\">NG Claim Coverage</a></p></div><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode EHCPOL}\">extended healthcare</span></p><p><b>beneficiary</b>: <a href=\"Bundle-ClaimSubmission-Request.html#urn-uuid-aaabbbc2-e5f6-4789-a123-456789abcdef\">Amaka Nwosu Female, DoB: 1992-07-15 ( mobile: 08045678901)</a></p><p><b>period</b>: 2025-01-01 --> 2025-12-31</p><p><b>payor</b>: <a href=\"Bundle-ClaimSubmission-Request.html#urn-uuid-ddd44455-e5f6-4789-a123-456789abcdef\">Organization MediCare Plus HMO</a></p></div>"
},
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "EHCPOL",
"display": "extended healthcare"
}
]
},
"beneficiary": {
"reference": "urn:uuid:aaabbbc2-e5f6-4789-a123-456789abcdef"
},
"period": {
"start": "2025-01-01",
"end": "2025-12-31"
},
"payor": [
{
"reference": "urn:uuid:ddd44455-e5f6-4789-a123-456789abcdef"
}
]
},
"request": {
"method": "POST",
"url": "Coverage"
}
},
{
"fullUrl": "urn:uuid:fff66677-e5f6-4789-a123-456789abcdef",
"resource": {
"resourceType": "Claim",
"id": "NgClaim-Claim-001",
"meta": {
"profile": [
"https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-claim"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_NgClaim-Claim-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim NgClaim-Claim-001</b></p><a name=\"NgClaim-Claim-001\"> </a><a name=\"hcNgClaim-Claim-001\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ng-claim.html\">NG Claim</a></p></div><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=\"Bundle-ClaimSubmission-Request.html#urn-uuid-aaabbbc2-e5f6-4789-a123-456789abcdef\">Amaka Nwosu Female, DoB: 1992-07-15 ( mobile: 08045678901)</a></p><p><b>created</b>: 2025-10-25 14:35:00+0100</p><p><b>provider</b>: <a href=\"Bundle-ClaimSubmission-Request.html#urn-uuid-ccc33344-e5f6-4789-a123-456789abcdef\">Organization Rivers State Teaching Hospital</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></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=\"Bundle-ClaimSubmission-Request.html#urn-uuid-eee55566-e5f6-4789-a123-456789abcdef\">Coverage: status = active; type = extended healthcare; period = 2025-01-01 --> 2025-12-31</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-USCLS 1205}\">Appendectomy</span></p><p><b>serviced</b>: 2025-10-22</p><p><b>quantity</b>: 1</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>150000</td><td>Nigerian naira</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>150000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 2</p><p><b>productOrService</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-USCLS 1201}\">Exam, recall</span></p><p><b>serviced</b>: 2025-10-22 --> 2025-10-25</p><p><b>quantity</b>: 3</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>20000</td><td>Nigerian naira</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>60000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 3</p><p><b>productOrService</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-USCLS 1101}\">Laboratory Tests</span></p><p><b>serviced</b>: 2025-10-22</p><p><b>quantity</b>: 1</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>15000</td><td>Nigerian naira</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>15000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 4</p><p><b>productOrService</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-USCLS 1102}\">Medications</span></p><p><b>serviced</b>: 2025-10-22</p><p><b>quantity</b>: 1</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>25000</td><td>Nigerian naira</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>25000</td><td>Nigerian naira</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>250000</td><td>Nigerian naira</td></tr></table></div>"
},
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional",
"display": "Institutional"
}
]
},
"use": "claim",
"patient": {
"reference": "urn:uuid:aaabbbc2-e5f6-4789-a123-456789abcdef"
},
"created": "2025-10-25T14:35:00+01:00",
"provider": {
"reference": "urn:uuid:ccc33344-e5f6-4789-a123-456789abcdef"
},
"priority": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/processpriority",
"code": "normal"
}
]
},
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "urn:uuid:eee55566-e5f6-4789-a123-456789abcdef"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code": "1205"
}
],
"text": "Appendectomy"
},
"servicedDate": "2025-10-22",
"quantity": {
"value": 1
},
"unitPrice": {
"value": 150000,
"currency": "NGN"
},
"net": {
"value": 150000,
"currency": "NGN"
}
},
{
"sequence": 2,
"productOrService": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code": "1201"
}
],
"text": "Exam, recall"
},
"servicedPeriod": {
"start": "2025-10-22",
"end": "2025-10-25"
},
"quantity": {
"value": 3
},
"unitPrice": {
"value": 20000,
"currency": "NGN"
},
"net": {
"value": 60000,
"currency": "NGN"
}
},
{
"sequence": 3,
"productOrService": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code": "1101"
}
],
"text": "Laboratory Tests"
},
"servicedDate": "2025-10-22",
"quantity": {
"value": 1
},
"unitPrice": {
"value": 15000,
"currency": "NGN"
},
"net": {
"value": 15000,
"currency": "NGN"
}
},
{
"sequence": 4,
"productOrService": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code": "1102"
}
],
"text": "Medications"
},
"servicedDate": "2025-10-22",
"quantity": {
"value": 1
},
"unitPrice": {
"value": 25000,
"currency": "NGN"
},
"net": {
"value": 25000,
"currency": "NGN"
}
}
],
"total": {
"value": 250000,
"currency": "NGN"
}
},
"request": {
"method": "POST",
"url": "Claim"
}
}
]
}