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Packageorg.dhin-hie.sandbox
Resource TypeExplanationOfBenefit
IdExplanationOfBenefit-NgExplanationOfBenefit-002.json
FHIR VersionR4

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Narrative

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

Generated Narrative: ExplanationOfBenefit NgExplanationOfBenefit-002

status: Active

type: Pharmacy

use: Claim

patient: Musa Abdullahi Male, DoB: 1987-07-06 ( nin)

created: 2025-11-04 12:51:00+0000

insurer: Organization Truth Health Maintenance Organization

provider: Organization Port Harcourt Emergency Hospital

claim: Claim: identifier = https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry#CLM-2025-0001; status = active; type = Pharmacy; use = claim; created = 2025-11-04 12:30:00+0000; priority = Normal

claimResponse: ClaimResponse: status = active; type = Pharmacy; use = claim; created = 2025-11-04 12:50:00+0000; outcome = partial; disposition = Partially approved; copay applied.; preAuthRef = 5678

outcome: Partial Processing

Insurances

-FocalCoveragePreAuthRef
*trueCoverage: status = active; type = extended healthcare; subscriberId = TRUTH-HMO-CHIKA-2025; dependent = 00; relationship = Self; period = 2025-01-01 --> 2025-12-31; order = 1PA-2025-8847

benefitPeriod: 2025-01-01 --> 2025-12-31

Source1

{
  "resourceType": "ExplanationOfBenefit",
  "id": "NgExplanationOfBenefit-002",
  "meta": {
    "profile": [
      "https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-explanation-of-benefit"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "pharmacy"
      }
    ]
  },
  "use": "claim",
  "patient": {
    "reference": "Patient/NgPatient-002"
  },
  "created": "2025-11-04T12:51:00Z",
  "insurer": {
    "reference": "Organization/Organization-Truth-HMO"
  },
  "provider": {
    "reference": "Organization/Organization-PortHarcourt-Hospital"
  },
  "claim": {
    "reference": "Claim/NgClaim-001"
  },
  "claimResponse": {
    "reference": "ClaimResponse/NgClaimResponse-002"
  },
  "outcome": "partial",
  "insurance": [
    {
      "focal": true,
      "coverage": {
        "reference": "Coverage/Coverage-Chika-TruthHMO"
      },
      "preAuthRef": [
        "PA-2025-8847"
      ]
    }
  ],
  "benefitPeriod": {
    "start": "2025-01-01",
    "end": "2025-12-31"
  }
}