FHIR IG analytics| Package | pharmacyeclaim.trial |
| Resource Type | Bundle |
| Id | Claim Reversal Request.json |
| FHIR Version | R4 |
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No narrative content found in resource
{
"resourceType": "Bundle",
"id": "c149ce78-0983-4fc2-ba63-aeac253e933e",
"meta": {
"tag": [
{
"system": "http://pharmacyeclaims.ca/FHIR/CodeSystem/message-version",
"code": "1.0"
}
]
},
"type": "message",
"timestamp": "2025-01-06T22:03:23+00:00",
"entry": [
{
"fullUrl": "urn:uuid:6d8041af-7963-4bff-baf4-968d600fbd1e",
"resource": {
"resourceType": "MessageHeader",
"id": "6d8041af-7963-4bff-baf4-968d600fbd1e",
"eventCoding": {
"system": "http://pharmacyeclaims.ca/fhir/CodeSystem/message-events",
"code": "11"
},
"destination": [
{
"name": "Name of Adjudicator",
"endpoint": "urn:oid:2.16.840.1.113883.3.7066.1",
"receiver": {
"reference": "Organization/12345",
"identifier": {
"system": "urn:oid:http://pharmacyeclaims.ca/FHIR/CPHA-identifier/IIN",
"value": "Device-123"
}
}
}
],
"sender": {
"reference": "Organization/12345",
"identifier": {
"system": "urn:oid:setbyPOSvendor",
"value": "SoftwareVendorClientName"
}
},
"source": {
"name": "thename",
"software": "POS software name",
"version": "POSversion",
"endpoint": "urn:uuid:2fcd0a14-4ad6-11e8-9c2d-fa7ae01bbebc"
},
"responsible": {
"reference": "Organization/086968a8c716",
"identifier": {
"system": "http://pharmacyeclaims.ca/FHIR/PharmacyID",
"value": "Device-123"
}
},
"focus": [
{
"reference": "urn:uuid:6d8041af-7963-4bff-baf4-968d600fbd1"
}
]
}
},
{
"fullUrl": "urn:uuid:6d8041af-7963-4bff-baf4-968d600para",
"resource": {
"resourceType": "Parameters",
"id": "6d8041af-7963-4bff-baf4-968d600fpara",
"parameter": [
{
"name": "AdjudicationDate",
"valueDateTime": "2025-08-01T10:00:00Z"
},
{
"name": "TraceNumber",
"valueIdentifier": {
"system": "http://pharmacyeclaims.ca/FHIR/TraceNumber",
"value": "TRC-9876543210"
}
},
{
"name": "ReferenceNumber",
"valueIdentifier": {
"system": "http://pharmacyeclaims.ca/FHIR/reference",
"value": "REF-1234567890"
}
},
{
"name": "CurrentRXNumber",
"valueIdentifier": {
"system": "http://pharmacyeclaims.ca/FHIR/rx",
"value": "RX-00012345"
}
},
{
"name": "ProviderTransactionDate",
"valueDateTime": "2025-07-31T14:45:00Z"
},
{
"name": "ClientID",
"valueIdentifier": {
"value": "123451234512345"
}
}
]
}
}
]
}