FHIR IG analytics| Package | pharmacyeclaim.trial |
| Resource Type | Bundle |
| Id | Claim Reversal Response Accepted .json |
| FHIR Version | R4 |
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No resources found
No narrative content found in resource
{
"resourceType": "Bundle",
"id": "6d8041af-7963-4bff-baf4-968d600gbd1e",
"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-baf4-968d600gbd1e",
"resource": {
"resourceType": "MessageHeader",
"id": "6d8041af-7963-4bff-baf4-968d600fbond",
"eventCoding": {
"system": "http://pharmacyeclaims.ca/fhir/CodeSystem/message-events",
"code": "61"
},
"destination": [
{
"name": "Name of Sending System",
"target": {
"reference": "Organization/b5c8a272-b078-4ac7-b53d-086968a8c716"
},
"endpoint": "urn:oid:2.16.840.1.113883.3.7066.2"
}
],
"source": {
"endpoint": "urn:uuid:2fcd0a14-4ad6-11e8-9c2d-fa7ae01bbebc"
},
"response": {
"identifier": "6d8041af-7963-4bff-baf4-968d600fbd1e",
"code": "ok"
},
"focus": [
{
"reference": "urn:uuid:6d8041af-7963-4bff-baf4-968d600fclrs"
}
]
}
},
{
"fullUrl": "urn:uuid:6d8041af-7963-4bff-baf4-968d600fclrs",
"resource": {
"resourceType": "Parameters",
"id": "6d8041af-7963-4bff-baf4-968d600revr",
"parameter": [
{
"name": "AdjudicationDate",
"valueDateTime": "2025-08-01T12:00:00Z"
},
{
"name": "TraceNumber",
"valueIdentifier": {
"system": "http://pharmacyeclaims.ca/FHIR/trace-number",
"value": "TRACE123456"
}
},
{
"name": "ReferenceNumber",
"valueIdentifier": {
"system": "http://pharmacyeclaims.ca/FHIR/reference-number",
"value": "REF987654"
}
},
{
"name": "ClaimOrCurrentRXNumber",
"valueIdentifier": {
"system": "http://pharmacyeclaims.ca/FHIR//rx",
"value": "RX20230808001"
}
},
{
"name": "ResponseStatus",
"valueCode": "V"
},
{
"name": "ReversalAmount",
"valueMoney": {
"value": 123.45
}
},
{
"name": "PayeeType",
"valueString": "Provider"
}
]
}
}
]
}