FHIRsmith: ClaimResponse/ClaimResponse-claim-response-example.json

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Package	tw.gov.mohw.nhi.pas
Resource Type	ClaimResponse
Id	ClaimResponse-claim-response-example.json
FHIR Version	R4

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Narrative

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

Profile: 事前審查結果-ClaimResponse TWPAS

狀態：Active

類型：Institutional

用途：Preauthorization

病人：Patient/pat-min

核定日期：2024-07-30

關聯的事前審查：Claim/cla-1

保險商：Organization 衛生福利部中央健康保險署

requestor：Organization 醫事機構

處置狀態：Processing Complete

案件受理狀態：審畢結果

item
itemSequence：1
受理審查案件核定註記
- 類型 受理審查案件核定註記 核定數量
* Submitted Amount 同意備查 ( NHI-健保事前審查-核定註記#1) ) 2
個別醫令核定註記
- 類型 Claim.item.sequence 個別醫令核定註記
* Submitted Amount 1 同意備查 ( NHI-健保事前審查-核定註記#1) )
* Submitted Amount 2 同意備查 ( NHI-健保事前審查-核定註記#1) )

Source1

{
  "resourceType": "ClaimResponse",
  "id": "claim-response-example",
  "meta": {
    "profile": [
      "https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClaimResponse-twpas"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "institutional"
      }
    ]
  },
  "use": "preauthorization",
  "patient": {
    "reference": "Patient/pat-min"
  },
  "created": "2024-07-30",
  "insurer": {
    "reference": "Organization/org-nhi"
  },
  "requestor": {
    "reference": "Organization/org-hosp-example"
  },
  "request": {
    "reference": "Claim/cla-1"
  },
  "outcome": "complete",
  "disposition": "審畢結果",
  "item": [
    {
      "itemSequence": 1,
      "adjudication": [
        {
          "category": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                "code": "submitted"
              }
            ]
          },
          "reason": {
            "coding": [
              {
                "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-approve-comment",
                "code": "1"
              }
            ]
          },
          "value": 2
        }
      ],
      "detail": [
        {
          "detailSequence": 1,
          "adjudication": [
            {
              "category": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                    "code": "submitted"
                  }
                ]
              },
              "reason": {
                "coding": [
                  {
                    "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-approve-comment",
                    "code": "1"
                  }
                ]
              }
            }
          ]
        },
        {
          "detailSequence": 2,
          "adjudication": [
            {
              "category": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                    "code": "submitted"
                  }
                ]
              },
              "reason": {
                "coding": [
                  {
                    "system": "https://nhicore.nhi.gov.tw/pas/CodeSystem/nhi-approve-comment",
                    "code": "1"
                  }
                ]
              }
            }
          ]
        }
      ]
    }
  ]
}