0.1.0 - ci-build

kenyaClaimsIG - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: Example Claim - JSON Representation

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{
  "resourceType" : "Claim",
  "id" : "ClaimProfileExample",
  "meta" : {
    "profile" : [
      🔗 "https://shr.tiberbuapps.com/fhir/StructureDefinition/ClaimProfile"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim ClaimProfileExample</b></p><a name=\"ClaimProfileExample\"> </a><a name=\"hcClaimProfileExample\"> </a><a name=\"ClaimProfileExample-en-US\"> </a><p><b>identifier</b>: <code>http://example.org/fhir/claims</code>/123456</p><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>subType</b>: <span title=\"Codes:{http://example.org/fhir/claim-subtypes emergency}\">emergency</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-SHAPatientExample.html\">Eliud Kipchoge Kiptun Male, DoB: 1984-11-05 ( Unique Patient Identifier: 123456\u00a0(use:\u00a0official,\u00a0))</a></p><p><b>billablePeriod</b>: 2023-01-01 --&gt; 2023-01-31</p><p><b>created</b>: 2023-02-01</p><p><b>insurer</b>: <a href=\"Organization-SHAOrganizationExample.html\">Organization Kenyatta National Hospital</a></p><p><b>provider</b>: <a href=\"Practitioner-PractitionerExample.html\">Practitioner John Doe </a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Relateds</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Claim</b></td><td><b>Relationship</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Claim-ClaimExample.html\">Claim: status = active; type = Professional; use = claim; created = 2020-06-15; priority = Normal</a></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-claimrelationship associated}\">associated</span></td></tr></table><p><b>prescription</b>: <a href=\"MedicationRequest-MedicationRequestExample.html\">MedicationRequest: status = active; intent = order; medication[x] = -&gt;Medication Codeine phosphate</a></p><p><b>originalPrescription</b>: <a href=\"MedicationRequest-MedicationRequestExample.html\">MedicationRequest: status = active; intent = order; medication[x] = -&gt;Medication Codeine phosphate</a></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td></tr></table><p><b>referral</b>: <a href=\"ServiceRequest-ServiceRequestExample.html\">ServiceRequest: status = active; intent = order</a></p><p><b>facility</b>: <a href=\"Location-LocationExample.html\">Location Kenya Medical Research Institute</a></p><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td><td><b>Role</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Practitioner-PractitionerExample.html\">Practitioner John Doe </a></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claimcareteamrole primary}\">Primary provider</span></td></tr></table><h3>SupportingInfos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Code</b></td><td><b>Timing[x]</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claiminformationcategory info}\">Information</span></td><td><span title=\"Codes:{http://example.org/fhir/supporting-info additional-info}\">additional-info</span></td><td>2023-01-15</td><td>Supporting information value</td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10 I}\">DIAG-1a</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/diagnosis-type principal}\">principal</span></td></tr></table><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><td><b>ClaimResponse</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"CoverageExample\">CoverageExample</a></td><td><a href=\"ClaimResponse-ClaimResponseExample.html\">ClaimResponse: status = active; type = Professional; use = claim; created = 2020-06-15; outcome = complete</a></td></tr></table><h3>Accidents</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Date</b></td><td><b>Type</b></td><td><b>Location[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>2023-01-20</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActIncidentCode MVA}\">MVA</span></td><td>1234 Elm Street, Somewhere, ST 12345</td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://example.org/fhir/item-codes exam}\">exam</span></p><p><b>serviced</b>: 2023-01-21</p><p><b>quantity</b>: 1</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>100</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>100</td></tr></table><p><b>udi</b>: <a href=\"Device-DeviceExample.html\">Device: status = active</a></p><p><b>bodySite</b>: <span title=\"Codes:{http://example.org/fhir/bodysites forehead}\">forehead</span></p><p><b>subSite</b>: <span title=\"Codes:{http://example.org/fhir/subsites left}\">left</span></p><blockquote><p><b>detail</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://example.org/fhir/item-detail-codes service}\">service</span></p><p><b>quantity</b>: 1</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>50</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>50</td></tr></table><p><b>udi</b>: <a href=\"Device-DeviceExample.html\">Device: status = active</a></p><blockquote><p><b>subDetail</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://example.org/fhir/billings Billing}\">Billing</span></p><p><b>quantity</b>: 1</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>25</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>25</td></tr></table><p><b>udi</b>: <a href=\"Device-DeviceExample.html\">Device: status = active</a></p></blockquote></blockquote></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>175</td></tr></table></div>"
  },
  "identifier" : [
    {
      "system" : "http://example.org/fhir/claims",
      "value" : "123456"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "institutional"
      }
    ]
  },
  "subType" : {
    "coding" : [
      {
        "system" : "http://example.org/fhir/claim-subtypes",
        "code" : "emergency"
      }
    ]
  },
  "use" : "claim",
  "patient" : {
    🔗 "reference" : "Patient/SHAPatientExample"
  },
  "billablePeriod" : {
    "start" : "2023-01-01",
    "end" : "2023-01-31"
  },
  "created" : "2023-02-01",
  "insurer" : {
    🔗 "reference" : "Organization/SHAOrganizationExample"
  },
  "provider" : {
    🔗 "reference" : "Practitioner/PractitionerExample"
  },
  "priority" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
        "code" : "normal"
      }
    ]
  },
  "related" : [
    {
      "claim" : {
        🔗 "reference" : "Claim/ClaimExample"
      },
      "relationship" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/ex-claimrelationship",
            "code" : "associated"
          }
        ]
      }
    }
  ],
  "prescription" : {
    🔗 "reference" : "MedicationRequest/MedicationRequestExample"
  },
  "originalPrescription" : {
    🔗 "reference" : "MedicationRequest/MedicationRequestExample"
  },
  "payee" : {
    "type" : {
      "coding" : [
        {
          "system" : "http://terminology.hl7.org/CodeSystem/payeetype",
          "code" : "provider"
        }
      ]
    }
  },
  "referral" : {
    🔗 "reference" : "ServiceRequest/ServiceRequestExample"
  },
  "facility" : {
    🔗 "reference" : "Location/LocationExample"
  },
  "careTeam" : [
    {
      "sequence" : 1,
      "provider" : {
        🔗 "reference" : "Practitioner/PractitionerExample"
      },
      "role" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
            "code" : "primary"
          }
        ]
      }
    }
  ],
  "supportingInfo" : [
    {
      "sequence" : 1,
      "category" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code" : "info"
          }
        ]
      },
      "code" : {
        "coding" : [
          {
            "system" : "http://example.org/fhir/supporting-info",
            "code" : "additional-info"
          }
        ]
      },
      "timingDate" : "2023-01-15",
      "valueString" : "Supporting information value"
    }
  ],
  "diagnosis" : [
    {
      "sequence" : 1,
      "diagnosisCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/sid/icd-10",
            "code" : "I",
            "display" : "Certain infectious and parasitic diseases"
          }
        ],
        "text" : "DIAG-1a"
      },
      "type" : [
        {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/diagnosis-type",
              "code" : "principal"
            }
          ]
        }
      ]
    }
  ],
  "insurance" : [
    {
      "sequence" : 1,
      "focal" : true,
      "coverage" : {
        "reference" : "CoverageExample"
      },
      "claimResponse" : {
        🔗 "reference" : "ClaimResponse/ClaimResponseExample"
      }
    }
  ],
  "accident" : {
    "date" : "2023-01-20",
    "type" : {
      "coding" : [
        {
          "system" : "http://terminology.hl7.org/CodeSystem/v3-ActIncidentCode",
          "code" : "MVA"
        }
      ]
    },
    "locationAddress" : {
      "text" : "1234 Elm Street, Somewhere, ST 12345"
    }
  },
  "item" : [
    {
      "sequence" : 1,
      "productOrService" : {
        "coding" : [
          {
            "system" : "http://example.org/fhir/item-codes",
            "code" : "exam"
          }
        ]
      },
      "servicedDate" : "2023-01-21",
      "quantity" : {
        "value" : 1
      },
      "unitPrice" : {
        "value" : 100
      },
      "net" : {
        "value" : 100
      },
      "udi" : [
        {
          🔗 "reference" : "Device/DeviceExample"
        }
      ],
      "bodySite" : {
        "coding" : [
          {
            "system" : "http://example.org/fhir/bodysites",
            "code" : "forehead"
          }
        ]
      },
      "subSite" : [
        {
          "coding" : [
            {
              "system" : "http://example.org/fhir/subsites",
              "code" : "left"
            }
          ]
        }
      ],
      "detail" : [
        {
          "sequence" : 1,
          "productOrService" : {
            "coding" : [
              {
                "system" : "http://example.org/fhir/item-detail-codes",
                "code" : "service"
              }
            ]
          },
          "quantity" : {
            "value" : 1
          },
          "unitPrice" : {
            "value" : 50
          },
          "net" : {
            "value" : 50
          },
          "udi" : [
            {
              🔗 "reference" : "Device/DeviceExample"
            }
          ],
          "subDetail" : [
            {
              "sequence" : 1,
              "productOrService" : {
                "coding" : [
                  {
                    "system" : "http://example.org/fhir/billings",
                    "code" : "Billing"
                  }
                ]
              },
              "quantity" : {
                "value" : 1
              },
              "unitPrice" : {
                "value" : 25
              },
              "net" : {
                "value" : 25
              },
              "udi" : [
                {
                  🔗 "reference" : "Device/DeviceExample"
                }
              ]
            }
          ]
        }
      ]
    }
  ],
  "total" : {
    "value" : 175
  }
}