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
{
"resourceType" : "ClaimResponse",
"id" : "ClaimResponseProfileExample",
"meta" : {
"profile" : [
🔗 "https://shr.tiberbuapps.com/fhir/StructureDefinition/ClaimResponse-ke"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse ClaimResponseProfileExample</b></p><a name=\"ClaimResponseProfileExample\"> </a><a name=\"hcClaimResponseProfileExample\"> </a><a name=\"ClaimResponseProfileExample-en-US\"> </a><p><b>identifier</b>: <code>http://example.org/fhir/identifier-type</code>/KMFL12345\u00a0(use:\u00a0official,\u00a0)</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>subType</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-claimsubtype ortho}\">Orthodontic Claim</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-SHAPatientExample2.html\">Eliud Kipchoge Kiptun Male, DoB: 1984-11-05 ( Unique Patient Identifier: 123456\u00a0(use:\u00a0official,\u00a0))</a></p><p><b>created</b>: 2020-06-15</p><p><b>insurer</b>: <a href=\"Organization-SHAOrganizationExample.html\">Organization Kenyatta National Hospital</a></p><p><b>requestor</b>: <a href=\"SHAPractitionerExample\">SHAPractitionerExample</a></p><p><b>request</b>: <a href=\"Claim-ClaimExample.html\">Claim: status = active; type = Professional; use = claim; created = 2020-06-15; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Claim settled as per policy.</p><p><b>payeeType</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><p><b>noteNumber</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication tax}\">Tax</span></p><p><b>reason</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication-reason ar001}\">Not covered</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>100</td><td>Kenyan shilling</td></tr></table><p><b>value</b>: 100</p></blockquote><blockquote><p><b>detail</b></p><p><b>detailSequence</b>: 1</p><p><b>noteNumber</b>: 1</p><blockquote><p><b>adjudication</b></p></blockquote><blockquote><p><b>subDetail</b></p><p><b>subDetailSequence</b>: 1</p><p><b>noteNumber</b>: 1</p><blockquote><p><b>adjudication</b></p></blockquote></blockquote></blockquote></blockquote><h3>ProcessNotes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Number</b></td><td><b>Type</b></td><td><b>Text</b></td><td><b>Language</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>Display</td><td>Claim settled as per policy.</td><td><span title=\"Codes:{urn:ietf:bcp:47 en}\">English</span></td></tr></table><p><b>communicationRequest</b>: <a href=\"CommunicationRequest-CommunicationRequestExample.html\">CommunicationRequest: status = active</a></p><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>Errors</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>DetailSequence</b></td><td><b>SubDetailSequence</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>1</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication-error a001}\">Missing Creation Date</span></td></tr></table></div>"
},
"identifier" : [
{
"use" : "official",
"system" : "http://example.org/fhir/identifier-type",
"value" : "KMFL12345"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "professional",
"display" : "Professional"
}
],
"text" : "Professional"
},
"subType" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-claimsubtype",
"code" : "ortho",
"display" : "Orthodontic Claim"
}
],
"text" : "Orthodontic Claim"
},
"use" : "claim",
"patient" : {
🔗 "reference" : "Patient/SHAPatientExample2"
},
"created" : "2020-06-15",
"insurer" : {
🔗 "reference" : "Organization/SHAOrganizationExample"
},
"requestor" : {
"reference" : "SHAPractitionerExample"
},
"request" : {
🔗 "reference" : "Claim/ClaimExample"
},
"outcome" : "complete",
"disposition" : "Claim settled as per policy.",
"payeeType" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/payeetype",
"code" : "provider",
"display" : "Provider"
}
],
"text" : "Provider"
},
"item" : [
{
"itemSequence" : 1,
"noteNumber" : [
1
],
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "tax",
"display" : "Tax"
}
],
"text" : "Tax"
},
"reason" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication-reason",
"code" : "ar001",
"display" : "Not covered"
}
],
"text" : "Not covered"
},
"amount" : {
"value" : 100,
"currency" : "KES"
},
"value" : 100
}
],
"detail" : [
{
"detailSequence" : 1,
"noteNumber" : [
1
],
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "tax",
"display" : "Tax"
}
],
"text" : "Tax"
},
"reason" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication-reason",
"code" : "ar001",
"display" : "Not covered"
}
],
"text" : "Not covered"
},
"amount" : {
"value" : 100,
"currency" : "KES"
},
"value" : 100
}
],
"subDetail" : [
{
"subDetailSequence" : 1,
"noteNumber" : [
1
],
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "tax",
"display" : "Tax"
}
],
"text" : "Tax"
},
"reason" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication-reason",
"code" : "ar001",
"display" : "Not covered"
}
],
"text" : "Not covered"
},
"amount" : {
"value" : 100,
"currency" : "KES"
},
"value" : 100
}
]
}
]
}
]
}
],
"processNote" : [
{
"number" : 1,
"type" : "display",
"text" : "Claim settled as per policy.",
"language" : {
"coding" : [
{
"system" : "urn:ietf:bcp:47",
"code" : "en",
"display" : "English"
}
],
"text" : "English"
}
}
],
"communicationRequest" : [
{
🔗 "reference" : "CommunicationRequest/CommunicationRequestExample"
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "CoverageExample"
},
"claimResponse" : {
🔗 "reference" : "ClaimResponse/ClaimResponseExample"
}
}
],
"error" : [
{
"detailSequence" : 1,
"subDetailSequence" : 1,
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication-error",
"code" : "a001",
"display" : "Missing Creation Date"
}
],
"text" : "Missing Creation Date"
}
}
]
}