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
<ClaimResponse xmlns="http://hl7.org/fhir">
<id value="ClaimResponseProfileExample"/>
<meta>
<profile
value="https://shr.tiberbuapps.com/fhir/StructureDefinition/ClaimResponse-ke"/>
</meta>
<text>
<status value="generated"/>
<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 (use: official, )</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 (use: official, ))</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>
</text>
<identifier>
<use value="official"/>
<system value="http://example.org/fhir/identifier-type"/>
<value value="KMFL12345"/>
</identifier>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="professional"/>
<display value="Professional"/>
</coding>
<text value="Professional"/>
</type>
<subType>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/ex-claimsubtype"/>
<code value="ortho"/>
<display value="Orthodontic Claim"/>
</coding>
<text value="Orthodontic Claim"/>
</subType>
<use value="claim"/>
<patient>🔗
<reference value="Patient/SHAPatientExample2"/>
</patient>
<created value="2020-06-15"/>
<insurer>🔗
<reference value="Organization/SHAOrganizationExample"/>
</insurer>
<requestor>
<reference value="SHAPractitionerExample"/>
</requestor>
<request>🔗
<reference value="Claim/ClaimExample"/>
</request>
<outcome value="complete"/>
<disposition value="Claim settled as per policy."/>
<payeeType>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/payeetype"/>
<code value="provider"/>
<display value="Provider"/>
</coding>
<text value="Provider"/>
</payeeType>
<item>
<itemSequence value="1"/>
<noteNumber value="1"/>
<adjudication>
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="tax"/>
<display value="Tax"/>
</coding>
<text value="Tax"/>
</category>
<reason>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication-reason"/>
<code value="ar001"/>
<display value="Not covered"/>
</coding>
<text value="Not covered"/>
</reason>
<amount>
<value value="100"/>
<currency value="KES"/>
</amount>
<value value="100"/>
</adjudication>
<detail>
<detailSequence value="1"/>
<noteNumber value="1"/>
<adjudication>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="tax"/>
<display value="Tax"/>
</coding>
<text value="Tax"/>
</category>
<reason>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication-reason"/>
<code value="ar001"/>
<display value="Not covered"/>
</coding>
<text value="Not covered"/>
</reason>
<amount>
<value value="100"/>
<currency value="KES"/>
</amount>
<value value="100"/>
</adjudication>
<subDetail>
<subDetailSequence value="1"/>
<noteNumber value="1"/>
<adjudication>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="tax"/>
<display value="Tax"/>
</coding>
<text value="Tax"/>
</category>
<reason>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication-reason"/>
<code value="ar001"/>
<display value="Not covered"/>
</coding>
<text value="Not covered"/>
</reason>
<amount>
<value value="100"/>
<currency value="KES"/>
</amount>
<value value="100"/>
</adjudication>
</subDetail>
</detail>
</item>
<processNote>
<number value="1"/>
<type value="display"/>
<text value="Claim settled as per policy."/>
<language>
<coding>
<system value="urn:ietf:bcp:47"/>
<code value="en"/>
<display value="English"/>
</coding>
<text value="English"/>
</language>
</processNote>
<communicationRequest>🔗
<reference value="CommunicationRequest/CommunicationRequestExample"/>
</communicationRequest>
<insurance>
<sequence value="1"/>
<focal value="true"/>
<coverage>
<reference value="CoverageExample"/>
</coverage>
<claimResponse>🔗
<reference value="ClaimResponse/ClaimResponseExample"/>
</claimResponse>
</insurance>
<error>
<detailSequence value="1"/>
<subDetailSequence value="1"/>
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication-error"/>
<code value="a001"/>
<display value="Missing Creation Date"/>
</coding>
<text value="Missing Creation Date"/>
</code>
</error>
</ClaimResponse>