QI-Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 7.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-qi-core/ and changes regularly. See the Directory of published versions
{
"resourceType" : "ClaimResponse",
"id" : "example",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse example</b></p><a name=\"example\"> </a><a name=\"hcexample\"> </a><a name=\"example-en-US\"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type vision}\">Vision</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-example.html\">Jim Chalmers Male, DoB: 1974-12-25 ( Medical record number\u00a0(use:\u00a0usual,\u00a0period:\u00a02001-05-06 --> (ongoing)))</a></p><p><b>created</b>: 2018-02-24</p><p><b>insurer</b>: <a href=\"Organization-example.html\">Organization Health Level Seven International</a></p><p><b>requestor</b>: <a href=\"Practitioner-example.html\">Practitioner Adam Careful </a></p><p><b>request</b>: <a href=\"Claim-example.html\">Claim: identifier = http://happysight.com/claim#6612346; status = active; type = Vision; use = claim; created = 2014-08-16; priority = Normal</a></p><p><b>outcome</b>: Queued</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</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>235.40</td><td>United States dollar</td></tr></table></blockquote></blockquote></div>"
},
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "vision"
}
]
},
"use" : "preauthorization",
"patient" : {
🔗 "reference" : "Patient/example"
},
"created" : "2018-02-24",
"insurer" : {
🔗 "reference" : "Organization/example"
},
"requestor" : {
🔗 "reference" : "Practitioner/example"
},
"request" : {
🔗 "reference" : "Claim/example"
},
"outcome" : "queued",
"item" : [
{
"itemSequence" : 1,
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "submitted"
}
]
},
"amount" : {
"value" : 235.40,
"currency" : "USD"
}
}
]
}
]
}