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

• Narrative Content
• XML
• JSON
• TTL

: ClaimResponse example - XML Representation

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<ClaimResponse xmlns="http://hl7.org/fhir">
  <id value="example"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse"/>
  </meta>
  <text>
    <status value="generated"/>
    <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 (use: usual, period: 2001-05-06 --&gt; (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>
  </text>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="vision"/>
    </coding>
  </type>
  <use value="preauthorization"/>
  <patient>🔗 
    <reference value="Patient/example"/>
  </patient>
  <created value="2018-02-24"/>
  <insurer>🔗 
    <reference value="Organization/example"/>
  </insurer>
  <requestor>🔗 
    <reference value="Practitioner/example"/>
  </requestor>
  <request>🔗 
    <reference value="Claim/example"/>
  </request>
  <outcome value="queued"/>
  <item>
    <itemSequence value="1"/>
    <adjudication>
      <category>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
          <code value="submitted"/>
        </coding>
      </category>
      <amount>
        <value value="235.40"/>
        <currency value="USD"/>
      </amount>
    </adjudication>
  </item>
</ClaimResponse>