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
<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 --> (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>