DHIN 2025Connectathon FHIR IG
0.2.0 - ci-build Nigeria flag

DHIN 2025Connectathon FHIR IG, published by DHIN. This guide is not an authorized publication; it is the continuous build for version 0.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/Nigeria-FHIR-Community/2025Connectathon/ and changes regularly. See the Directory of published versions

: Claim Submission - Request (Transaction) - XML Representation

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<Bundle xmlns="http://hl7.org/fhir">
  <id value="ClaimSubmission-Request"/>
  <meta>
    <profile
             value="https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-claim-submission-bundle"/>
  </meta>
  <type value="transaction"/>
  <entry>
    <fullUrl value="urn:uuid:aaabbbc2-e5f6-4789-a123-456789abcdef"/>
    <resource>
      <Patient>
        <id value="NgPatient-Claim-001"/>
        <meta>
          <lastUpdated value="2025-10-25T14:30:00+01:00"/>
          <profile
                   value="https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-patient"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_NgPatient-Claim-001"> </a><p class="res-header-id"><b>Generated Narrative: Patient NgPatient-Claim-001</b></p><a name="NgPatient-Claim-001"> </a><a name="hcNgPatient-Claim-001"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Last updated: 2025-10-25 14:30:00+0100</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ng-patient.html">NG Patient</a></p></div><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">Amaka Nwosu  Female, DoB: 1992-07-15 ( mobile: 08045678901)</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Record is active">Active:</td><td colspan="3">true</td></tr><tr><td style="background-color: #f3f5da" title="Ways to contact the Patient">Contact Detail</td><td colspan="3">22 River Road Port Harcourt RI </td></tr></table></div>
        </text>
        <identifier>
          <type>
            <coding>
              <system
                      value="https://sandbox.dhin-hie.org/ig/CodeSystem/patient-identifier-cs"/>
              <code value="MOBILE"/>
              <display value="mobile"/>
            </coding>
          </type>
          <system
                  value="https://sandbox.dhin-hie.org/ig/CodeSystem/patient-identifier-cs"/>
          <value value="08045678901"/>
        </identifier>
        <active value="true"/>
        <name>
          <family value="Nwosu"/>
          <given value="Amaka"/>
        </name>
        <gender value="female"/>
        <birthDate value="1992-07-15"/>
        <address>
          <line value="22 River Road"/>
          <city value="Port Harcourt"/>
          <district value="ri-oyigbo"/>
          <state value="RI"/>
        </address>
      </Patient>
    </resource>
    <request>
      <method value="POST"/>
      <url value="Patient"/>
    </request>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:ccc33344-e5f6-4789-a123-456789abcdef"/>
    <resource>
      <Organization>
        <id value="NgOrganization-Provider-Claim-001"/>
        <meta>
          <profile
                   value="https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-provider-organization"/>
        </meta>
        <text>
          <status value="extensions"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_NgOrganization-Provider-Claim-001"> </a><p class="res-header-id"><b>Generated Narrative: Organization NgOrganization-Provider-Claim-001</b></p><a name="NgOrganization-Provider-Claim-001"> </a><a name="hcNgOrganization-Provider-Claim-001"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ng-provider-organization.html">NG Provider Organization</a></p></div><p><b>NG Owner of Facility</b>: <span title="Codes:{https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-location-owner-cs public}">Public Health Institution Location</span></p><p><b>identifier</b>: <code>https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry</code>/HCF-RS-5678</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/organization-type prov}">Healthcare Provider</span></p><p><b>name</b>: Rivers State Teaching Hospital</p><p><b>telecom</b>: ph: 084-234-5678</p><p><b>address</b>: 100 Hospital Boulevard Port Harcourt RI </p></div>
        </text>
        <extension
                   url="https://sandbox.dhin-hie.org/ig/StructureDefinition/organization-owner">
          <valueCodeableConcept>
            <coding>
              <system
                      value="https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-location-owner-cs"/>
              <code value="public"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <identifier>
          <system
                  value="https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry"/>
          <value value="HCF-RS-5678"/>
        </identifier>
        <active value="true"/>
        <type>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/organization-type"/>
            <code value="prov"/>
            <display value="Healthcare Provider"/>
          </coding>
        </type>
        <name value="Rivers State Teaching Hospital"/>
        <telecom>
          <system value="phone"/>
          <value value="084-234-5678"/>
        </telecom>
        <address>
          <line value="100 Hospital Boulevard"/>
          <city value="Port Harcourt"/>
          <district value="ri-oyigbo"/>
          <state value="RI"/>
        </address>
      </Organization>
    </resource>
    <request>
      <method value="POST"/>
      <url value="Organization"/>
    </request>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:ddd44455-e5f6-4789-a123-456789abcdef"/>
    <resource>
      <Organization>
        <id value="NgOrganization-Insurer-Claim-001"/>
        <meta>
          <profile
                   value="https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-insurer-organization"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_NgOrganization-Insurer-Claim-001"> </a><p class="res-header-id"><b>Generated Narrative: Organization NgOrganization-Insurer-Claim-001</b></p><a name="NgOrganization-Insurer-Claim-001"> </a><a name="hcNgOrganization-Insurer-Claim-001"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ng-insurer-organization.html">NG Insurer Organization</a></p></div><p><b>identifier</b>: <code>https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry</code>/HMO-MC-9988</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/organization-type ins}">Insurance Company</span></p><p><b>name</b>: MediCare Plus HMO</p><p><b>telecom</b>: ph: 0700-MEDICARE</p><p><b>address</b>: 15 Insurance Plaza Port Harcourt RI </p></div>
        </text>
        <identifier>
          <system
                  value="https://sandbox.dhin-hie.org/ig/CodeSystem/nigeria-facility-registry"/>
          <value value="HMO-MC-9988"/>
        </identifier>
        <active value="true"/>
        <type>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/organization-type"/>
            <code value="ins"/>
            <display value="Insurance Company"/>
          </coding>
        </type>
        <name value="MediCare Plus HMO"/>
        <telecom>
          <system value="phone"/>
          <value value="0700-MEDICARE"/>
        </telecom>
        <address>
          <line value="15 Insurance Plaza"/>
          <city value="Port Harcourt"/>
          <district value="ri-oyigbo"/>
          <state value="RI"/>
        </address>
      </Organization>
    </resource>
    <request>
      <method value="POST"/>
      <url value="Organization"/>
    </request>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:eee55566-e5f6-4789-a123-456789abcdef"/>
    <resource>
      <Coverage>
        <id value="NgCoverage-Claim-001"/>
        <meta>
          <profile
                   value="https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-coverage"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Coverage_NgCoverage-Claim-001"> </a><p class="res-header-id"><b>Generated Narrative: Coverage NgCoverage-Claim-001</b></p><a name="NgCoverage-Claim-001"> </a><a name="hcNgCoverage-Claim-001"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ng-coverage.html">NG Claim Coverage</a></p></div><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode EHCPOL}">extended healthcare</span></p><p><b>beneficiary</b>: <a href="Bundle-ClaimSubmission-Request.html#urn-uuid-aaabbbc2-e5f6-4789-a123-456789abcdef">Amaka Nwosu  Female, DoB: 1992-07-15 ( mobile: 08045678901)</a></p><p><b>period</b>: 2025-01-01 --&gt; 2025-12-31</p><p><b>payor</b>: <a href="Bundle-ClaimSubmission-Request.html#urn-uuid-ddd44455-e5f6-4789-a123-456789abcdef">Organization MediCare Plus HMO</a></p></div>
        </text>
        <status value="active"/>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
            <code value="EHCPOL"/>
            <display value="extended healthcare"/>
          </coding>
        </type>
        <beneficiary>
          <reference value="urn:uuid:aaabbbc2-e5f6-4789-a123-456789abcdef"/>
        </beneficiary>
        <period>
          <start value="2025-01-01"/>
          <end value="2025-12-31"/>
        </period>
        <payor>
          <reference value="urn:uuid:ddd44455-e5f6-4789-a123-456789abcdef"/>
        </payor>
      </Coverage>
    </resource>
    <request>
      <method value="POST"/>
      <url value="Coverage"/>
    </request>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:fff66677-e5f6-4789-a123-456789abcdef"/>
    <resource>
      <Claim>
        <id value="NgClaim-Claim-001"/>
        <meta>
          <profile
                   value="https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-claim"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Claim_NgClaim-Claim-001"> </a><p class="res-header-id"><b>Generated Narrative: Claim NgClaim-Claim-001</b></p><a name="NgClaim-Claim-001"> </a><a name="hcNgClaim-Claim-001"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ng-claim.html">NG Claim</a></p></div><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}">Institutional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href="Bundle-ClaimSubmission-Request.html#urn-uuid-aaabbbc2-e5f6-4789-a123-456789abcdef">Amaka Nwosu  Female, DoB: 1992-07-15 ( mobile: 08045678901)</a></p><p><b>created</b>: 2025-10-25 14:35:00+0100</p><p><b>provider</b>: <a href="Bundle-ClaimSubmission-Request.html#urn-uuid-ccc33344-e5f6-4789-a123-456789abcdef">Organization Rivers State Teaching Hospital</a></p><p><b>priority</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}">Normal</span></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></tr><tr><td style="display: none">*</td><td>1</td><td>true</td><td><a href="Bundle-ClaimSubmission-Request.html#urn-uuid-eee55566-e5f6-4789-a123-456789abcdef">Coverage: status = active; type = extended healthcare; period = 2025-01-01 --&gt; 2025-12-31</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/ex-USCLS 1205}">Appendectomy</span></p><p><b>serviced</b>: 2025-10-22</p><p><b>quantity</b>: 1</p><h3>UnitPrices</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>150000</td><td>Nigerian naira</td></tr></table><h3>Nets</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>150000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 2</p><p><b>productOrService</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/ex-USCLS 1201}">Exam, recall</span></p><p><b>serviced</b>: 2025-10-22 --&gt; 2025-10-25</p><p><b>quantity</b>: 3</p><h3>UnitPrices</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>20000</td><td>Nigerian naira</td></tr></table><h3>Nets</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>60000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 3</p><p><b>productOrService</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/ex-USCLS 1101}">Laboratory Tests</span></p><p><b>serviced</b>: 2025-10-22</p><p><b>quantity</b>: 1</p><h3>UnitPrices</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>15000</td><td>Nigerian naira</td></tr></table><h3>Nets</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>15000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 4</p><p><b>productOrService</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/ex-USCLS 1102}">Medications</span></p><p><b>serviced</b>: 2025-10-22</p><p><b>quantity</b>: 1</p><h3>UnitPrices</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>25000</td><td>Nigerian naira</td></tr></table><h3>Nets</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>25000</td><td>Nigerian naira</td></tr></table></blockquote><h3>Totals</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>250000</td><td>Nigerian naira</td></tr></table></div>
        </text>
        <status value="active"/>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
            <code value="institutional"/>
            <display value="Institutional"/>
          </coding>
        </type>
        <use value="claim"/>
        <patient>
          <reference value="urn:uuid:aaabbbc2-e5f6-4789-a123-456789abcdef"/>
        </patient>
        <created value="2025-10-25T14:35:00+01:00"/>
        <provider>
          <reference value="urn:uuid:ccc33344-e5f6-4789-a123-456789abcdef"/>
        </provider>
        <priority>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/processpriority"/>
            <code value="normal"/>
          </coding>
        </priority>
        <insurance>
          <sequence value="1"/>
          <focal value="true"/>
          <coverage>
            <reference value="urn:uuid:eee55566-e5f6-4789-a123-456789abcdef"/>
          </coverage>
        </insurance>
        <item>
          <sequence value="1"/>
          <productOrService>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/ex-USCLS"/>
              <code value="1205"/>
            </coding>
            <text value="Appendectomy"/>
          </productOrService>
          <servicedDate value="2025-10-22"/>
          <quantity>
            <value value="1"/>
          </quantity>
          <unitPrice>
            <value value="150000"/>
            <currency value="NGN"/>
          </unitPrice>
          <net>
            <value value="150000"/>
            <currency value="NGN"/>
          </net>
        </item>
        <item>
          <sequence value="2"/>
          <productOrService>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/ex-USCLS"/>
              <code value="1201"/>
            </coding>
            <text value="Exam, recall"/>
          </productOrService>
          <servicedPeriod>
            <start value="2025-10-22"/>
            <end value="2025-10-25"/>
          </servicedPeriod>
          <quantity>
            <value value="3"/>
          </quantity>
          <unitPrice>
            <value value="20000"/>
            <currency value="NGN"/>
          </unitPrice>
          <net>
            <value value="60000"/>
            <currency value="NGN"/>
          </net>
        </item>
        <item>
          <sequence value="3"/>
          <productOrService>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/ex-USCLS"/>
              <code value="1101"/>
            </coding>
            <text value="Laboratory Tests"/>
          </productOrService>
          <servicedDate value="2025-10-22"/>
          <quantity>
            <value value="1"/>
          </quantity>
          <unitPrice>
            <value value="15000"/>
            <currency value="NGN"/>
          </unitPrice>
          <net>
            <value value="15000"/>
            <currency value="NGN"/>
          </net>
        </item>
        <item>
          <sequence value="4"/>
          <productOrService>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/ex-USCLS"/>
              <code value="1102"/>
            </coding>
            <text value="Medications"/>
          </productOrService>
          <servicedDate value="2025-10-22"/>
          <quantity>
            <value value="1"/>
          </quantity>
          <unitPrice>
            <value value="25000"/>
            <currency value="NGN"/>
          </unitPrice>
          <net>
            <value value="25000"/>
            <currency value="NGN"/>
          </net>
        </item>
        <total>
          <value value="250000"/>
          <currency value="NGN"/>
        </total>
      </Claim>
    </resource>
    <request>
      <method value="POST"/>
      <url value="Claim"/>
    </request>
  </entry>
</Bundle>