DHIN 2025Connectathon FHIR IG
0.2.0 - ci-build
DHIN 2025Connectathon FHIR IG
0.2.0 - ci-build
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
<Bundle xmlns="http://hl7.org/fhir">
<id value="ClaimSubmission-Response"/>
<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 --> 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:aaa77788-e5f6-4789-a123-456789abcdef"/>
<resource>
<ClaimResponse>
<id value="NgClaimResponse-Claim-001"/>
<meta>
<profile
value="https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-claim-response"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="ClaimResponse_NgClaimResponse-Claim-001"> </a><p class="res-header-id"><b>Generated Narrative: ClaimResponse NgClaimResponse-Claim-001</b></p><a name="NgClaimResponse-Claim-001"> </a><a name="hcNgClaimResponse-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-response.html">NG ClaimResponse</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>: 2025-10-26 09:15:00+0100</p><p><b>insurer</b>: <a href="Bundle-ClaimSubmission-Request.html#urn-uuid-ddd44455-e5f6-4789-a123-456789abcdef">Organization MediCare Plus HMO</a></p><p><b>outcome</b>: Partial Processing</p><p><b>disposition</b>: Claim partially approved. Patient responsible for co-pay and non-covered items.</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 eligible}">Eligible 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>5000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}">Benefit 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>4500</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication copay}">CoPay</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>500</td><td>Nigerian naira</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 2</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}">Eligible 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>3000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}">Benefit 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>3000</td><td>Nigerian naira</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 3</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}">Eligible 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>15000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}">Benefit 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>1500</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication copay}">CoPay</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>0</td><td>Nigerian naira</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 4</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}">Eligible 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>2000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}">Benefit 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>2000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication copay}">CoPay</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>0</td><td>Nigerian naira</td></tr></table></blockquote></blockquote><blockquote><p><b>total</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>25000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}">Benefit 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>23000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication copay}">CoPay</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>2000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>payment</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/ex-paymenttype complete}">Complete</span></p><p><b>date</b>: 2025-10-30</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>25000</td><td>Nigerian naira</td></tr></table></blockquote></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="2025-10-26T09:15:00+01:00"/>
<insurer>
<reference value="urn:uuid:ddd44455-e5f6-4789-a123-456789abcdef"/>
</insurer>
<outcome value="partial"/>
<disposition
value="Claim partially approved. Patient responsible for co-pay and non-covered items."/>
<item>
<itemSequence value="1"/>
<adjudication>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="eligible"/>
</coding>
</category>
<amount>
<value value="5000"/>
<currency value="NGN"/>
</amount>
</adjudication>
<adjudication>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="benefit"/>
</coding>
</category>
<amount>
<value value="4500"/>
<currency value="NGN"/>
</amount>
</adjudication>
<adjudication>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="copay"/>
</coding>
</category>
<amount>
<value value="500"/>
<currency value="NGN"/>
</amount>
</adjudication>
</item>
<item>
<itemSequence value="2"/>
<adjudication>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="eligible"/>
</coding>
</category>
<amount>
<value value="3000"/>
<currency value="NGN"/>
</amount>
</adjudication>
<adjudication>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="benefit"/>
</coding>
</category>
<amount>
<value value="3000"/>
<currency value="NGN"/>
</amount>
</adjudication>
</item>
<item>
<itemSequence value="3"/>
<adjudication>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="eligible"/>
</coding>
</category>
<amount>
<value value="15000"/>
<currency value="NGN"/>
</amount>
</adjudication>
<adjudication>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="benefit"/>
</coding>
</category>
<amount>
<value value="1500"/>
<currency value="NGN"/>
</amount>
</adjudication>
<adjudication>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="copay"/>
</coding>
</category>
<amount>
<value value="0"/>
<currency value="NGN"/>
</amount>
</adjudication>
</item>
<item>
<itemSequence value="4"/>
<adjudication>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="eligible"/>
</coding>
</category>
<amount>
<value value="2000"/>
<currency value="NGN"/>
</amount>
</adjudication>
<adjudication>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="benefit"/>
</coding>
</category>
<amount>
<value value="2000"/>
<currency value="NGN"/>
</amount>
</adjudication>
<adjudication>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="copay"/>
</coding>
</category>
<amount>
<value value="0"/>
<currency value="NGN"/>
</amount>
</adjudication>
</item>
<total>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="submitted"/>
</coding>
</category>
<amount>
<value value="25000"/>
<currency value="NGN"/>
</amount>
</total>
<total>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="benefit"/>
</coding>
</category>
<amount>
<value value="23000"/>
<currency value="NGN"/>
</amount>
</total>
<total>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="copay"/>
</coding>
</category>
<amount>
<value value="2000"/>
<currency value="NGN"/>
</amount>
</total>
<payment>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/ex-paymenttype"/>
<code value="complete"/>
</coding>
</type>
<date value="2025-10-30"/>
<amount>
<value value="25000"/>
<currency value="NGN"/>
</amount>
</payment>
</ClaimResponse>
</resource>
<request>
<method value="POST"/>
<url value="ClaimResponse"/>
</request>
</entry>
<entry>
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<ExplanationOfBenefit>
<id value="NgEOB-Claim-001"/>
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<div xmlns="http://www.w3.org/1999/xhtml"><a name="ExplanationOfBenefit_NgEOB-Claim-001"> </a><p class="res-header-id"><b>Generated Narrative: ExplanationOfBenefit NgEOB-Claim-001</b></p><a name="NgEOB-Claim-001"> </a><a name="hcNgEOB-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-explanation-of-benefit.html">NG ExplanationOfBenefit</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>: 2025-10-26 09:15:00+0100</p><p><b>insurer</b>: <a href="Bundle-ClaimSubmission-Request.html#urn-uuid-ddd44455-e5f6-4789-a123-456789abcdef">Organization MediCare Plus HMO</a></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>outcome</b>: Partial Processing</p><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style="display: none">*</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 --> 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}">Exam, emergency</span></p><p><b>serviced</b>: 2025-10-22</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}">Eligible 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>15000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}">Benefit 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>13000</td><td>Nigerian naira</td></tr></table></blockquote></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 --> 2025-10-25</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}">Benefit 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>6000</td><td>Nigerian naira</td></tr></table></blockquote></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}">Exam, comp, primary</span></p><p><b>serviced</b>: 2025-10-22</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}">Benefit 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>1500</td><td>Nigerian naira</td></tr></table></blockquote></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}">Exam, comp, mixed</span></p><p><b>serviced</b>: 2025-10-22</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}">Benefit 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>1500</td><td>Nigerian naira</td></tr></table></blockquote></blockquote><blockquote><p><b>total</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>2500</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}">Benefit 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>22000</td><td>Nigerian naira</td></tr></table></blockquote><blockquote><p><b>payment</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/ex-paymenttype complete}">Complete</span></p><p><b>date</b>: 2025-10-30</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>2200</td><td>Nigerian naira</td></tr></table></blockquote></div>
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<coding>
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