{ "resourceType" : "Bundle", "id" : "ClaimSubmission-Request", "meta" : { "profile" : ["https://fhir-ig.digitalhealth.gov.ng/StructureDefinition/ng-claim-submission-bundle"] }, "type" : "transaction", "entry" : [{ "fullUrl" : "urn:uuid:aaabbbc2-e5f6-4789-a123-456789abcdef", "resource" : { "resourceType" : "Patient", "id" : "NgPatient-Claim-001", "meta" : { "lastUpdated" : "2025-10-25T14:30:00+01:00", "profile" : ["https://fhir-ig.digitalhealth.gov.ng/StructureDefinition/ng-patient"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Patient NgPatient-Claim-001

Last updated: 2025-10-25 14:30:00+0100

Profile: NG Patient

Amaka Nwosu Female, DoB: 1992-07-15 ( mobile: 08045678901)

Active:true
Contact Detail22 River Road Port Harcourt RI
" }, "identifier" : [{ "type" : { "coding" : [{ "system" : "https://fhir-ig.digitalhealth.gov.ng/CodeSystem/patient-identifier-cs", "code" : "MOBILE", "display" : "mobile" }] }, "system" : "https://fhir-ig.digitalhealth.gov.ng/CodeSystem/patient-identifier-cs", "value" : "08045678901" }], "active" : true, "name" : [{ "family" : "Nwosu", "given" : ["Amaka"] }], "gender" : "female", "birthDate" : "1992-07-15", "address" : [{ "line" : ["22 River Road"], "city" : "Port Harcourt", "district" : "ri-oyigbo", "state" : "RI" }] }, "request" : { "method" : "POST", "url" : "Patient" } }, { "fullUrl" : "urn:uuid:ccc33344-e5f6-4789-a123-456789abcdef", "resource" : { "resourceType" : "Organization", "id" : "NgOrganization-Provider-Claim-001", "meta" : { "profile" : ["https://fhir-ig.digitalhealth.gov.ng/StructureDefinition/ng-provider-organization"] }, "text" : { "status" : "extensions", "div" : "

Generated Narrative: Organization NgOrganization-Provider-Claim-001

Profile: NG Provider Organization

NG Owner of Facility: Public Health Institution Location

identifier: https://fhir-ig.digitalhealth.gov.ng/CodeSystem/nigeria-facility-registry/HCF-RS-5678

active: true

type: Healthcare Provider

name: Rivers State Teaching Hospital

telecom: ph: 084-234-5678

address: 100 Hospital Boulevard Port Harcourt RI

" }, "extension" : [{ "url" : "https://fhir-ig.digitalhealth.gov.ng/StructureDefinition/organization-owner", "valueCodeableConcept" : { "coding" : [{ "system" : "https://fhir-ig.digitalhealth.gov.ng/CodeSystem/nigeria-location-owner-cs", "code" : "public" }] } }], "identifier" : [{ "system" : "https://fhir-ig.digitalhealth.gov.ng/CodeSystem/nigeria-facility-registry", "value" : "HCF-RS-5678" }], "active" : true, "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/organization-type", "code" : "prov", "display" : "Healthcare Provider" }] }], "name" : "Rivers State Teaching Hospital", "telecom" : [{ "system" : "phone", "value" : "084-234-5678" }], "address" : [{ "line" : ["100 Hospital Boulevard"], "city" : "Port Harcourt", "district" : "ri-oyigbo", "state" : "RI" }] }, "request" : { "method" : "POST", "url" : "Organization" } }, { "fullUrl" : "urn:uuid:ddd44455-e5f6-4789-a123-456789abcdef", "resource" : { "resourceType" : "Organization", "id" : "NgOrganization-Insurer-Claim-001", "meta" : { "profile" : ["https://fhir-ig.digitalhealth.gov.ng/StructureDefinition/ng-insurer-organization"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Organization NgOrganization-Insurer-Claim-001

Profile: NG Insurer Organization

identifier: https://fhir-ig.digitalhealth.gov.ng/CodeSystem/nigeria-facility-registry/HMO-MC-9988

active: true

type: Insurance Company

name: MediCare Plus HMO

telecom: ph: 0700-MEDICARE

address: 15 Insurance Plaza Port Harcourt RI

" }, "identifier" : [{ "system" : "https://fhir-ig.digitalhealth.gov.ng/CodeSystem/nigeria-facility-registry", "value" : "HMO-MC-9988" }], "active" : true, "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/organization-type", "code" : "ins", "display" : "Insurance Company" }] }], "name" : "MediCare Plus HMO", "telecom" : [{ "system" : "phone", "value" : "0700-MEDICARE" }], "address" : [{ "line" : ["15 Insurance Plaza"], "city" : "Port Harcourt", "district" : "ri-oyigbo", "state" : "RI" }] }, "request" : { "method" : "POST", "url" : "Organization" } }, { "fullUrl" : "urn:uuid:eee55566-e5f6-4789-a123-456789abcdef", "resource" : { "resourceType" : "Coverage", "id" : "NgCoverage-Claim-001", "meta" : { "profile" : ["https://fhir-ig.digitalhealth.gov.ng/StructureDefinition/ng-coverage"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Coverage NgCoverage-Claim-001

Profile: NG Claim Coverage

status: Active

type: extended healthcare

beneficiary: Amaka Nwosu Female, DoB: 1992-07-15 ( mobile: 08045678901)

period: 2025-01-01 --> 2025-12-31

payor: Organization MediCare Plus HMO

" }, "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code" : "EHCPOL", "display" : "extended healthcare" }] }, "beneficiary" : { "reference" : "urn:uuid:aaabbbc2-e5f6-4789-a123-456789abcdef" }, "period" : { "start" : "2025-01-01", "end" : "2025-12-31" }, "payor" : [{ "reference" : "urn:uuid:ddd44455-e5f6-4789-a123-456789abcdef" }] }, "request" : { "method" : "POST", "url" : "Coverage" } }, { "fullUrl" : "urn:uuid:fff66677-e5f6-4789-a123-456789abcdef", "resource" : { "resourceType" : "Claim", "id" : "NgClaim-Claim-001", "meta" : { "profile" : ["https://fhir-ig.digitalhealth.gov.ng/StructureDefinition/ng-claim"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Claim NgClaim-Claim-001

Profile: NG Claim

status: Active

type: Institutional

use: Claim

patient: Amaka Nwosu Female, DoB: 1992-07-15 ( mobile: 08045678901)

created: 2025-10-25 14:35:00+0100

provider: Organization Rivers State Teaching Hospital

priority: Normal

Insurances

-SequenceFocalCoverage
*1trueCoverage: status = active; type = extended healthcare; period = 2025-01-01 --> 2025-12-31

item

sequence: 1

productOrService: Appendectomy

serviced: 2025-10-22

quantity: 1

UnitPrices

-ValueCurrency
*150000Nigerian naira

Nets

-ValueCurrency
*150000Nigerian naira

item

sequence: 2

productOrService: Exam, recall

serviced: 2025-10-22 --> 2025-10-25

quantity: 3

UnitPrices

-ValueCurrency
*20000Nigerian naira

Nets

-ValueCurrency
*60000Nigerian naira

item

sequence: 3

productOrService: Laboratory Tests

serviced: 2025-10-22

quantity: 1

UnitPrices

-ValueCurrency
*15000Nigerian naira

Nets

-ValueCurrency
*15000Nigerian naira

item

sequence: 4

productOrService: Medications

serviced: 2025-10-22

quantity: 1

UnitPrices

-ValueCurrency
*25000Nigerian naira

Nets

-ValueCurrency
*25000Nigerian naira

Totals

-ValueCurrency
*250000Nigerian naira
" }, "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "institutional", "display" : "Institutional" }] }, "use" : "claim", "patient" : { "reference" : "urn:uuid:aaabbbc2-e5f6-4789-a123-456789abcdef" }, "created" : "2025-10-25T14:35:00+01:00", "provider" : { "reference" : "urn:uuid:ccc33344-e5f6-4789-a123-456789abcdef" }, "priority" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal" }] }, "insurance" : [{ "sequence" : 1, "focal" : true, "coverage" : { "reference" : "urn:uuid:eee55566-e5f6-4789-a123-456789abcdef" } }], "item" : [{ "sequence" : 1, "productOrService" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS", "code" : "1205" }], "text" : "Appendectomy" }, "servicedDate" : "2025-10-22", "quantity" : { "value" : 1 }, "unitPrice" : { "value" : 150000, "currency" : "NGN" }, "net" : { "value" : 150000, "currency" : "NGN" } }, { "sequence" : 2, "productOrService" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS", "code" : "1201" }], "text" : "Exam, recall" }, "servicedPeriod" : { "start" : "2025-10-22", "end" : "2025-10-25" }, "quantity" : { "value" : 3 }, "unitPrice" : { "value" : 20000, "currency" : "NGN" }, "net" : { "value" : 60000, "currency" : "NGN" } }, { "sequence" : 3, "productOrService" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS", "code" : "1101" }], "text" : "Laboratory Tests" }, "servicedDate" : "2025-10-22", "quantity" : { "value" : 1 }, "unitPrice" : { "value" : 15000, "currency" : "NGN" }, "net" : { "value" : 15000, "currency" : "NGN" } }, { "sequence" : 4, "productOrService" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS", "code" : "1102" }], "text" : "Medications" }, "servicedDate" : "2025-10-22", "quantity" : { "value" : 1 }, "unitPrice" : { "value" : 25000, "currency" : "NGN" }, "net" : { "value" : 25000, "currency" : "NGN" } }], "total" : { "value" : 250000, "currency" : "NGN" } }, "request" : { "method" : "POST", "url" : "Claim" } }] }