{
  "resourceType" : "Bundle",
  "id" : "ClaimSubmission-Response",
  "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" : "<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>"
      },
      "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" : "<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://fhir-ig.digitalhealth.gov.ng/CodeSystem/nigeria-location-owner-cs public}\">Public Health Institution Location</span></p><p><b>identifier</b>: <code>https://fhir-ig.digitalhealth.gov.ng/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>"
      },
      "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" : "<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://fhir-ig.digitalhealth.gov.ng/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>"
      },
      "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" : "<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>"
      },
      "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:aaa77788-e5f6-4789-a123-456789abcdef",
    "resource" : {
      "resourceType" : "ClaimResponse",
      "id" : "NgClaimResponse-Claim-001",
      "meta" : {
        "profile" : ["https://fhir-ig.digitalhealth.gov.ng/StructureDefinition/ng-claim-response"]
      },
      "text" : {
        "status" : "generated",
        "div" : "<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>"
      },
      "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" : "2025-10-26T09:15:00+01:00",
      "insurer" : {
        "reference" : "urn:uuid:ddd44455-e5f6-4789-a123-456789abcdef"
      },
      "outcome" : "partial",
      "disposition" : "Claim partially approved. Patient responsible for co-pay and non-covered items.",
      "item" : [{
        "itemSequence" : 1,
        "adjudication" : [{
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "eligible"
            }]
          },
          "amount" : {
            "value" : 5000,
            "currency" : "NGN"
          }
        },
        {
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "benefit"
            }]
          },
          "amount" : {
            "value" : 4500,
            "currency" : "NGN"
          }
        },
        {
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "copay"
            }]
          },
          "amount" : {
            "value" : 500,
            "currency" : "NGN"
          }
        }]
      },
      {
        "itemSequence" : 2,
        "adjudication" : [{
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "eligible"
            }]
          },
          "amount" : {
            "value" : 3000,
            "currency" : "NGN"
          }
        },
        {
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "benefit"
            }]
          },
          "amount" : {
            "value" : 3000,
            "currency" : "NGN"
          }
        }]
      },
      {
        "itemSequence" : 3,
        "adjudication" : [{
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "eligible"
            }]
          },
          "amount" : {
            "value" : 15000,
            "currency" : "NGN"
          }
        },
        {
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "benefit"
            }]
          },
          "amount" : {
            "value" : 1500,
            "currency" : "NGN"
          }
        },
        {
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "copay"
            }]
          },
          "amount" : {
            "value" : 0,
            "currency" : "NGN"
          }
        }]
      },
      {
        "itemSequence" : 4,
        "adjudication" : [{
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "eligible"
            }]
          },
          "amount" : {
            "value" : 2000,
            "currency" : "NGN"
          }
        },
        {
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "benefit"
            }]
          },
          "amount" : {
            "value" : 2000,
            "currency" : "NGN"
          }
        },
        {
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "copay"
            }]
          },
          "amount" : {
            "value" : 0,
            "currency" : "NGN"
          }
        }]
      }],
      "total" : [{
        "category" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
            "code" : "submitted"
          }]
        },
        "amount" : {
          "value" : 25000,
          "currency" : "NGN"
        }
      },
      {
        "category" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
            "code" : "benefit"
          }]
        },
        "amount" : {
          "value" : 23000,
          "currency" : "NGN"
        }
      },
      {
        "category" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
            "code" : "copay"
          }]
        },
        "amount" : {
          "value" : 2000,
          "currency" : "NGN"
        }
      }],
      "payment" : {
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/ex-paymenttype",
            "code" : "complete"
          }]
        },
        "date" : "2025-10-30",
        "amount" : {
          "value" : 25000,
          "currency" : "NGN"
        }
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "ClaimResponse"
    }
  },
  {
    "fullUrl" : "urn:uuid:bbb88899-e5f6-4789-a123-456789abcdef",
    "resource" : {
      "resourceType" : "ExplanationOfBenefit",
      "id" : "NgEOB-Claim-001",
      "meta" : {
        "profile" : ["https://fhir-ig.digitalhealth.gov.ng/StructureDefinition/ng-explanation-of-benefit"]
      },
      "text" : {
        "status" : "generated",
        "div" : "<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 --&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}\">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 --&gt; 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>"
      },
      "status" : "active",
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
          "code" : "institutional"
        }]
      },
      "use" : "claim",
      "patient" : {
        "reference" : "urn:uuid:aaabbbc2-e5f6-4789-a123-456789abcdef"
      },
      "created" : "2025-10-26T09:15:00+01:00",
      "insurer" : {
        "reference" : "urn:uuid:ddd44455-e5f6-4789-a123-456789abcdef"
      },
      "provider" : {
        "reference" : "urn:uuid:ccc33344-e5f6-4789-a123-456789abcdef"
      },
      "outcome" : "partial",
      "insurance" : [{
        "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"
          }]
        },
        "servicedDate" : "2025-10-22",
        "adjudication" : [{
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "eligible"
            }]
          },
          "amount" : {
            "value" : 15000,
            "currency" : "NGN"
          }
        },
        {
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "benefit"
            }]
          },
          "amount" : {
            "value" : 13000,
            "currency" : "NGN"
          }
        }]
      },
      {
        "sequence" : 2,
        "productOrService" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS",
            "code" : "1201"
          }]
        },
        "servicedPeriod" : {
          "start" : "2025-10-22",
          "end" : "2025-10-25"
        },
        "adjudication" : [{
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "benefit"
            }]
          },
          "amount" : {
            "value" : 6000,
            "currency" : "NGN"
          }
        }]
      },
      {
        "sequence" : 3,
        "productOrService" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS",
            "code" : "1101"
          }]
        },
        "servicedDate" : "2025-10-22",
        "adjudication" : [{
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "benefit"
            }]
          },
          "amount" : {
            "value" : 1500,
            "currency" : "NGN"
          }
        }]
      },
      {
        "sequence" : 4,
        "productOrService" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS",
            "code" : "1102"
          }]
        },
        "servicedDate" : "2025-10-22",
        "adjudication" : [{
          "category" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
              "code" : "benefit"
            }]
          },
          "amount" : {
            "value" : 1500,
            "currency" : "NGN"
          }
        }]
      }],
      "total" : [{
        "category" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
            "code" : "submitted"
          }]
        },
        "amount" : {
          "value" : 2500,
          "currency" : "NGN"
        }
      },
      {
        "category" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
            "code" : "benefit"
          }]
        },
        "amount" : {
          "value" : 22000,
          "currency" : "NGN"
        }
      }],
      "payment" : {
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/ex-paymenttype",
            "code" : "complete"
          }]
        },
        "date" : "2025-10-30",
        "amount" : {
          "value" : 2200,
          "currency" : "NGN"
        }
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "ExplanationOfBenefit"
    }
  }]
}