{ "resourceType" : "Bundle", "id" : "ex15", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementdemandreply"] }, "language" : "en", "type" : "message", "timestamp" : "2015-07-14T11:15:37+02:00", "entry" : [{ "fullUrl" : "urn:uuid:667b18ce-3d37-4581-9baa-6fada338038c", "resource" : { "resourceType" : "MessageHeader", "id" : "667b18ce-3d37-4581-9baa-6fada338038c", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-messageheader"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: MessageHeader 667b18ce-3d37-4581-9baa-6fada338038c

Profile: MyCareNet MessageHeader BE profile

event: CodeSystem message events: claimresponse-completeAgreement (claimresponse-completeAgreement)

Destinations

-EndpointReceiver
*urn:be:fgov:person:ssin:ehealth:1.0:physiotherapist:nihii11:54263481527PractitionerRole physician

sender: Organization Union Nationale des Mutualités Socialistes - Nationaal Verbond van de Socialistische Mutualiteiten

Sources

-Endpoint
*urn:be:fgov:kbo-bce:organization:cbe-number:0411724220

Responses

-IdentifierCode
*267b18ce-3d37-4581-9baa-6fada338038bOK

focus: ClaimResponse: status = active; type = Institutional; subType = rehabilitation-convention; use = preauthorization; created = 2024-05-09 11:15:30+0200; outcome = complete

" }, "eventCoding" : { "system" : "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/message-events", "code" : "claimresponse-completeAgreement" }, "destination" : [{ "endpoint" : "urn:be:fgov:person:ssin:ehealth:1.0:physiotherapist:nihii11:54263481527", "receiver" : { "reference" : "urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3" } }], "sender" : { "reference" : "urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358" }, "source" : { "endpoint" : "urn:be:fgov:kbo-bce:organization:cbe-number:0411724220" }, "response" : { "identifier" : "267b18ce-3d37-4581-9baa-6fada338038b", "code" : "ok" }, "focus" : [{ "reference" : "urn:uuid:0a0d60df-0340-45a6-a493-a5d67f74d693" }] } }, { "fullUrl" : "urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3", "resource" : { "resourceType" : "PractitionerRole", "id" : "1dc5d974-5447-4afe-a4ab-57081ca518c3", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: PractitionerRole 1dc5d974-5447-4afe-a4ab-57081ca518c3

Profile: BePractitionerRole

practitioner: Practitioner John Smith

code: physiotherapist

" }, "practitioner" : { "reference" : "urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931" }, "code" : [{ "coding" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty", "code" : "persphysiotherapist" }] }] } }, { "fullUrl" : "urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931", "resource" : { "resourceType" : "Practitioner", "id" : "03972cc4-d781-4285-8d79-0f05810e1931", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitioner"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: Practitioner 03972cc4-d781-4285-8d79-0f05810e1931

Profile: BePractitioner

identifier: BeNIHDINamingSystem/54263481527

name: John Smith

" }, "identifier" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi", "value" : "54263481527" }], "name" : [{ "family" : "Smith", "given" : ["John"] }] } }, { "fullUrl" : "urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358", "resource" : { "resourceType" : "Organization", "id" : "cfabb40d-a53f-4c56-bc19-725ea669b358", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-organization"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: Organization cfabb40d-a53f-4c56-bc19-725ea669b358

Profile: BeOrganization

identifier: BeInsuranceNumberNamingSystem/300

name: Union Nationale des Mutualités Socialistes - Nationaal Verbond van de Socialistische Mutualiteiten

" }, "identifier" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancenumber", "value" : "300" }], "name" : "Union Nationale des Mutualités Socialistes - Nationaal Verbond van de Socialistische Mutualiteiten" } }, { "fullUrl" : "urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686", "resource" : { "resourceType" : "Patient", "id" : "a52efcb6-1f81-4333-a115-d45bd3183686", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: Patient a52efcb6-1f81-4333-a115-d45bd3183686

Profile: BePatient

Jean Dupont Male, DoB Unknown ( https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancymembership#BeInsurancymembershipNamingSystem#n° inscription mutualiste)

" }, "identifier" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancymembership", "value" : "n° inscription mutualiste", "assigner" : { "identifier" : { "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancenumber", "value" : "n° mutualité" } } }], "name" : [{ "family" : "Dupont", "given" : ["Jean"] }], "gender" : "male" } }, { "fullUrl" : "urn:uuid:0a0d60df-0340-45a6-a493-a5d67f74d693", "resource" : { "resourceType" : "ClaimResponse", "id" : "0a0d60df-0340-45a6-a493-a5d67f74d693", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaimresponse"] }, "language" : "en", "text" : { "status" : "generated", "div" : "

Generated Narrative: ClaimResponse 0a0d60df-0340-45a6-a493-a5d67f74d693

Profile: MyCareNet eAgreement Claim Response BE profile

status: Active

type: Professional

subType: physiotherapy-fb

use: Preauthorization

patient: Jean Dupont Male, DoB Unknown ( https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin#BeSSINNamingSystem#79121137740)

created: 2015-07-14 11:15:35+0200

insurer: Organization Union Nationale des Mutualités Socialistes - Nationaal Verbond van de Socialistische Mutualiteiten

requestor: PractitionerRole physician

outcome: Processing Complete

preAuthRef: identifiant business de l'accord complété

" }, "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "professional" }] }, "subType" : { "coding" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types", "code" : "physiotherapy-fb" }] }, "use" : "preauthorization", "patient" : { "reference" : "urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686" }, "created" : "2015-07-14T11:15:35+02:00", "insurer" : { "reference" : "urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358" }, "requestor" : { "reference" : "urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3" }, "outcome" : "complete", "preAuthRef" : "identifiant business de l'accord complété" } }] }