FHIR Implementation Guide for HCX
0.7.1 - CI Build
FHIR Implementation Guide for HCX
0.7.1 - CI Build
FHIR Implementation Guide for HCX - Local Development build (v0.7.1). See the Directory of published versions
{
"resourceType" : "Claim",
"id" : "example-01",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2020-10-07T03:26:09.060+00:00",
"source" : "#BHZcRrcF4oS0JQ42"
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Claim</b><a name=\"example-01\"> </a></p><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\">Resource Claim "example-01" Version "1" Updated "2020-10-07 03:26:09+0000" </p><p style=\"margin-bottom: 0px\">Information Source: #BHZcRrcF4oS0JQ42!</p></div><p><b>identifier</b>: id:\u00a0dc82673b-8c71-29js-8a17-16dj3i20352n</p><p><b>status</b>: active</p><p><b>type</b>: Institutional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#institutional)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <span/></p><p><b>billablePeriod</b>: 1979-02-27 16:01:08-0500 --> 1979-02-28 16:01:08-0500</p><p><b>created</b>: 1979-02-28 16:01:08-0500</p><p><b>insurer</b>: <span/></p><p><b>provider</b>: <span/></p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><h3>Payees</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td>*</td><td>Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-payeetype.html\">Claim Payee Type Codes</a>#provider)</span></td><td><span/></td></tr></table><h3>CareTeams</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td>*</td><td>1</td><td><span/></td></tr></table><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 1</p><p><b>procedure</b>: PROC-1 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4/codesystem-icd-10-procedures.html\">ICD-10 Procedure Codes</a>#123001)</span></p></blockquote><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 2</p><p><b>procedure</b>: PROC-2 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4/codesystem-icd-10-procedures.html\">ICD-10 Procedure Codes</a>#123002)</span></p></blockquote><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 3</p><p><b>procedure</b>: PROC-3 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4/codesystem-icd-10-procedures.html\">ICD-10 Procedure Codes</a>#123003)</span></p></blockquote><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>true</td><td><span>: Cigna Health</span></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: Encounter for problem <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#185347001)</span></p></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 2</p><p><b>procedureSequence</b>: 1</p><p><b>productOrService</b>: Hearing examination (procedure) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#398171003)</span></p><h3>Nets</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>516.65</td><td>USD</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 3</p><p><b>procedureSequence</b>: 2</p><p><b>productOrService</b>: Combined chemotherapy and radiation therapy (procedure) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#703423002)</span></p><h3>Nets</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>16924.49</td><td>USD</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 4</p><p><b>procedureSequence</b>: 3</p><p><b>productOrService</b>: High resolution computed tomography of chest without contrast (procedure) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#16335031000119103)</span></p><h3>Nets</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>516.65</td><td>USD</td></tr></table></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>129.16</td><td>USD</td></tr></table></div>"
},
"identifier" : [
{
"system" : "https://www.tmh.in/claim-request",
"value" : "dc82673b-8c71-29js-8a17-16dj3i20352n"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "institutional"
}
]
},
"use" : "claim",
"patient" : {
"id" : "RVH1003",
"identifier" : {
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "SN",
"display" : "Subscriber Number"
}
]
},
"system" : "http://gicofIndia.com/beneficiaries",
"value" : "BEN-101"
}
},
"billablePeriod" : {
"start" : "1979-02-27T16:01:08-05:00",
"end" : "1979-02-28T16:01:08-05:00"
},
"created" : "1979-02-28T16:01:08-05:00",
"insurer" : {
"id" : "GICOFINDIA",
"identifier" : {
"system" : "http://irdai.gov.in/insurers",
"value" : "112"
}
},
"provider" : {
"id" : "Tmh01",
"identifier" : {
"system" : "http://abdm.gov.in/facilities",
"value" : "HFR-ID-FOR-TMH"
}
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "normal"
}
]
},
"payee" : {
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/payeetype",
"code" : "provider"
}
]
},
"party" : {
"id" : "Tmh02",
"identifier" : {
"system" : "http://abdm.gov.in/facilities",
"value" : "HFR-ID-FOR-TMH"
}
}
},
"careTeam" : [
{
"sequence" : 1,
"provider" : {
"id" : "Tmh03",
"identifier" : {
"system" : "http://abdm.gov.in/facilities",
"value" : "HFR-ID-FOR-TMH"
}
}
}
],
"procedure" : [
{
"sequence" : 1,
"procedureCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/ex-icd-10-procedures",
"code" : "123001"
}
]
}
},
{
"sequence" : 2,
"procedureCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/ex-icd-10-procedures",
"code" : "123002"
}
]
}
},
{
"sequence" : 3,
"procedureCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/ex-icd-10-procedures",
"code" : "123003"
}
]
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"display" : "Cigna Health"
}
}
],
"item" : [
{
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "185347001",
"display" : "Encounter for problem"
}
],
"text" : "Encounter for problem"
}
},
{
"sequence" : 2,
"procedureSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "398171003",
"display" : "Hearing examination (procedure)"
}
],
"text" : "Hearing examination (procedure)"
},
"net" : {
"value" : 516.65,
"currency" : "USD"
}
},
{
"sequence" : 3,
"procedureSequence" : [
2
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "703423002",
"display" : "Combined chemotherapy and radiation therapy (procedure)"
}
],
"text" : "Combined chemotherapy and radiation therapy (procedure)"
},
"net" : {
"value" : 16924.49,
"currency" : "USD"
}
},
{
"sequence" : 4,
"procedureSequence" : [
3
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "16335031000119103",
"display" : "High resolution computed tomography of chest without contrast (procedure)"
}
],
"text" : "High resolution computed tomography of chest without contrast (procedure)"
},
"net" : {
"value" : 516.65,
"currency" : "USD"
}
}
],
"total" : {
"value" : 129.16,
"currency" : "USD"
}
}
IG © 2021+ HCX Open Community. Package hcxprotocol.io#0.7.1 based on FHIR 4.0.1. Generated 2023-03-10
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