FHIR Implementation Guide for HCX
0.7.0 - CI Build

FHIR Implementation Guide for HCX - Local Development build (v0.7.0). See the Directory of published versions

Example Bundle: HCX Claim Request Document example

Hina Patel Female, DoB: ( Subscriber Number: BEN-101)

Generated Narrative: Composition

Resource Composition "42ff4a07-3e36-402f-a99e-29f16c0c9eee"

identifier: id: 42ff4a07-3e36-402f-a99e-29f16c0c9eee

status: FINAL

type: Claim Request Doc (document-type#HcxClaimRequest)

date: 2022-02-08 09:49:55+0530

author: See above (Organization/Tmh01)

title: Claim Request


# Claim Request


Additional Document Content


2. Organization/Tmh01 (Organization/Tmh01)

Generated Narrative: Organization

Resource Organization "Tmh01"

identifier: id: HFR-ID-FOR-TMH, id: IRDA-ID-FOR-TMH

name: Tata Memorial Hospital

alias: TMH, TMC

Contacts

-TelecomAddress
*ph: (+91) 022-2417-7000Dr Ernest Borges Rd, Parel East, Parel, Mumbai, Maharashtra 400012 Mumbai Maharashtra 400012 INDIA

endpoint: https://www.tmc.gov.in/: Website


3. Patient/RVH1003 (Patient/RVH1003)

Hina Patel Female, DoB: ( Subscriber Number: BEN-101)


4. ClaimRequest/dc82673b-8c71-48c2-8a17-16dcb3b035f6 (Claim/1532676)

Generated Narrative: Claim

Resource Claim "1532676" Version "1" Updated "2020-10-07 03:26:09+0000"

Information Source: #BHZcRrcF4oS0JQ42!

status: ACTIVE

type: Institutional (Claim Type Codes#institutional)

use: CLAIM

patient: Patient/1531634: Hina Patel

billablePeriod: 1979-02-27 04:01:08-0500 --> 1979-02-28 04:01:08-0500

created: 1979-02-28 04:01:08-0500

provider: Organization/2: PMJAY, MoHFW, Govt Of India

priority: Normal (Process Priority Codes#normal)

procedure

sequence: 1

procedure: Procedure/1532663

procedure

sequence: 2

procedure: Procedure/1532664

procedure

sequence: 3

procedure: Procedure/1532665

Insurances

-SequenceFocalCoverage
*1true: Cigna Health

item

sequence: 1

productOrService: Encounter for problem (SNOMED CT#185347001)

encounter: Encounter/1532617

item

sequence: 2

procedureSequence: 1

productOrService: Hearing examination (procedure) (SNOMED CT#398171003)

Nets

-ValueCurrency
*516.65USD

item

sequence: 3

procedureSequence: 2

productOrService: Combined chemotherapy and radiation therapy (procedure) (SNOMED CT#703423002)

Nets

-ValueCurrency
*16924.49USD

item

sequence: 4

procedureSequence: 3

productOrService: High resolution computed tomography of chest without contrast (procedure) (SNOMED CT#16335031000119103)

Nets

-ValueCurrency
*516.65USD

Totals

-ValueCurrency
*129.16USD


5. Organization/GICOFINDIA (Organization/GICOFINDIA)

Generated Narrative: Organization

Resource Organization "GICOFINDIA"

identifier: id: 112

name: General Insurance Corporation of India


6. Coverage/dadde132-ad64-4d18-8c18-1d52d7e86abc (Coverage/dadde132-ad64-4d18-8c18-1d52d7e86abc)

Generated Narrative: Coverage

Resource Coverage "dadde132-ad64-4d18-8c18-1d52d7e86abc"

identifier: id: policy-RVH1003

status: ACTIVE

subscriber: See above (Patient/RVH1003)

subscriberId: id: SN-RVH1003

beneficiary: See above (Patient/RVH1003)

relationship: self (subscriber-relationship#self)