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 Claim: HCX Claim example

Generated Narrative: Claim

Resource Claim "example-01" Version "1" Updated "2020-10-07 03:26:09+0000"

Information Source: #BHZcRrcF4oS0JQ42!

identifier: id: dc82673b-8c71-29js-8a17-16dj3i20352n

status: active

type: Institutional (Claim Type Codes#institutional)

use: claim

patient:

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

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

insurer:

provider:

priority: Normal (Process Priority Codes#normal)

Payees

-TypeParty
*Provider (ClaimPayeeTypeCodes#provider)

CareTeams

-SequenceProvider
*1

procedure

sequence: 1

procedure: PROC-1 (ICD-10 Procedure Codes#123001)

procedure

sequence: 2

procedure: PROC-2 (ICD-10 Procedure Codes#123002)

procedure

sequence: 3

procedure: PROC-3 (ICD-10 Procedure Codes#123003)

Insurances

-SequenceFocalCoverage
*1true: Cigna Health

item

sequence: 1

productOrService: Encounter for problem (SNOMED CT#185347001)

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