FHIR Implementation Guide for HCX
0.8.0 - CI Build
FHIR Implementation Guide for HCX
0.8.0 - CI Build
FHIR Implementation Guide for HCX - Local Development build (v0.8.0). See the Directory of published versions
{
"resourceType" : "Bundle",
"id" : "ClaimRequestDocument-example-01",
"meta" : {
"lastUpdated" : "2022-02-08T21:49:55.458+05:30"
},
"identifier" : {
"system" : "https://www.tmh.in/bundle",
"value" : "ClaimRequestDocument-example-01"
},
"type" : "document",
"timestamp" : "2022-02-08T21:49:55.458+05:30",
"entry" : [
{
"fullUrl" : "Composition/42ff4a07-3e36-402f-a99e-29f16c0c9eee",
"resource" : {
"resourceType" : "Composition",
"id" : "42ff4a07-3e36-402f-a99e-29f16c0c9eee",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Composition</b><a name=\"42ff4a07-3e36-402f-a99e-29f16c0c9eee\"> </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 Composition "42ff4a07-3e36-402f-a99e-29f16c0c9eee" </p></div><p><b>identifier</b>: id:\u00a042ff4a07-3e36-402f-a99e-29f16c0c9eee</p><p><b>status</b>: final</p><p><b>type</b>: Claim Request Doc <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (document-type#HcxClaimRequest)</span></p><p><b>date</b>: 2022-02-08 21:49:55+0530</p><p><b>author</b>: <a href=\"#Organization_Tmh01\">See above (Organization/Tmh01)</a></p><p><b>title</b>: Claim Request</p></div>"
},
"identifier" : {
"system" : "https://www.tmh.in/hcx-documents",
"value" : "42ff4a07-3e36-402f-a99e-29f16c0c9eee"
},
"status" : "final",
"type" : {
"coding" : [
{
"system" : "https://www.hcx.org/document-type",
"code" : "HcxClaimRequest",
"display" : "Claim Request Doc"
}
]
},
"subject" : {
"reference" : "Patient/RVH1003"
},
"date" : "2022-02-08T21:49:55+05:30",
"author" : [
{
"reference" : "Organization/Tmh01"
}
],
"title" : "Claim Request",
"section" : [
{
"title" : "# Claim Request",
"code" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/ValueSet/resource-types",
"code" : "ClaimRequest",
"display" : "Claim Request"
}
],
"text" : "ClaimRequest"
},
"entry" : [
{
"reference" : "ClaimRequest/dc82673b-8c71-48c2-8a17-16dcb3b035f6"
}
]
}
]
}
},
{
"fullUrl" : "Organization/Tmh01",
"resource" : {
"resourceType" : "Organization",
"id" : "Tmh01",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"Tmh01\"> </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 Organization "Tmh01" </p></div><p><b>identifier</b>: id:\u00a0HFR-ID-FOR-TMH, id:\u00a0IRDA-ID-FOR-TMH</p><p><b>name</b>: Tata Memorial Hospital</p><p><b>alias</b>: TMH, TMC</p><p><b>telecom</b>: ph: (+91) 022-2417-7000</p><p><b>address</b>: Dr Ernest Borges Rd, Parel East, Parel, Mumbai, Maharashtra 400012 Mumbai Maharashtra 400012 INDIA </p><p><b>endpoint</b>: <a href=\"https://www.tmc.gov.in/\">https://www.tmc.gov.in/: Website</a></p></div>"
},
"identifier" : [
{
"system" : "http://abdm.gov.in/facilities",
"value" : "HFR-ID-FOR-TMH"
},
{
"system" : "http://irdai.gov.in/facilities",
"value" : "IRDA-ID-FOR-TMH"
}
],
"name" : "Tata Memorial Hospital",
"alias" : [
"TMH",
"TMC"
],
"telecom" : [
{
"system" : "phone",
"value" : "(+91) 022-2417-7000"
}
],
"address" : [
{
"line" : [
"Dr Ernest Borges Rd, Parel East, Parel, Mumbai, Maharashtra 400012"
],
"city" : "Mumbai",
"state" : "Maharashtra",
"postalCode" : "400012",
"country" : "INDIA"
}
],
"endpoint" : [
{
"reference" : "https://www.tmc.gov.in/",
"display" : "Website"
}
]
}
},
{
"fullUrl" : "Patient/RVH1003",
"resource" : {
"resourceType" : "Patient",
"id" : "RVH1003",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Patient</b><a name=\"RVH1003\"> </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 Patient "RVH1003" </p></div><p><b>identifier</b>: Subscriber Number: BEN-101, id:\u00a0hinapatel@abdm</p><p><b>name</b>: Hina Patel</p><p><b>gender</b>: female</p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "SN",
"display" : "Subscriber Number"
}
]
},
"system" : "http://gicofIndia.com/beneficiaries",
"value" : "BEN-101"
},
{
"system" : "http://abdm.gov.in/patients",
"value" : "hinapatel@abdm"
}
],
"name" : [
{
"text" : "Hina Patel"
}
],
"gender" : "female"
}
},
{
"fullUrl" : "ClaimRequest/dc82673b-8c71-48c2-8a17-16dcb3b035f6",
"resource" : {
"resourceType" : "Claim",
"id" : "1532676",
"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=\"1532676\"> </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 "1532676" Version "1" Updated "2020-10-07 03:26:09+0000" </p><p style=\"margin-bottom: 0px\">Information Source: #BHZcRrcF4oS0JQ42!</p></div><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>: <a href=\"Patient/1531634\">Patient/1531634: Hina Patel</a></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>provider</b>: <a href=\"Bundle-CoverageEligibilityResponseDocument-example-01.html#Organization_2\">Organization/2: PMJAY, MoHFW, Govt Of India</a></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><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 1</p><p><b>procedure</b>: <a href=\"Procedure/1532663\">Procedure/1532663</a></p></blockquote><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 2</p><p><b>procedure</b>: <a href=\"Procedure/1532664\">Procedure/1532664</a></p></blockquote><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 3</p><p><b>procedure</b>: <a href=\"Procedure/1532665\">Procedure/1532665</a></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><p><b>encounter</b>: <a href=\"Encounter/1532617\">Encounter/1532617</a></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>"
},
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "institutional"
}
]
},
"use" : "claim",
"patient" : {
"reference" : "Patient/1531634",
"display" : "Hina Patel"
},
"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",
"provider" : {
"reference" : "Organization/2",
"display" : "PMJAY, MoHFW, Govt Of India"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "normal"
}
]
},
"procedure" : [
{
"sequence" : 1,
"procedureReference" : {
"reference" : "Procedure/1532663"
}
},
{
"sequence" : 2,
"procedureReference" : {
"reference" : "Procedure/1532664"
}
},
{
"sequence" : 3,
"procedureReference" : {
"reference" : "Procedure/1532665"
}
}
],
"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"
},
"encounter" : [
{
"reference" : "Encounter/1532617"
}
]
},
{
"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"
}
}
},
{
"fullUrl" : "Organization/GICOFINDIA",
"resource" : {
"resourceType" : "Organization",
"id" : "GICOFINDIA",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"GICOFINDIA\"> </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 Organization "GICOFINDIA" </p></div><p><b>identifier</b>: id:\u00a0112</p><p><b>name</b>: General Insurance Corporation of India</p></div>"
},
"identifier" : [
{
"system" : "http://irdai.gov.in/insurers",
"value" : "112"
}
],
"name" : "General Insurance Corporation of India"
}
},
{
"fullUrl" : "Coverage/dadde132-ad64-4d18-8c18-1d52d7e86abc",
"resource" : {
"resourceType" : "Coverage",
"id" : "dadde132-ad64-4d18-8c18-1d52d7e86abc",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Coverage</b><a name=\"dadde132-ad64-4d18-8c18-1d52d7e86abc\"> </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 Coverage "dadde132-ad64-4d18-8c18-1d52d7e86abc" </p></div><p><b>identifier</b>: id:\u00a0policy-RVH1003</p><p><b>status</b>: active</p><p><b>subscriber</b>: <a href=\"#Patient_RVH1003\">See above (Patient/RVH1003)</a></p><p><b>subscriberId</b>: SN-RVH1003</p><p><b>beneficiary</b>: <a href=\"#Patient_RVH1003\">See above (Patient/RVH1003)</a></p><p><b>relationship</b>: self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (subscriber-relationship#self)</span></p><p><b>payor</b>: <a href=\"#Organization_GICOFINDIA\">See above (Organization/GICOFINDIA)</a></p></div>"
},
"identifier" : [
{
"system" : "https://www.gicofIndia.in/policies",
"value" : "policy-RVH1003"
}
],
"status" : "active",
"subscriber" : {
"reference" : "Patient/RVH1003"
},
"subscriberId" : "SN-RVH1003",
"beneficiary" : {
"reference" : "Patient/RVH1003"
},
"relationship" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/ValueSet/subscriber-relationship",
"code" : "self"
}
]
},
"payor" : [
{
"reference" : "Organization/GICOFINDIA"
}
]
}
}
]
}
IG © 2021+ HCX Open Community. Package hcxprotocol.io#0.8.0 based on FHIR 4.0.1. Generated 2023-03-15
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