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" : "ClaimResponseDocument-example-01",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2021-12-22T15:32:26.605+05:30"
},
"identifier" : {
"system" : "urn:ietf:rfc:3986",
"value" : "urn:uuiad:9699444a"
},
"type" : "document",
"timestamp" : "2021-12-22T15:32:26.605+05:30",
"entry" : [
{
"fullUrl" : "Composition/1",
"resource" : {
"resourceType" : "Composition",
"id" : "1",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2021-12-22T15:32:26.605+05:30"
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Composition</b><a name=\"1\"> </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 "1" Version "1" Updated "2021-12-22 15:32:26+0530" </p></div><p><b>identifier</b>: id:\u00a0urn:uuid:28b6b35e</p><p><b>status</b>: final</p><p><b>type</b>: Claim Response <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (document-types#HCXClaimResponse)</span></p><p><b>date</b>: 2021-12-22 15:32:26+0530</p><p><b>author</b>: <a href=\"#Practitioner_1\">See above (Practitioner/1: Dr. Sudhir Naik (PMJAY Gujrat))</a></p><p><b>title</b>: Claim Request</p><h3>Attesters</h3><table class=\"grid\"><tr><td>-</td><td><b>Mode</b></td><td><b>Time</b></td><td><b>Party</b></td></tr><tr><td>*</td><td>official</td><td>2021-12-22 14:10:14+0000</td><td><a href=\"#Organization_2\">See above (Organization/2: PMJAY, MoHFW, Govt Of India)</a></td></tr></table></div>"
},
"identifier" : {
"system" : "urn:ietf:rfc:3986",
"value" : "urn:uuid:28b6b35e"
},
"status" : "final",
"type" : {
"coding" : [
{
"system" : "https://hcx.org/document-types",
"code" : "HCXClaimResponse",
"display" : "Claim Response"
}
],
"text" : "Claim Response"
},
"subject" : {
"reference" : "Patient/1",
"display" : "Hina Patel"
},
"date" : "2021-12-22T15:32:26.605+05:30",
"author" : [
{
"reference" : "Practitioner/1",
"display" : "Dr. Sudhir Naik (PMJAY Gujrat)"
}
],
"title" : "Claim Request",
"attester" : [
{
"mode" : "official",
"time" : "2021-12-22T14:10:14Z",
"party" : {
"reference" : "Organization/2",
"display" : "PMJAY, MoHFW, Govt Of India"
}
}
],
"section" : [
{
"title" : "Claim Response",
"code" : {
"coding" : [
{
"system" : "https://www.hl7.org/fhir/valueset-resource-types",
"code" : "ClaimResponse",
"display" : "Claim Response"
}
],
"text" : "ClaimResponse"
},
"entry" : [
{
"reference" : "ClaimResponse/res-id-1"
}
]
}
]
}
},
{
"fullUrl" : "ClaimResponse/ress-id-1",
"resource" : {
"resourceType" : "ClaimResponse",
"id" : "1355110",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2020-07-03T22:50:39.698+00:00",
"source" : "#JrkobxCRdZUI6QNh"
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ClaimResponse</b><a name=\"1355110\"> </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 ClaimResponse "1355110" Version "1" Updated "2020-07-03 22:50:39+0000" </p><p style=\"margin-bottom: 0px\">Information Source: #JrkobxCRdZUI6QNh!</p></div><p><b>status</b>: active</p><p><b>type</b>: institutional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#institutional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"Patient/1353519\">Patient/1353519</a></p><p><b>created</b>: 2020-07-03 18:50:39-0400</p><p><b>insurer</b>: <a href=\"Organization/185\">Organization/185</a></p><p><b>request</b>: <a href=\"Claim/1355109\">Claim/1355109</a></p><p><b>outcome</b>: complete</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: eligible <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#eligible)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>500000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: copay <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#copay)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>50000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: eligpercent <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#eligpercent)</span></p><p><b>value</b>: 80.00</p></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: benefit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#benefit)</span></p><p><b>reason</b>: Plan Limit Reached <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-adjudication-reason.html\">Adjudication Reason Codes</a>#ar002)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>360000</td><td>INR</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: submitted <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#submitted)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>500000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: benefit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#benefit)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>360000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>payment</b></p><p><b>type</b>: Complete <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-ex-paymenttype.html\">Example Payment Type Codes</a>#complete)</span></p><p><b>date</b>: 2014-08-31</p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>410000</td><td>INR</td></tr></table><p><b>identifier</b>: id:\u00a0201408-2-1569478</p></blockquote></div>"
},
"status" : "active",
"type" : {
"coding" : [
{
"code" : "institutional"
}
]
},
"use" : "preauthorization",
"patient" : {
"reference" : "Patient/1353519",
"type" : "Patient"
},
"created" : "2020-07-03T18:50:39-04:00",
"insurer" : {
"reference" : "Organization/185",
"type" : "Organization"
},
"request" : {
"reference" : "Claim/1355109"
},
"outcome" : "complete",
"item" : [
{
"itemSequence" : 1,
"adjudication" : [
{
"category" : {
"coding" : [
{
"code" : "eligible"
}
]
},
"amount" : {
"value" : 500000,
"currency" : "INR"
}
},
{
"category" : {
"coding" : [
{
"code" : "copay"
}
]
},
"amount" : {
"value" : 50000,
"currency" : "INR"
}
},
{
"category" : {
"coding" : [
{
"code" : "eligpercent"
}
]
},
"value" : 80.00
},
{
"category" : {
"coding" : [
{
"code" : "benefit"
}
]
},
"reason" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication-reason",
"code" : "ar002",
"display" : "Plan Limit Reached"
}
]
},
"amount" : {
"value" : 360000,
"currency" : "INR"
}
}
]
}
],
"total" : [
{
"category" : {
"coding" : [
{
"code" : "submitted"
}
]
},
"amount" : {
"value" : 500000,
"currency" : "INR"
}
},
{
"category" : {
"coding" : [
{
"code" : "benefit"
}
]
},
"amount" : {
"value" : 360000,
"currency" : "INR"
}
}
],
"payment" : {
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-paymenttype",
"code" : "complete"
}
]
},
"date" : "2014-08-31",
"amount" : {
"value" : 410000,
"currency" : "INR"
},
"identifier" : {
"system" : "http://www.BenefitsInc.com/fhir/paymentidentifier",
"value" : "201408-2-1569478"
}
}
}
},
{
"fullUrl" : "Patient/1",
"resource" : {
"resourceType" : "Patient",
"id" : "1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Patient</b><a name=\"1\"> </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 "1" </p></div><p><b>identifier</b>: PHRADDR: 654321, PMJAYID: QWRT12345</p><p><b>name</b>: Hina Patel (OFFICIAL)</p><p><b>gender</b>: female</p><p><b>birthDate</b>: 1974-12-25</p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://ndhm.gov.in/ValueSet/identifier-type",
"code" : "PHRADDR"
}
]
},
"system" : "http://ndhm.gov.in/healthId",
"value" : "654321"
},
{
"type" : {
"coding" : [
{
"system" : "http://ndhm.gov.in/ValueSet/identifier-type",
"code" : "PMJAYID"
}
]
},
"system" : "http://ndhm.gov.in/pmjay",
"value" : "QWRT12345"
}
],
"name" : [
{
"use" : "official",
"family" : "Patel",
"given" : [
"Hina"
]
}
],
"gender" : "female",
"birthDate" : "1974-12-25"
}
},
{
"fullUrl" : "Organization/MaxSaket01",
"resource" : {
"resourceType" : "Organization",
"id" : "MaxSaket01",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"MaxSaket01\"> </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 "MaxSaket01" </p></div><p><b>identifier</b>: id:\u00a0HFR-10000005</p><p><b>name</b>: Max Super Speciality Hospital, Saket</p></div>"
},
"identifier" : [
{
"system" : "https://ndhm.gov.in/hfr",
"value" : "HFR-10000005"
}
],
"name" : "Max Super Speciality Hospital, Saket"
}
},
{
"fullUrl" : "Organization/2",
"resource" : {
"resourceType" : "Organization",
"id" : "2",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"2\"> </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 "2" </p></div><p><b>identifier</b>: id:\u00a0PMJAY</p><p><b>name</b>: PMJAY, MoHFW, Govt Of India</p></div>"
},
"identifier" : [
{
"system" : "https://hcx.org/orgs",
"value" : "PMJAY"
}
],
"name" : "PMJAY, MoHFW, Govt Of India"
}
},
{
"fullUrl" : "Practitioner/1",
"resource" : {
"resourceType" : "Practitioner",
"id" : "1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Practitioner</b><a name=\"1\"> </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 Practitioner "1" </p></div><p><b>identifier</b>: id:\u00a0NPR-6897</p><p><b>name</b>: Sudhir Naik (PMJAY Gujrat)</p></div>"
},
"identifier" : [
{
"system" : "https://ndhm.gov.in/npr",
"value" : "NPR-6897"
}
],
"name" : [
{
"text" : "Sudhir Naik (PMJAY Gujrat)",
"prefix" : [
"Dr"
],
"suffix" : [
"MD"
]
}
]
}
}
]
}
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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