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
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 16:01:08-0500 --> 1979-02-28 16:01:08-0500
created: 1979-02-28 16:01:08-0500
insurer:
provider:
priority: Normal (Process Priority Codes#normal)
| - | Type | Party |
| * | Provider (Claim Payee Type Codes#provider) |
| - | Sequence | Provider |
| * | 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)
| - | Sequence | Focal | Coverage |
| * | 1 | true | : 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
- Value Currency * 516.65 USD
item
sequence: 3
procedureSequence: 2
productOrService: Combined chemotherapy and radiation therapy (procedure) (SNOMED CT#703423002)
Nets
- Value Currency * 16924.49 USD
item
sequence: 4
procedureSequence: 3
productOrService: High resolution computed tomography of chest without contrast (procedure) (SNOMED CT#16335031000119103)
Nets
- Value Currency * 516.65 USD
| - | Value | Currency |
| * | 129.16 | USD |