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

Example ClaimResponse: HCX Claim Response example

Generated Narrative: ClaimResponse

Resource ClaimResponse "example-01" Version "1" Updated "2020-07-03 22:50:39+0000"

Information Source: #JrkobxCRdZUI6QNh!

identifier: id: dc82673b-8c71-48c2-2k9s-16dcb3b829m2

status: active

type: Institutional (Claim Type Codes#institutional)

use: preauthorization

patient:

created: 2020-07-03 18:50:39-0400

insurer:

requestor:

request:

outcome: complete

item

itemSequence: 1

adjudication

category: Eligible Amount (Adjudication Value Codes#eligible)

Amounts

-ValueCurrency
*500000INR

adjudication

category: CoPay (Adjudication Value Codes#copay)

Amounts

-ValueCurrency
*50000INR

adjudication

category: Eligible % (Adjudication Value Codes#eligpercent)

value: 80.00

adjudication

category: Benefit Amount (Adjudication Value Codes#benefit)

reason: Plan Limit Reached (Adjudication Reason Codes#ar002)

Amounts

-ValueCurrency
*360000INR

total

category: Submitted Amount (Adjudication Value Codes#submitted)

Amounts

-ValueCurrency
*500000INR

total

category: Benefit Amount (Adjudication Value Codes#benefit)

Amounts

-ValueCurrency
*360000INR

payment

type: Complete (Example Payment Type Codes#complete)

date: 2014-08-31

Amounts

-ValueCurrency
*410000INR

identifier: id: 201408-2-1569478