FHIR Implementation Guide for HCX
0.9.0 - CI Build
FHIR Implementation Guide for HCX
0.9.0 - CI Build
FHIR Implementation Guide for HCX - Local Development build (v0.9.0). See the Directory of published versions
<Bundle xmlns="http://hl7.org/fhir">
<id value="ClaimRequestDocument-example-01"/>
<meta>
<lastUpdated value="2022-02-08T21:49:55.458+05:30"/>
</meta>
<identifier>
<system value="https://www.tmh.in/bundle"/>
<value value="ClaimRequestDocument-example-01"/>
</identifier>
<type value="document"/>
<timestamp value="2022-02-08T21:49:55.458+05:30"/>
<entry>
<fullUrl value="Composition/42ff4a07-3e36-402f-a99e-29f16c0c9eee"/>
<resource>
<Composition>
<id value="42ff4a07-3e36-402f-a99e-29f16c0c9eee"/>
<text>
<status value="generated"/>
<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: 42ff4a07-3e36-402f-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>
</text>
<identifier>
<system value="https://www.tmh.in/hcx-documents"/>
<value value="42ff4a07-3e36-402f-a99e-29f16c0c9eee"/>
</identifier>
<status value="final"/>
<type>
<coding>
<system value="https://www.hcx.org/document-type"/>
<code value="HcxClaimRequest"/>
<display value="Claim Request Doc"/>
</coding>
</type>
<subject>
<reference value="Patient/RVH1003"/>
</subject>
<date value="2022-02-08T21:49:55+05:30"/>
<author>
<reference value="Organization/Tmh01"/>
</author>
<title value="Claim Request"/>
<section>
<title value="# Claim Request"/>
<code>
<coding>
<system value="http://hl7.org/fhir/ValueSet/resource-types"/>
<code value="ClaimRequest"/>
<display value="Claim Request"/>
</coding>
<text value="ClaimRequest"/>
</code>
<entry>
<reference
value="ClaimRequest/dc82673b-8c71-48c2-8a17-16dcb3b035f6"/>
</entry>
</section>
</Composition>
</resource>
</entry>
<entry>
<fullUrl value="Organization/Tmh01"/>
<resource>
<Organization>
<id value="Tmh01"/>
<text>
<status value="generated"/>
<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: HFR-ID-FOR-TMH, id: IRDA-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>
</text>
<identifier>
<system value="http://abdm.gov.in/facilities"/>
<value value="HFR-ID-FOR-TMH"/>
</identifier>
<identifier>
<system value="http://irdai.gov.in/facilities"/>
<value value="IRDA-ID-FOR-TMH"/>
</identifier>
<name value="Tata Memorial Hospital"/>
<alias value="TMH"/>
<alias value="TMC"/>
<telecom>
<system value="phone"/>
<value value="(+91) 022-2417-7000"/>
</telecom>
<address>
<line
value="Dr Ernest Borges Rd, Parel East, Parel, Mumbai, Maharashtra 400012"/>
<city value="Mumbai"/>
<state value="Maharashtra"/>
<postalCode value="400012"/>
<country value="INDIA"/>
</address>
<endpoint>
<reference value="https://www.tmc.gov.in/"/>
<display value="Website"/>
</endpoint>
</Organization>
</resource>
</entry>
<entry>
<fullUrl value="Patient/RVH1003"/>
<resource>
<Patient>
<id value="RVH1003"/>
<text>
<status value="generated"/>
<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: hinapatel@abdm</p><p><b>name</b>: Hina Patel</p><p><b>gender</b>: female</p></div>
</text>
<identifier>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="SN"/>
<display value="Subscriber Number"/>
</coding>
</type>
<system value="http://gicofIndia.com/beneficiaries"/>
<value value="BEN-101"/>
</identifier>
<identifier>
<system value="http://abdm.gov.in/patients"/>
<value value="hinapatel@abdm"/>
</identifier>
<name>
<text value="Hina Patel"/>
</name>
<gender value="female"/>
</Patient>
</resource>
</entry>
<entry>
<fullUrl value="ClaimRequest/dc82673b-8c71-48c2-8a17-16dcb3b035f6"/>
<resource>
<Claim>
<id value="1532676"/>
<meta>
<versionId value="1"/>
<lastUpdated value="2020-10-07T03:26:09.060+00:00"/>
<source value="#BHZcRrcF4oS0JQ42"/>
</meta>
<text>
<status value="generated"/>
<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/5.3.0/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/5.3.0/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>
</text>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="institutional"/>
</coding>
</type>
<use value="claim"/>
<patient>
<reference value="Patient/1531634"/>
<display value="Hina Patel"/>
</patient>
<billablePeriod>
<start value="1979-02-27T16:01:08-05:00"/>
<end value="1979-02-28T16:01:08-05:00"/>
</billablePeriod>
<created value="1979-02-28T16:01:08-05:00"/>
<provider>
<reference value="Organization/2"/>
<display value="PMJAY, MoHFW, Govt Of India"/>
</provider>
<priority>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/processpriority"/>
<code value="normal"/>
</coding>
</priority>
<procedure>
<sequence value="1"/>
<procedureReference>
<reference value="Procedure/1532663"/>
</procedureReference>
</procedure>
<procedure>
<sequence value="2"/>
<procedureReference>
<reference value="Procedure/1532664"/>
</procedureReference>
</procedure>
<procedure>
<sequence value="3"/>
<procedureReference>
<reference value="Procedure/1532665"/>
</procedureReference>
</procedure>
<insurance>
<sequence value="1"/>
<focal value="true"/>
<coverage>
<display value="Cigna Health"/>
</coverage>
</insurance>
<item>
<sequence value="1"/>
<productOrService>
<coding>
<system value="http://snomed.info/sct"/>
<code value="185347001"/>
<display value="Encounter for problem"/>
</coding>
<text value="Encounter for problem"/>
</productOrService>
<encounter>
<reference value="Encounter/1532617"/>
</encounter>
</item>
<item>
<sequence value="2"/>
<procedureSequence value="1"/>
<productOrService>
<coding>
<system value="http://snomed.info/sct"/>
<code value="398171003"/>
<display value="Hearing examination (procedure)"/>
</coding>
<text value="Hearing examination (procedure)"/>
</productOrService>
<net>
<value value="516.65"/>
<currency value="USD"/>
</net>
</item>
<item>
<sequence value="3"/>
<procedureSequence value="2"/>
<productOrService>
<coding>
<system value="http://snomed.info/sct"/>
<code value="703423002"/>
<display
value="Combined chemotherapy and radiation therapy (procedure)"/>
</coding>
<text
value="Combined chemotherapy and radiation therapy (procedure)"/>
</productOrService>
<net>
<value value="16924.49"/>
<currency value="USD"/>
</net>
</item>
<item>
<sequence value="4"/>
<procedureSequence value="3"/>
<productOrService>
<coding>
<system value="http://snomed.info/sct"/>
<code value="16335031000119103"/>
<display
value="High resolution computed tomography of chest without contrast (procedure)"/>
</coding>
<text
value="High resolution computed tomography of chest without contrast (procedure)"/>
</productOrService>
<net>
<value value="516.65"/>
<currency value="USD"/>
</net>
</item>
<total>
<value value="129.16"/>
<currency value="USD"/>
</total>
</Claim>
</resource>
</entry>
<entry>
<fullUrl value="Organization/GICOFINDIA"/>
<resource>
<Organization>
<id value="GICOFINDIA"/>
<text>
<status value="generated"/>
<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: 112</p><p><b>name</b>: General Insurance Corporation of India</p></div>
</text>
<identifier>
<system value="http://irdai.gov.in/insurers"/>
<value value="112"/>
</identifier>
<name value="General Insurance Corporation of India"/>
</Organization>
</resource>
</entry>
<entry>
<fullUrl value="Coverage/dadde132-ad64-4d18-8c18-1d52d7e86abc"/>
<resource>
<Coverage>
<id value="dadde132-ad64-4d18-8c18-1d52d7e86abc"/>
<text>
<status value="generated"/>
<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: policy-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>
</text>
<identifier>
<system value="https://www.gicofIndia.in/policies"/>
<value value="policy-RVH1003"/>
</identifier>
<status value="active"/>
<subscriber>
<reference value="Patient/RVH1003"/>
</subscriber>
<subscriberId value="SN-RVH1003"/>
<beneficiary>
<reference value="Patient/RVH1003"/>
</beneficiary>
<relationship>
<coding>
<system
value="http://hl7.org/fhir/ValueSet/subscriber-relationship"/>
<code value="self"/>
</coding>
</relationship>
<payor>
<reference value="Organization/GICOFINDIA"/>
</payor>
</Coverage>
</resource>
</entry>
</Bundle>
IG © 2021+ HCX Open Community. Package hcxprotocol.io#0.9.0 based on FHIR 4.0.1. Generated 2023-12-14
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