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:

Hina Patel (OFFICIAL) Female, DoB: 1974-12-25 ( PHRADDR: 654321)

Generated Narrative: Composition

Resource Composition "1" Version "1" Updated "2021-12-22 15:32:26+0530"

Texts

-Div
*<div/>

identifier: id: urn:uuid:28b6b35e

status: FINAL

type: Claim Response (document-types#HCXClaimResponse)

date: 2021-12-22 15:32:26+0530

author: See above (Practitioner/1: Dr. Sudhir Naik (PMJAY Gujrat))

title: Claim Request

Attesters

-ModeTimeParty
*Official (CompositionAttestationMode#official)2021-12-22 14:10:14+0000See above (Organization/2: PMJAY, MoHFW, Govt Of India)

Claim Response


Additional Document Content


2. ClaimResponse/ress-id-1 (ClaimResponse/1355110)

Generated Narrative: ClaimResponse

Resource ClaimResponse "1355110" Version "1" Updated "2020-07-03 22:50:39+0000"

Information Source: #JrkobxCRdZUI6QNh!

Texts

-Div
*<div/>

status: ACTIVE

type: institutional ([not stated]#institutional)

use: PREAUTHORIZATION

patient: Patient/1353519

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

insurer: Organization/185

request: Claim/1355109

outcome: COMPLETE

item

itemSequence: 1

adjudication

category: eligible ([not stated]#eligible)

Amounts

-ValueCurrency
*500000INR

adjudication

category: copay ([not stated]#copay)

Amounts

-ValueCurrency
*50000INR

adjudication

category: eligpercent ([not stated]#eligpercent)

adjudication

category: benefit ([not stated]#benefit)

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

Amounts

-ValueCurrency
*360000INR

total

category: submitted ([not stated]#submitted)

Amounts

-ValueCurrency
*500000INR

total

category: benefit ([not stated]#benefit)

Amounts

-ValueCurrency
*360000INR

payment

type: Complete (Example Payment Type Codes#complete)

date: 2014-08-31

Amounts

-ValueCurrency
*410000INR

identifier: id: 201408-2-1569478


3. Patient/1 (Patient/1)

Hina Patel (OFFICIAL) Female, DoB: 1974-12-25 ( PHRADDR: 654321)


4. Organization/MaxSaket01 (Organization/MaxSaket01)

Generated Narrative: Organization

Resource Organization "MaxSaket01"

Texts

-Div
*<div/>

identifier: id: HFR-10000005

name: Max Super Speciality Hospital, Saket


5. Organization/2 (Organization/2)

Generated Narrative: Organization

Resource Organization "2"

Texts

-Div
*<div/>

identifier: id: PMJAY

name: PMJAY, MoHFW, Govt Of India


6. Practitioner/1 (Practitioner/1)

Generated Narrative: Practitioner

Resource Practitioner "1"

Texts

-Div
*<div/>

identifier: id: NPR-6897

name: Sudhir Naik (PMJAY Gujrat)