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="ClaimResponseDocument-example-01"/>
<meta>
<versionId value="1"/>
<lastUpdated value="2021-12-22T15:32:26.605+05:30"/>
</meta>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuiad:9699444a"/>
</identifier>
<type value="document"/>
<timestamp value="2021-12-22T15:32:26.605+05:30"/>
<entry>
<fullUrl value="Composition/1"/>
<resource>
<Composition>
<id value="1"/>
<meta>
<versionId value="1"/>
<lastUpdated value="2021-12-22T15:32:26.605+05:30"/>
</meta>
<text>
<status value="generated"/>
<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: urn: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>
</text>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:28b6b35e"/>
</identifier>
<status value="final"/>
<type>
<coding>
<system value="https://hcx.org/document-types"/>
<code value="HCXClaimResponse"/>
<display value="Claim Response"/>
</coding>
<text value="Claim Response"/>
</type>
<subject>
<reference value="Patient/1"/>
<display value="Hina Patel"/>
</subject>
<date value="2021-12-22T15:32:26.605+05:30"/>
<author>
<reference value="Practitioner/1"/>
<display value="Dr. Sudhir Naik (PMJAY Gujrat)"/>
</author>
<title value="Claim Request"/>
<attester>
<mode value="official"/>
<time value="2021-12-22T14:10:14Z"/>
<party>
<reference value="Organization/2"/>
<display value="PMJAY, MoHFW, Govt Of India"/>
</party>
</attester>
<section>
<title value="Claim Response"/>
<code>
<coding>
<system
value="https://www.hl7.org/fhir/valueset-resource-types"/>
<code value="ClaimResponse"/>
<display value="Claim Response"/>
</coding>
<text value="ClaimResponse"/>
</code>
<entry>
<reference value="ClaimResponse/res-id-1"/>
</entry>
</section>
</Composition>
</resource>
</entry>
<entry>
<fullUrl value="ClaimResponse/ress-id-1"/>
<resource>
<ClaimResponse>
<id value="1355110"/>
<meta>
<versionId value="1"/>
<lastUpdated value="2020-07-03T22:50:39.698+00:00"/>
<source value="#JrkobxCRdZUI6QNh"/>
</meta>
<text>
<status value="generated"/>
<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/5.3.0/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/5.3.0/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: 201408-2-1569478</p></blockquote></div>
</text>
<status value="active"/>
<type>
<coding>
<code value="institutional"/>
</coding>
</type>
<use value="preauthorization"/>
<patient>
<reference value="Patient/1353519"/>
<type value="Patient"/>
</patient>
<created value="2020-07-03T18:50:39-04:00"/>
<insurer>
<reference value="Organization/185"/>
<type value="Organization"/>
</insurer>
<request>
<reference value="Claim/1355109"/>
</request>
<outcome value="complete"/>
<item>
<itemSequence value="1"/>
<adjudication>
<category>
<coding>
<code value="eligible"/>
</coding>
</category>
<amount>
<value value="500000"/>
<currency value="INR"/>
</amount>
</adjudication>
<adjudication>
<category>
<coding>
<code value="copay"/>
</coding>
</category>
<amount>
<value value="50000"/>
<currency value="INR"/>
</amount>
</adjudication>
<adjudication>
<category>
<coding>
<code value="eligpercent"/>
</coding>
</category>
<value value="80.00"/>
</adjudication>
<adjudication>
<category>
<coding>
<code value="benefit"/>
</coding>
</category>
<reason>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adjudication-reason"/>
<code value="ar002"/>
<display value="Plan Limit Reached"/>
</coding>
</reason>
<amount>
<value value="360000"/>
<currency value="INR"/>
</amount>
</adjudication>
</item>
<total>
<category>
<coding>
<code value="submitted"/>
</coding>
</category>
<amount>
<value value="500000"/>
<currency value="INR"/>
</amount>
</total>
<total>
<category>
<coding>
<code value="benefit"/>
</coding>
</category>
<amount>
<value value="360000"/>
<currency value="INR"/>
</amount>
</total>
<payment>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/ex-paymenttype"/>
<code value="complete"/>
</coding>
</type>
<date value="2014-08-31"/>
<amount>
<value value="410000"/>
<currency value="INR"/>
</amount>
<identifier>
<system
value="http://www.BenefitsInc.com/fhir/paymentidentifier"/>
<value value="201408-2-1569478"/>
</identifier>
</payment>
</ClaimResponse>
</resource>
</entry>
<entry>
<fullUrl value="Patient/1"/>
<resource>
<Patient>
<id value="1"/>
<text>
<status value="generated"/>
<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>
</text>
<identifier>
<type>
<coding>
<system value="http://ndhm.gov.in/ValueSet/identifier-type"/>
<code value="PHRADDR"/>
</coding>
</type>
<system value="http://ndhm.gov.in/healthId"/>
<value value="654321"/>
</identifier>
<identifier>
<type>
<coding>
<system value="http://ndhm.gov.in/ValueSet/identifier-type"/>
<code value="PMJAYID"/>
</coding>
</type>
<system value="http://ndhm.gov.in/pmjay"/>
<value value="QWRT12345"/>
</identifier>
<name>
<use value="official"/>
<family value="Patel"/>
<given value="Hina"/>
</name>
<gender value="female"/>
<birthDate value="1974-12-25"/>
</Patient>
</resource>
</entry>
<entry>
<fullUrl value="Organization/MaxSaket01"/>
<resource>
<Organization>
<id value="MaxSaket01"/>
<text>
<status value="generated"/>
<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: HFR-10000005</p><p><b>name</b>: Max Super Speciality Hospital, Saket</p></div>
</text>
<identifier>
<system value="https://ndhm.gov.in/hfr"/>
<value value="HFR-10000005"/>
</identifier>
<name value="Max Super Speciality Hospital, Saket"/>
</Organization>
</resource>
</entry>
<entry>
<fullUrl value="Organization/2"/>
<resource>
<Organization>
<id value="2"/>
<text>
<status value="generated"/>
<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: PMJAY</p><p><b>name</b>: PMJAY, MoHFW, Govt Of India</p></div>
</text>
<identifier>
<system value="https://hcx.org/orgs"/>
<value value="PMJAY"/>
</identifier>
<name value="PMJAY, MoHFW, Govt Of India"/>
</Organization>
</resource>
</entry>
<entry>
<fullUrl value="Practitioner/1"/>
<resource>
<Practitioner>
<id value="1"/>
<text>
<status value="generated"/>
<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: NPR-6897</p><p><b>name</b>: Sudhir Naik (PMJAY Gujrat)</p></div>
</text>
<identifier>
<system value="https://ndhm.gov.in/npr"/>
<value value="NPR-6897"/>
</identifier>
<name>
<text value="Sudhir Naik (PMJAY Gujrat)"/>
<prefix value="Dr"/>
<suffix value="MD"/>
</name>
</Practitioner>
</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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