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
<ClaimResponse xmlns="http://hl7.org/fhir">
<id value="example-01"/>
<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="example-01"> </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 "example-01" Version "1" Updated "2020-07-03 22:50:39+0000" </p><p style="margin-bottom: 0px">Information Source: #JrkobxCRdZUI6QNh!</p></div><p><b>identifier</b>: id: dc82673b-8c71-48c2-2k9s-16dcb3b829m2</p><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>: preauthorization</p><p><b>patient</b>: <span/></p><p><b>created</b>: 2020-07-03 18:50:39-0400</p><p><b>insurer</b>: <span/></p><p><b>requestor</b>: <span/></p><p><b>request</b>: <span/></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 Amount <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html">Adjudication Value Codes</a>#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"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html">Adjudication Value Codes</a>#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>: Eligible % <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html">Adjudication Value Codes</a>#eligpercent)</span></p><p><b>value</b>: 80.00</p></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Benefit Amount <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html">Adjudication Value Codes</a>#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 Amount <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html">Adjudication Value Codes</a>#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 Amount <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html">Adjudication Value Codes</a>#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>
<identifier>
<system value="https://www.tmh.in/claim-response"/>
<value value="dc82673b-8c71-48c2-2k9s-16dcb3b829m2"/>
</identifier>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="institutional"/>
</coding>
</type>
<use value="preauthorization"/>
<patient id="RVH1003">
<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>
</patient>
<created value="2020-07-03T18:50:39-04:00"/>
<insurer id="GICOFINDIA">
<identifier>
<system value="http://irdai.gov.in/insurers"/>
<value value="112"/>
</identifier>
</insurer>
<requestor id="Tmh01">
<identifier>
<system value="http://abdm.gov.in/facilities"/>
<value value="HFR-ID-FOR-TMH"/>
</identifier>
</requestor>
<request id="example-01">
<identifier>
<system value="https://www.tmh.in/claim-request"/>
<value value="dc82673b-8c71-29js-8a17-16dj3i20352n"/>
</identifier>
</request>
<outcome value="complete"/>
<item>
<itemSequence value="1"/>
<adjudication>
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="eligible"/>
</coding>
</category>
<amount>
<value value="500000"/>
<currency value="INR"/>
</amount>
</adjudication>
<adjudication>
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="copay"/>
</coding>
</category>
<amount>
<value value="50000"/>
<currency value="INR"/>
</amount>
</adjudication>
<adjudication>
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="eligpercent"/>
</coding>
</category>
<value value="80.00"/>
</adjudication>
<adjudication>
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<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>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="submitted"/>
</coding>
</category>
<amount>
<value value="500000"/>
<currency value="INR"/>
</amount>
</total>
<total>
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<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>
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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