Claim
ID: 1425
Payload:
{
"resourceType": "Claim",
"meta": {
"versionId": "7",
"lastUpdated": "2019-09-26T06:46:11.903+00:00"
},
"diagnosis": [
{
"diagnosis": {
"code": "F33.9"
}
}
],
"patient": {
"reference": "Patient/1424"
}
}
ID: 1316241
Payload:
{
"resourceType": "Claim",
"meta": {
"extension": [
{
"url": "http://hapifhir.io/fhir/StructureDefinition/resource-meta-source",
"valueUri": "#6b1faedb714b691e"
}
],
"versionId": "1",
"lastUpdated": "2019-09-25T14:27:37.759+00:00"
},
"text": {
"status": "generated",
"div": " <div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Oral Health
Claim</div>"
},
"contained": [
{
"resourceType": "Patient",
"id": "patient-1",
"name": [
{
"use": "official",
"family": "Donald",
"given": [
"Duck"
]
}
],
"gender": "male",
"birthDate": "1986-05-17",
"address": [
{
"use": "home",
"line": [
"1234 Main Street"
],
"city": "Vancouver",
"postalCode": "V2H1Y3",
"country": "CAD"
}
]
},
{
"resourceType": "Organization",
"id": "org-insurer",
"identifier": [
{
"system": "http://www.bindb.com/bin",
"value": "123456"
}
]
},
{
"resourceType": "Organization",
"id": "org-org",
"identifier": [
{
"system": "http://www.jurisdiction.com/oralhealthoffices",
"value": "3456"
}
]
},
{
"resourceType": "Practitioner",
"id": "provider-1",
"identifier": [
{
"system": "http://www.jurisdiction.com/oralhealthproviders",
"value": "123456789"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage-1",
"identifier": [
{
"system": "http://benefitsinc.com/certificate",
"value": "12345"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/v3/ActCode",
"code": "EHCPOL"
}
]
},
"subscriber": {
"reference": "#patient-1"
},
"beneficiary": {
"reference": "#patient-1"
},
"relationship": {
"coding": [
{
"code": "self"
}
]
},
"payor": [
{
"identifier": {
"system": "http://www.bindb.com/bin",
"value": "123456"
}
}
],
"grouping": {
"plan": "CBI35",
"planDisplay": "Corporate Baker's Inc. Plan#35",
"subPlan": "123",
"subPlanDisplay": "Trainee Part-time Benefits"
},
"dependent": "1",
"sequence": "1"
}
],
"identifier": [
{
"system": "http://happyvalley.com/claim",
"value": "12347"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/ex-claimtype",
"code": "oral"
}
]
},
"use": "complete",
"patient": {
"reference": "#patient-1"
},
"created": "2014-08-16",
"insurer": {
"reference": "#org-insurer"
},
"organization": {
"reference": "#org-org"
},
"priority": {
"coding": [
{
"code": "normal"
}
]
},
"payee": {
"type": {
"coding": [
{
"code": "provider"
}
]
}
},
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "#provider-1"
}
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"code": "123456"
}
]
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "#coverage-1"
}
}
],
"item": [
{
"sequence": 1,
"careTeamLinkId": [
1
],
"service": {
"coding": [
{
"code": "1200"
}
]
},
"servicedDate": "2014-08-16",
"unitPrice": {
"value": 135.57,
"system": "urn:iso:std:iso:4217",
"code": "USD"
},
"net": {
"value": 135.57,
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
}
]
}
ID: 7aa6ffec-cea4-4301-8dd9-f2637fac6df7
Payload:
{
"billablePeriod": {
"end": "1981-06-24T22:15:24+00:00",
"start": "1981-06-24T21:45:24+00:00"
},
"diagnosis": [
{
"diagnosisReference": {
"reference": "Condition/c9d8d2e7-3844-4978-8519-8d64a6e6b93c"
},
"sequence": 1
}
],
"item": [
{
"encounter": [
{
"reference": "Encounter/eeefa74c-1835-48cd-9680-220359bb203e"
}
],
"sequence": 1
},
{
"diagnosisLinkId": [
1
],
"sequence": 2
}
],
"meta": {
"lastUpdated": "2019-10-30T10:49:02.273487+00:00",
"versionId": "MTU3MjQzMjU0MjI3MzQ4NzAwMA"
},
"organization": {
"reference": "Organization/b0e04623-b02c-3f8b-92ea-943fc4db60da"
},
"patient": {
"reference": "Patient/f2243092-c684-4146-acb8-ee581136332f"
},
"resourceType": "Claim",
"status": "active",
"total": {
"code": "USD",
"system": "urn:iso:std:iso:4217",
"value": 125
},
"use": "complete"
}