ClaimBundle-preauth-example-01
type: Bundle
node role: treeRoot
resource.id:
  value: ClaimBundle-preauth-example-01
resource.meta:
  meta.version id:
    value: 1
  meta.last updated:
    value: 2022-12-20T15:32:26.605+05:30
  meta.profile:
    value: https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimBundle
    index: 0
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimBundle
  meta.security:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/v3-Confidentiality
    coding.code:
      value: V
    coding.display:
      value: very restricted
bundle.identifier:
  identifier.system:
    value: http://hip.in
bundle.type:
  value: collection
bundle.timestamp:
  value: 2022-12-20T15:32:26.605+05:30
bundle.entry:
  index: 0
  bundle.entry.full url:
    value: Claim/preauth-example-01
  bundle.entry.resource: preauth-example-01
bundle.entry:
  index: 1
  bundle.entry.full url:
    value: Patient/example-01
  bundle.entry.resource: example-01
bundle.entry:
  index: 2
  bundle.entry.full url:
    value: Organization/example-01
  bundle.entry.resource: example-01
bundle.entry:
  index: 3
  bundle.entry.full url:
    value: Organization/example-02
  bundle.entry.resource: example-02
bundle.entry:
  index: 4
  bundle.entry.full url:
    value: Coverage/example-01
  bundle.entry.resource: example-01
bundle.entry:
  index: 5
  bundle.entry.full url:
    value: Condition/example-01
  bundle.entry.resource: example-01
bundle.entry:
  index: 6
  bundle.entry.full url:
    value: Condition/example-02
  bundle.entry.resource: example-02
bundle.entry:
  index: 7
  bundle.entry.full url:
    value: DocumentReference/example-01
  bundle.entry.resource: example-01

preauth-example-01
type: Claim
resource.id:
  value: Claim-preauth-example-01
resource.meta:
  meta.profile:
    value: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim
    index: 0
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: Claim Resource Claim "Claim-preauth-example-01" Profile: Claim identifier: id: 7612345 status: active type: Professional (Claim Type Codes#professional) use: preauthorization patient: See above (Patient/example-01) created: 2022-07-20 11:01:00+0500 insurer: See above (Organization/example-01) provider: See above (Organization/example-02) priority: Normal (Process Priority Codes#normal) SupportingInfos - Sequence Category Code Value[x] * 1 proof of identity (SupportingInfo Category#POI) Adhaar number (Identifier Type Code#ADN) See above (DocumentReference/example-01) diagnosis sequence: 1 diagnosis: See above (Condition/example-01) type: Clinical Diagnosis (Example Diagnosis Type Codes#clinical) diagnosis sequence: 2 diagnosis: See above (Condition/example-02) type: Clinical Diagnosis (Example Diagnosis Type Codes#clinical) Insurances - Sequence Focal Coverage PreAuthRef * 1 true See above (Coverage/example-01) 12S52 item sequence: 1 category: Dental care (SNOMED CT#225362009) productOrService: Removal of foreign body (SNOMED CT#10849003) programCode: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) (Program Code#AB-PMJAY) UnitPrices - Value Currency * 25000 INR item sequence: 2 category: Medical care (SNOMED CT#781087000) productOrService: Chronic diarrhea (SNOMED CT#236071009) programCode: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) (Program Code#AB-PMJAY) UnitPrices - Value Currency * 15000 INR
claim.identifier:
  index: 0
  identifier.system:
    value: http://happypharma.com/claim
  identifier.value:
    value: 7612345
claim.status:
  value: active
claim.type:
  codeable concept.coding:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/claim-type
    coding.code:
      value: professional
claim.use:
  value: preauthorization
claim.patient:
  link: https://nrces.in/ndhm/fhir/r4/Patient/example-01
  reference.reference:
    value: Patient/example-01
claim.created:
  value: 2022-07-20T11:01:00+05:00
claim.insurer:
  link: https://nrces.in/ndhm/fhir/r4/Organization/example-01
  reference.reference:
    value: Organization/example-01
claim.provider:
  link: https://nrces.in/ndhm/fhir/r4/Organization/example-02
  reference.reference:
    value: Organization/example-02
claim.priority:
  codeable concept.coding:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/processpriority
    coding.code:
      value: normal
claim.supporting info:
  index: 0
  claim.supporting info.sequence:
    value: 1
  claim.supporting info.category:
    codeable concept.coding:
      index: 0
      coding.system:
        value: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category
      coding.code:
        value: POI
      coding.display:
        value: proof of identity
  claim.supporting info.code:
    codeable concept.coding:
      index: 0
      coding.system:
        value: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code
      coding.code:
        value: ADN
      coding.display:
        value: Adhaar number
  claim.supporting info.value reference:
    link: https://nrces.in/ndhm/fhir/r4/DocumentReference/example-01
    reference.reference:
      value: DocumentReference/example-01
claim.diagnosis:
  index: 0
  claim.diagnosis.sequence:
    value: 1
  claim.diagnosis.diagnosis reference:
    link: https://nrces.in/ndhm/fhir/r4/Condition/example-01
    reference.reference:
      value: Condition/example-01
  claim.diagnosis.type:
    index: 0
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
      coding.code:
        value: clinical
      coding.display:
        value: Clinical Diagnosis
claim.diagnosis:
  index: 1
  claim.diagnosis.sequence:
    value: 2
  claim.diagnosis.diagnosis reference:
    link: https://nrces.in/ndhm/fhir/r4/Condition/example-02
    reference.reference:
      value: Condition/example-02
  claim.diagnosis.type:
    index: 0
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
      coding.code:
        value: clinical
      coding.display:
        value: Clinical Diagnosis
claim.insurance:
  index: 0
  claim.insurance.sequence:
    value: 1
  claim.insurance.focal:
    value: true
  claim.insurance.coverage:
    link: https://nrces.in/ndhm/fhir/r4/Coverage/example-01
    reference.reference:
      value: Coverage/example-01
  claim.insurance.pre auth ref:
    value: 12S52
    index: 0
claim.item:
  index: 0
  claim.item.sequence:
    value: 1
  claim.item.category:
    codeable concept.coding: http://snomed.info/id/225362009
      index: 0
      coding.system:
        value: http://snomed.info/sct
      coding.code:
        value: 225362009
      coding.display:
        value: Dental care
  claim.item.product or service:
    codeable concept.coding: http://snomed.info/id/10849003
      index: 0
      coding.system:
        value: http://snomed.info/sct
      coding.code:
        value: 10849003
      coding.display:
        value: Removal of foreign body
  claim.item.program code:
    index: 0
    codeable concept.coding:
      index: 0
      coding.system:
        value: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-program-code
      coding.code:
        value: AB-PMJAY
      coding.display:
        value: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
  claim.item.unit price:
    money.value:
      value: 25000
    money.currency:
      value: INR
claim.item:
  index: 1
  claim.item.sequence:
    value: 2
  claim.item.category:
    codeable concept.coding: http://snomed.info/id/781087000
      index: 0
      coding.system:
        value: http://snomed.info/sct
      coding.code:
        value: 781087000
      coding.display:
        value: Medical care
  claim.item.product or service:
    codeable concept.coding: http://snomed.info/id/236071009
      index: 0
      coding.system:
        value: http://snomed.info/sct
      coding.code:
        value: 236071009
      coding.display:
        value: Chronic diarrhea
  claim.item.program code:
    index: 0
    codeable concept.coding:
      index: 0
      coding.system:
        value: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-program-code
      coding.code:
        value: AB-PMJAY
      coding.display:
        value: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
  claim.item.unit price:
    money.value:
      value: 15000
    money.currency:
      value: INR

example-01
type: Patient
resource.id:
  value: example-01
resource.meta:
  meta.version id:
    value: 1
  meta.last updated:
    value: 2020-07-09T14:58:58.181+05:30
  meta.profile:
    value: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient
    index: 0
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: Patient Resource Patient "example-01" Version "1" Updated "2020-07-09 02:58:58+0530" Profile: Patient identifier: Adhaar number: 7225-4829-5255 name: Ayush Sharma telecom: +919818512600 gender: male birthDate: 1981-01-12
patient.identifier:
  index: 0
  identifier.type:
    codeable concept.coding:
      index: 0
      coding.system:
        value: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code
      coding.code:
        value: ADN
      coding.display:
        value: Adhaar number
  identifier.system:
    value: https://uidai.gov.in/
  identifier.value:
    value: 7225-4829-5255
patient.name:
  index: 0
  human name.text:
    value: Ayush Sharma
patient.telecom:
  index: 0
  contact point.system:
    value: phone
  contact point.value:
    value: +919818512600
  contact point.use:
    value: home
patient.gender:
  value: male
patient.birth date:
  value: 1981-01-12

example-01
type: Organization
resource.id:
  value: example-01
resource.meta:
  meta.profile:
    value: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization
    index: 0
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: Organization Resource Organization "example-01" Profile: Organization identifier: Provider number: 4567878 name: Appolo Hospital telecom: +91 243 2634 1234, contact@xyz.org
organization.identifier:
  index: 0
  identifier.type:
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/v2-0203
      coding.code:
        value: PRN
      coding.display:
        value: Provider number
  identifier.system:
    value: https://facility.ndhm.gov.in
  identifier.value:
    value: 4567878
organization.name:
  value: Appolo Hospital
organization.telecom:
  index: 0
  contact point.system:
    value: phone
  contact point.value:
    value: +91 243 2634 1234
  contact point.use:
    value: work
organization.telecom:
  index: 1
  contact point.system:
    value: email
  contact point.use:
    value: work

example-02
type: Organization
resource.id:
  value: example-02
resource.meta:
  meta.profile:
    value: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization
    index: 0
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: Organization Resource Organization "example-02" Profile: Organization identifier: Provider number: 555511 name: Star Health Corporation. telecom: +91 555 2634 888, contact@xyz.org
organization.identifier:
  index: 0
  identifier.type:
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/v2-0203
      coding.code:
        value: PRN
      coding.display:
        value: Provider number
  identifier.system:
    value: https://facility.ndhm.gov.in
  identifier.value:
    value: 555511
organization.name:
  value: Star Health Corporation.
organization.telecom:
  index: 0
  contact point.system:
    value: phone
  contact point.value:
    value: +91 555 2634 888
  contact point.use:
    value: work
organization.telecom:
  index: 1
  contact point.system:
    value: email
  contact point.use:
    value: work

example-01
type: Coverage
resource.id:
  value: example-01
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: Coverage Resource Coverage "example-01" identifier: id: SP12345678 status: active type: PAY (Coverage SelfPay Codes#pay) subscriber: See above (Patient/example-01) beneficiary: See above (Patient/example-01) relationship: Self (SubscriberPolicyholder Relationship Codes#self) period: ?? --> 2025-03-17 payor: See above (Patient/example-01)
coverage.identifier:
  index: 0
  identifier.system:
    value: http://hospitalx.com/selfpayagreement
  identifier.value:
    value: SP12345678
coverage.status:
  value: active
coverage.type:
  codeable concept.coding:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/coverage-selfpay
    coding.code:
      value: pay
    coding.display:
      value: PAY
coverage.subscriber:
  link: https://nrces.in/ndhm/fhir/r4/Patient/example-01
  reference.reference:
    value: Patient/example-01
coverage.beneficiary:
  link: https://nrces.in/ndhm/fhir/r4/Patient/example-01
  reference.reference:
    value: Patient/example-01
coverage.relationship:
  codeable concept.coding:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/subscriber-relationship
    coding.code:
      value: self
coverage.period:
  period.end:
    value: 2025-03-17
coverage.payor:
  index: 0
  link: https://nrces.in/ndhm/fhir/r4/Patient/example-01
  reference.reference:
    value: Patient/example-01

example-01
type: Condition
resource.id:
  value: example-01
resource.meta:
  meta.profile:
    value: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Condition
    index: 0
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Condition
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: Condition Resource Condition "example-01" Profile: Condition code: Dengue (disorder) (SNOMED CT#38362002) subject: See above (Patient/example-01)
condition.code:
  codeable concept.coding: http://snomed.info/id/38362002
    index: 0
    coding.system:
      value: http://snomed.info/sct
    coding.code:
      value: 38362002
    coding.display:
      value: Dengue (disorder)
condition.subject:
  link: https://nrces.in/ndhm/fhir/r4/Patient/example-01
  reference.reference:
    value: Patient/example-01

example-02
type: Condition
resource.id:
  value: example-02
resource.meta:
  meta.profile:
    value: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Condition
    index: 0
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Condition
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: Condition Resource Condition "example-02" Profile: Condition code: Chronic diarrhea of unknown origin (disorder) (SNOMED CT#17551007) subject: See above (Patient/example-01)
condition.code:
  codeable concept.coding: http://snomed.info/id/17551007
    index: 0
    coding.system:
      value: http://snomed.info/sct
    coding.code:
      value: 17551007
    coding.display:
      value: Chronic diarrhea of unknown origin (disorder)
condition.subject:
  link: https://nrces.in/ndhm/fhir/r4/Patient/example-01
  reference.reference:
    value: Patient/example-01

example-01
type: DocumentReference
resource.id:
  value: example-01
resource.meta:
  meta.profile:
    value: https://nrces.in/ndhm/fhir/r4/StructureDefinition/DocumentReference
    index: 0
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/DocumentReference
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: DocumentReference Resource DocumentReference "example-01" Profile: DocumentReference status: current docStatus: final subject: See above (Patient/example-01) content Attachments - ContentType Language Data Title Creation * application/pdf en-IN [binary] Adhar Card PDF 2019-05-29 02:58:58+0530
document reference.status:
  value: current
document reference.doc status:
  value: final
document reference.subject:
  link: https://nrces.in/ndhm/fhir/r4/Patient/example-01
  reference.reference:
    value: Patient/example-01
document reference.content:
  index: 0
  document reference.content.attachment:
    attachment.content type:
      value: application/pdf
    attachment.language:
      value: en-IN
    attachment.title:
      value: Adhar Card PDF
    attachment.creation:
      value: 2019-05-29T14:58:58.181+05:30