Resource Claim "Claim-example-01"
Profile: Claim
identifier: id: 7612345
status: active
type: Professional (Claim Type Codes#professional)
use: claim
patient: See above (Patient/Patient-example-01)
created: 2022-12-22 16:01:08-0500
insurer: See above (Organization/Organization-example-01)
provider: See above (Organization/Organization-example-02)
priority: Normal (Process Priority Codes#normal)
- | Sequence | Category | Code | Value[x] |
* | 1 | proof of identity (SupportingInfo Category#POI) | Adhaar number (Identifier Type Code#ADN) | See above (DocumentReference/DocumentReference-example-01) |
- | Sequence | Diagnosis[x] | Type |
* | 1 | See above (Condition/Condition-example-01) | Self Diagnosis (Example Diagnosis Type Codes#self) |
- | Sequence | Focal | Coverage | PreAuthRef |
* | 1 | true | See above (Coverage/Coverage-example-01) | 1234 |
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 * 5000 INR
Resource Patient "Patient-example-01" Version "1" Updated "2020-07-09 14:58:58+0530"
Profile: Patient
identifier: Adhaar number: 7225-4829-5255
name: Ayush Sharma
telecom: +919818512600
gender: male
birthDate: 1981-01-12
Generated Narrative: Organization
Resource Organization "Organization-example-01"
Profile: Organization
identifier: Provider number: 4567878
name: Appolo Hospital
telecom: +91 243 2634 1234, contact@xyz.org
Generated Narrative: Organization
Resource Organization "Organization-example-02"
Profile: Organization
identifier: Provider number: 555511
name: Star Health Corporation.
telecom: +91 555 2634 888, contact@xyz.org
Resource Coverage "Coverage-example-01"
identifier: id: SP12345678
status: active
type: PAY (Coverage SelfPay Codes#pay)
subscriber: Patient/example-01 ""
beneficiary: Patient/example-01 ""
relationship: Self (SubscriberPolicyholder Relationship Codes#self)
period: ?? --> 2023-03-17
payor: Patient/example-01 ""
Generated Narrative: Condition
Resource Condition "Condition-example-01"
Profile: Condition
code: Dental caries (SNOMED CT#80967001)
subject: Patient/example-01 ""
Generated Narrative: DocumentReference
Resource DocumentReference "DocumentReference-example-01"
Profile: DocumentReference
status: current
docStatus: final
subject: Patient/example-01 ""
content
Attachments
- ContentType Language Data Title Creation * application/pdf en-IN (base64 data - 80793 bytes) Adhar Card PDF 2019-05-29 14:58:58+0530