Generated Narrative: ClaimResponse
Resource ClaimResponse "example-01"
Profile: ClaimResponse
status: active
type: Oral (Claim Type Codes#oral)
use: preauthorization
patient: See above (Patient/Patient-example-01)
created: 2022-12-20 15:32:26+0530
insurer: See above (Organization/Organization-example-01)
requestor: See above (Organization/Organization-example-01)
request: See above (Claim/preauth-example-01)
outcome: complete
disposition: The enclosed services are authorized for your provision within 30 days of this notice.
preAuthRef: 18SS12345
payeeType: Provider (Claim Payee Type Codes#provider)
addItem
itemSequence: 1
productOrService: Dengue (SNOMED CT#38362002)
programCode: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) (Program Code#AB-PMJAY)
Nets
- Value Currency * 25000 INR adjudication
category: eligible ([not stated]#eligible)
amount
₹25,000.00 (INR)
addItem
itemSequence: 2
productOrService: Chronic diarrhea (SNOMED CT#236071009)
programCode: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) (Program Code#AB-PMJAY)
Nets
- Value Currency * 15000 INR adjudication
category: eligible ([not stated]#eligible)
amount
₹15,000.00 (INR)
- | Number | Type | Text | Language |
* | 101 | Please submit a Pre-Authorization request if a more extensive examination or urgent services are required. | English (Region=India) (Tags for the Identification of Languages#en-IN) |
- | Sequence | Focal | Coverage |
* | 1 | true | See above (Coverage/Coverage-example-01) |
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 Claim "preauth-example-01"
Profile: Claim
identifier: id: 7612345
status: active
type: Professional (Claim Type Codes#professional)
use: preauthorization
patient: Patient/example-01 ""
created: 2022-07-20 11:01:00+0500
insurer: See above (Organization/Organization-example-02)
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) | DocumentReference/example-01 |
diagnosis
sequence: 1
diagnosis: Condition/example-01
type: Clinical Diagnosis (Example Diagnosis Type Codes#clinical)
diagnosis
sequence: 2
diagnosis: See above (Condition/Condition-example-02)
type: Clinical Diagnosis (Example Diagnosis Type Codes#clinical)
- | Sequence | Focal | Coverage | PreAuthRef |
* | 1 | true | Coverage/example-01 | 12S52 |
item
sequence: 1
category: Medical care (SNOMED CT#781087000)
productOrService: Dengue (SNOMED CT#38362002)
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
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: 2022-12-01 --> 2025-03-17
payor: Organization/example-01 "XYZ Lab Pvt.Ltd."
Generated Narrative: Condition
Resource Condition "Condition-example-01"
code: Dengue (disorder) (SNOMED CT#38362002)
subject: Patient/example-01 ""
Generated Narrative: Condition
Resource Condition "Condition-example-02"
code: Chronic diarrhea of unknown origin (disorder) (SNOMED CT#17551007)
subject: Patient/example-01 ""