FHIR Implementation Guide for ABDM
3.1.0 - active
FHIR Implementation Guide for ABDM
3.1.0 - active
FHIR Implementation Guide for ABDM - Local Development build (v3.1.0). See the Directory of published versions
Generated Narrative: ClaimResponse
Resource ClaimResponse "example-01"
Profile: ClaimResponse
identifier: id: R3500
status: active
type: Oral (Claim Type Codes#oral)
subType: Emergency Claim (Example Claim SubType Codes#emergency)
use: claim
patient: Patient/example-01 ""
created: 2014-08-16
insurer: id: 555123
requestor: Organization/example-01 "XYZ Lab Pvt.Ltd."
request: Claim/example-01
outcome: complete
disposition: Claim settled as per contract.
payeeType: Provider (Claim Payee Type Codes#provider)
item
itemSequence: 1
adjudication
category: Eligible Amount (Adjudication Value Codes#eligible)
reason: Not covered (Adjudication Reason Codes#ar001)
Amounts
Value Currency 135.57 INR adjudication
category: CoPay (Adjudication Value Codes#copay)
reason: Not covered (Adjudication Reason Codes#ar001)
Amounts
Value Currency 10.00 INR adjudication
category: Eligible % (Adjudication Value Codes#eligpercent)
reason: Not covered (Adjudication Reason Codes#ar001)
value: 80.00
adjudication
category: benefit ([not stated]#benefit)
reason: Plan Limit Reached (Adjudication Reason Codes#ar002)
Amounts
Value Currency 90.47 INR
total
category: Submitted Amount (Adjudication Value Codes#submitted)
Amounts
Value Currency 135.57 INR
total
category: Benefit Amount (Adjudication Value Codes#benefit)
Amounts
Value Currency 90.47 INR
payment
type: Complete (Example Payment Type Codes#complete)
date: 2014-08-31
Amounts
Value Currency 100.47 INR identifier: id: 201408-2-1569478