Bundle ClaimBundle-predeter-example-01 of type collection

Entry 1 - fullUrl = Claim/Claim-predeter-example-01

Resource Claim:

Generated Narrative: Claim

Resource Claim "Claim-predeter-example-01"

Profile: Claim

identifier: id: 7612345

status: ACTIVE

type: Management of health status after discharge from hospital (procedure) (SNOMED CT#710967003)

subType: Emergency Claim (Example Claim SubType Codes#emergency)

use: PREDETERMINATION

patient: See above (Patient/Patient-example-01)

created: 2023-09-07

insurer: See above (Organization/Organization-example-01)

provider: See above (Organization/Organization-example-01)

priority: Immediate (Process Priority Codes#stat)

Payees

-	Type
*	Provider (Payee Type Codes#provider)

Diagnoses

-	Sequence	Diagnosis[x]	Type
*	1	Type 2 diabetes mellitus : Without complications (ICD-10#E11.9)	Final diagnosis (discharge) (contextual qualifier) (qualifier value) (SNOMED CT#89100005)

Procedures

-	Sequence	Procedure[x]
*	1	Consultant (SNOMED CT#768839008)

Insurances

-	Sequence	Focal	Coverage	PreAuthRef
*	1	true	See above (Coverage/Coverage-example-01)	12S52

item

sequence: 1

careTeamSequence: 1

productOrService: Consultant (SNOMED CT#768839008)

serviced: 2023-09-07

UnitPrices

-	Value	Currency
*	500.00	INR

Nets

-	Value	Currency
*	500.00	INR

item

sequence: 2

careTeamSequence: 1

productOrService: Metformin hydrochloride 500 mg prolonged-release oral tablet (SNOMED CT#765507008)

serviced: 2023-09-07

UnitPrices

-	Value	Currency
*	910.28	INR

Nets

-	Value	Currency
*	910.28	INR

Entry 2 - fullUrl = Patient/Patient-example-01

Resource Patient:

Adarsh Agrawal Male, DoB: 1981-01-12 ( Adhaar number: 7225-4829-5255)

Entry 3 - fullUrl = Organization/Organization-example-01

Resource Organization:

Generated Narrative: Organization

Resource Organization "Organization-example-01"

Profile: Organization

identifier: Provider number: 4567878

type: Insurance Company (Organization type#ins)

name: XYZ Insurance Co. Ltd.

Contacts

-	Telecom
*	+91 243 2634 1234, contact@xyz.org

Entry 4 - fullUrl = Coverage/Coverage-example-01

Resource Coverage:

Generated Narrative: Coverage

Resource Coverage "Coverage-example-01"

Profile: Coverage

identifier: id: SP12345678

status: ACTIVE

type: PAY (Coverage SelfPay Codes#pay)

subscriber: See above (Patient/Patient-example-01)

beneficiary: See above (Patient/Patient-example-01)

relationship: Self (SubscriberPolicyholder Relationship Codes#self)

period: ?? --> 2026-03-17