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)
- | Type |
* | Provider (Payee Type Codes#provider) |
- | 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) |
- | Sequence | Procedure[x] |
* | 1 | Consultant (SNOMED CT#768839008) |
- | 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
Resource Patient "Patient-example-01" Version "1" Updated "2023-09-07 14:58:58+0530"
Profile: Patient
identifier: Adhaar number: 7225-4829-5255
name: Adarsh Agrawal
telecom: +919818512600
gender: male
birthDate: 1981-01-12
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.
telecom: +91 243 2634 1234, contact@xyz.org
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