FHIR Implementation Guide for ABDM
4.0.0 - active
FHIR Implementation Guide for ABDM
4.0.0 - active
FHIR Implementation Guide for ABDM - Local Development build (v4.0.0). See the Directory of published versions
{
"resourceType" : "Claim",
"id" : "preauth-example-01",
"meta" : {
"profile" : [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Claim</b><a name=\"preauth-example-01\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Claim "preauth-example-01" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-Claim.html\">Claim</a></p></div><p><b>identifier</b>: id:\u00a07612345</p><p><b>status</b>: active</p><p><b>type</b>: Management of health status after discharge from hospital (procedure) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#710967003)</span></p><p><b>subType</b>: Emergency Claim <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-ex-claimsubtype.html\">Example Claim SubType Codes</a>#emergency)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"Patient-example-01.html\">Patient/example-01</a> ""</p><p><b>created</b>: 2023-09-07 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Organization-example-02.html\">Organization/example-02</a> "XYZ Insurance Co. Ltd."</p><p><b>provider</b>: <a href=\"Organization-example-02.html\">Organization/example-02</a> "XYZ Insurance Co. Ltd."</p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><p><b>prescription</b>: <a href=\"MedicationRequest-example-02.html\">MedicationRequest/example-02</a></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-payeetype.html\">Payee Type Codes</a>#provider)</span></td></tr></table><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td><td><b>Role</b></td><td><b>Qualification</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Practitioner-example-01.html\">Practitioner/example-01</a> ""</td><td>Consultant <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#768839008)</span></td><td>Clinical specialty (qualifier value) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#394658006)</span></td></tr></table><h3>SupportingInfos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>proof of identity <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndhm-supportinginfo-category.html\">SupportingInfo Category</a>#POI)</span></td><td>Adhaar number <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndhm-identifier-type-code.html\">Identifier Type Code</a>#ADN)</span></td><td><a href=\"DocumentReference-example-02.html\">DocumentReference/example-02</a></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>Type 2 diabetes mellitus : Without complications <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-icd10.html\">ICD-10</a>#E11.9)</span></td><td>Final diagnosis (discharge) (contextual qualifier) (qualifier value) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#89100005)</span></td></tr></table><h3>Procedures</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Procedure[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>Consultant <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#768839008)</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td><td><b>PreAuthRef</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-example-01.html\">Coverage/example-01</a></td><td>12S52</td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: Consultant <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#768839008)</span></p><p><b>serviced</b>: 2023-09-07</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>500.00</td><td>INR</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>500.00</td><td>INR</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 2</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: Metformin hydrochloride 500 mg prolonged-release oral tablet <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#765507008)</span></p><p><b>serviced</b>: 2023-09-07</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>910.28</td><td>INR</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>910.28</td><td>INR</td></tr></table></blockquote></div>"
},
"identifier" : [
{
"system" : "https://irdai.gov.in",
"value" : "7612345"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "710967003",
"display" : "Management of health status after discharge from hospital (procedure)"
}
]
},
"subType" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-claimsubtype",
"code" : "emergency"
}
]
},
"use" : "preauthorization",
"patient" : {
"reference" : "Patient/example-01"
},
"created" : "2023-09-07T11:01:00+05:00",
"insurer" : {
"reference" : "Organization/example-02"
},
"provider" : {
"reference" : "Organization/example-02"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "normal"
}
]
},
"prescription" : {
"reference" : "MedicationRequest/example-02"
},
"payee" : {
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/payeetype",
"code" : "provider",
"display" : "Provider"
}
]
}
},
"careTeam" : [
{
"sequence" : 1,
"provider" : {
"reference" : "Practitioner/example-01"
},
"role" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "768839008",
"display" : "Consultant"
}
]
},
"qualification" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "394658006",
"display" : "Clinical specialty (qualifier value)"
}
]
}
}
],
"supportingInfo" : [
{
"sequence" : 1,
"category" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category",
"code" : "POI",
"display" : "proof of identity"
}
]
},
"code" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code",
"code" : "ADN",
"display" : "Adhaar number"
}
]
},
"valueReference" : {
"reference" : "DocumentReference/example-02"
}
}
],
"diagnosis" : [
{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/icd-10",
"code" : "E11.9",
"display" : "Type 2 diabetes mellitus : Without complications"
}
]
},
"type" : [
{
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "89100005",
"display" : "Final diagnosis (discharge) (contextual qualifier) (qualifier value)"
}
]
}
]
}
],
"procedure" : [
{
"sequence" : 1,
"procedureCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "768839008",
"display" : "Consultant"
}
]
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "Coverage/example-01"
},
"preAuthRef" : [
"12S52"
]
}
],
"item" : [
{
"sequence" : 1,
"careTeamSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "768839008",
"display" : "Consultant"
}
]
},
"servicedDate" : "2023-09-07",
"unitPrice" : {
"value" : 500.00,
"currency" : "INR"
},
"net" : {
"value" : 500.00,
"currency" : "INR"
}
},
{
"sequence" : 2,
"careTeamSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "765507008",
"display" : "Metformin hydrochloride 500 mg prolonged-release oral tablet"
}
]
},
"servicedDate" : "2023-09-07",
"unitPrice" : {
"value" : 910.28,
"currency" : "INR"
},
"net" : {
"value" : 910.28,
"currency" : "INR"
}
}
]
}
IG © 2020+ National Resource Center for EHR Standards. Package ndhm.in#4.0.0 based on FHIR 4.0.1. Generated 2023-11-06
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