FHIR Implementation Guide for ABDM
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FHIR Implementation Guide for ABDM - Local Development build (v4.0.0). See the Directory of published versions

: Claim/predeter-example-01 - XML Representation

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<Claim xmlns="http://hl7.org/fhir">
  <id value="predeter-example-01"/>
  <meta>
    <profile value="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Claim</b><a name="predeter-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 &quot;predeter-example-01&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-Claim.html">Claim</a></p></div><p><b>identifier</b>: id: 7612345</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>: predetermination</p><p><b>patient</b>: <a href="Patient-example-01.html">Patient/example-01</a> &quot;&quot;</p><p><b>created</b>: 2023-09-07</p><p><b>insurer</b>: <a href="Organization-example-02.html">Organization/example-02</a> &quot;XYZ Insurance Co. Ltd.&quot;</p><p><b>provider</b>: <a href="Organization-example-02.html">Organization/example-02</a> &quot;XYZ Insurance Co. Ltd.&quot;</p><p><b>priority</b>: Immediate <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>#stat)</span></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>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>
  </text>
  <identifier>
    <system value="https://irdai.gov.in"/>
    <value value="7612345"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="710967003"/>
      <display
               value="Management of health status after discharge from hospital (procedure)"/>
    </coding>
  </type>
  <subType>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/ex-claimsubtype"/>
      <code value="emergency"/>
      <display value="Emergency Claim"/>
    </coding>
  </subType>
  <use value="predetermination"/>
  <patient>
    <reference value="Patient/example-01"/>
  </patient>
  <created value="2023-09-07"/>
  <insurer>
    <reference value="Organization/example-02"/>
  </insurer>
  <provider>
    <reference value="Organization/example-02"/>
  </provider>
  <priority>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
      <code value="stat"/>
      <display value="Immediate"/>
    </coding>
  </priority>
  <payee>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/payeetype"/>
        <code value="provider"/>
        <display value="Provider"/>
      </coding>
    </type>
  </payee>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <system value="http://hl7.org/fhir/sid/icd-10"/>
        <code value="E11.9"/>
        <display value="Type 2 diabetes mellitus : Without complications"/>
      </coding>
    </diagnosisCodeableConcept>
    <type>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="89100005"/>
        <display
                 value="Final diagnosis (discharge) (contextual qualifier) (qualifier value)"/>
      </coding>
    </type>
  </diagnosis>
  <procedure>
    <sequence value="1"/>
    <procedureCodeableConcept>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="768839008"/>
        <display value="Consultant"/>
      </coding>
    </procedureCodeableConcept>
  </procedure>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/example-01"/>
    </coverage>
    <preAuthRef value="12S52"/>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamSequence value="1"/>
    <productOrService>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="768839008"/>
        <display value="Consultant"/>
      </coding>
    </productOrService>
    <servicedDate value="2023-09-07"/>
    <unitPrice>
      <value value="500.00"/>
      <currency value="INR"/>
    </unitPrice>
    <net>
      <value value="500.00"/>
      <currency value="INR"/>
    </net>
  </item>
  <item>
    <sequence value="2"/>
    <careTeamSequence value="1"/>
    <productOrService>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="765507008"/>
        <display
                 value="Metformin hydrochloride 500 mg prolonged-release oral tablet"/>
      </coding>
    </productOrService>
    <servicedDate value="2023-09-07"/>
    <unitPrice>
      <value value="910.28"/>
      <currency value="INR"/>
    </unitPrice>
    <net>
      <value value="910.28"/>
      <currency value="INR"/>
    </net>
  </item>
</Claim>