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

Example ClaimResponse: ClaimResponse/predeter-example-01

Generated Narrative: ClaimResponse

Resource ClaimResponse "predeter-example-01"

Profile: ClaimResponse

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: Patient/example-01 ""

created: 2023-09-07 15:32:26+0530

insurer: Organization/example-02 "XYZ Insurance Co. Ltd."

requestor: Practitioner/example-01 ""

request: Claim/predeter-example-01

outcome: complete

payeeType: Provider (Payee Type Codes#provider)

addItem

itemSequence: 1

productOrService: Consultant (SNOMED CT#768839008)

Nets

-ValueCurrency
*500.00INR

adjudication

category: Eligible Amount (Adjudication Value Codes#eligible)

reason: Covered (SNOMED CT#255334000)

amount

₹500.00 (INR)

addItem

itemSequence: 2

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

Nets

-ValueCurrency
*910.28INR

adjudication

category: Eligible Amount (Adjudication Value Codes#eligible)

reason: Covered (SNOMED CT#255334000)

amount

₹910.28 (INR)

total

category: Submitted Amount (Adjudication Value Codes#submitted)

Amounts

-ValueCurrency
*1410.28INR

Insurances

-SequenceFocalCoverage
*1trueCoverage/example-01