Resource Claim "Claim-settlement-example-01"
Profile: Claim
identifier: id: 7612345
status: active
type: Inpatient care management (procedure) (SNOMED CT#737481003)
subType: Emergency Claim (Example Claim SubType Codes#emergency)
use: claim
patient: See above (Patient/Patient-example-01)
billablePeriod: 2023-12-09 11:01:00+0500 --> 2023-12-30 11:01:00+0500
created: 2023-12-30 11:01:00+0500
insurer: See above (Organization/Organization-example-01)
provider: See above (Organization/Organization-example-02)
priority: Normal (Process Priority Codes#normal)
- | Claim | Relationship |
* | See above (Claim/Claim-enhancement-example-01) | Settlement (Related Claim Relationship Code#settlement) |
prescription: See above (MedicationRequest/MedicationRequest-example-01)
- | Sequence | Provider | Role | Qualification |
* | 1 | See above (Practitioner/Practitioner-example-01) | Healthcare professional (occupation) (SNOMED CT#223366009) | Clinical specialty (qualifier value) (SNOMED CT#394658006) |
supportingInfo
sequence: 1
category: Document Type - Investigation (SupportingInfo Category#INV)
code: Angiography (SNOMED CT#77343006)
value: See above (DocumentReference/DocumentReference-example-01)
supportingInfo
sequence: 2
category: Document Type - Investigation (SupportingInfo Category#INV)
code: Angiography (SNOMED CT#77343006)
value: See above (DocumentReference/DocumentReference-example-02)
- | Sequence | Diagnosis[x] | Type |
* | 1 | Cardiac arrest, unspecified (ICD-10#I46.9) | Final diagnosis (discharge) (contextual qualifier) (qualifier value) (SNOMED CT#89100005) |
procedure
sequence: 1
procedure: Angiography (SNOMED CT#77343006)
procedure
sequence: 2
procedure: Angioplasty of blood vessel (SNOMED CT#418285008)
- | Sequence | Focal | Coverage | PreAuthRef |
* | 1 | true | See above (Coverage/Coverage-example-01) | 123456 |
item
sequence: 1
careTeamSequence: 1
productOrService: Angiography (SNOMED CT#77343006)
serviced: 2023-12-09
quantity: 2 Angiography
UnitPrices
- Value Currency * 10000.00 INR Nets
- Value Currency * 20000.00 INR
item
sequence: 2
careTeamSequence: 1
productOrService: Angioplasty of blood vessel (SNOMED CT#418285008)
UnitPrices
- Value Currency * 50000 INR Nets
- Value Currency * 50000 INR
item
sequence: 3
careTeamSequence: 1
productOrService: Intensive care unit (SNOMED CT#309904001)
serviced: 2023-12-11
quantity: 10 day
UnitPrices
- Value Currency * 2000 INR Nets
- Value Currency * 20000 INR
item
sequence: 4
careTeamSequence: 1
productOrService: Aspirin 75 mg oral tablet (SNOMED CT#319775004)
quantity: 10 tablet
UnitPrices
- Value Currency * 10 INR Nets
- Value Currency * 100 INR
- | Value | Currency |
* | 90100 | 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
Generated Narrative: Organization
Resource Organization "Organization-example-02"
Profile: Organization
identifier: Provider number: 45675454
type: Healthcare Provider (Organization type#prov)
name: XYZ Hospital Co. Ltd.
telecom: +91 243 2634 1278, contact@xyz.org
Generated Narrative: MedicationRequest
Resource MedicationRequest "MedicationRequest-example-01"
Profile: MedicationRequest
status: active
intent: order
medication: Aspirin 75 mg oral tablet (SNOMED CT#319775004)
subject: See above (Patient/Patient-example-01)
authoredOn: 2023-12-11
requester: See above (Practitioner/Practitioner-example-01)
reasonCode: Cardiac arrest (SNOMED CT#410429000)
reasonReference: See above (Condition/Condition-example-01)
- | Text | AdditionalInstruction | Timing | Route | Method |
* | One tablet at once | With or after food (SNOMED CT#311504000) | Once per 1 days | Oral Route (SNOMED CT#26643006) | Swallow (SNOMED CT#421521009) |
Generated Narrative: Practitioner
Resource Practitioner "Practitioner-example-01" Version "1" Updated "2023-09-07 14:58:58+0530"
Profile: Practitioner
identifier: Medical License number: 21-1521-3828-3227
name: Dr. Aayush Agrawal
Resource Coverage "Coverage-example-01"
Profile: Coverage
identifier: id: 235037120
status: active
type: PAY (Coverage SelfPay Codes#pay)
subscriber: See above (Patient/Patient-example-01)
subscriberId: ABC123456BI007
beneficiary: See above (Patient/Patient-example-01)
relationship: Self (SubscriberPolicyholder Relationship Codes#self)
period: ?? --> 2026-03-17
Generated Narrative: Condition
Resource Condition "Condition-example-01"
Profile: Condition
code: Cardiac arrest, unspecified (ICD-10#I46.9)
subject: See above (Patient/Patient-example-01)
onset: 1days
Resource Claim "Claim-enhancement-example-01"
Profile: Claim
identifier: id: 7612345
status: active
type: Inpatient care management (procedure) (SNOMED CT#737481003)
subType: Emergency Claim (Example Claim SubType Codes#emergency)
use: preauthorization
patient: See above (Patient/Patient-example-01)
billablePeriod: 2023-12-09 11:01:00+0500 --> 2023-12-30 11:01:00+0500
created: 2023-12-13 11:01:00+0500
insurer: See above (Organization/Organization-example-01)
provider: See above (Organization/Organization-example-02)
priority: Normal (Process Priority Codes#normal)
- | Claim | Relationship |
* | See above (Claim/Claim-preauth-example-01) | Enhancement (Related Claim Relationship Code#enhancement) |
- | Sequence | Provider | Role | Qualification |
* | 1 | See above (Practitioner/Practitioner-example-01) | Healthcare professional (occupation) (SNOMED CT#223366009) | Clinical specialty (qualifier value) (SNOMED CT#394658006) |
- | Sequence | Category | Code | Value[x] |
* | 1 | Document Type - Investigation (SupportingInfo Category#INV) | Angiography (SNOMED CT#77343006) | See above (DocumentReference/DocumentReference-example-02) |
- | Sequence | Diagnosis[x] | Type |
* | 1 | Cardiac arrest, unspecified (ICD-10#I46.9) | Final diagnosis (discharge) (contextual qualifier) (qualifier value) (SNOMED CT#89100005) |
procedure
sequence: 1
procedure: Angiography (SNOMED CT#77343006)
procedure
sequence: 2
procedure: Angioplasty of blood vessel (SNOMED CT#418285008)
- | Sequence | Focal | Coverage | PreAuthRef |
* | 1 | true | See above (Coverage/Coverage-example-01) | 123456 |
item
sequence: 1
careTeamSequence: 1
productOrService: Angiography (SNOMED CT#77343006)
serviced: 2023-12-09
UnitPrices
- Value Currency * 10000.00 INR Nets
- Value Currency * 10000.00 INR
item
sequence: 2
careTeamSequence: 1
productOrService: Angioplasty of blood vessel (SNOMED CT#418285008)
UnitPrices
- Value Currency * 10000 INR Nets
- Value Currency * 10000 INR
- | Value | Currency |
* | 20000 | INR |
Resource Claim "Claim-preauth-example-01"
Profile: Claim
identifier: id: 7612345
status: active
type: Inpatient care management (procedure) (SNOMED CT#737481003)
subType: Emergency Claim (Example Claim SubType Codes#emergency)
use: preauthorization
patient: See above (Patient/Patient-example-01)
billablePeriod: 2023-12-09 11:01:00+0500 --> 2023-12-30 11:01:00+0500
created: 2023-12-11 11:01:00+0500
insurer: See above (Organization/Organization-example-01)
provider: See above (Organization/Organization-example-02)
priority: Normal (Process Priority Codes#normal)
prescription: See above (MedicationRequest/MedicationRequest-example-01)
- | Sequence | Provider | Role | Qualification |
* | 1 | See above (Practitioner/Practitioner-example-01) | Healthcare professional (occupation) (SNOMED CT#223366009) | Clinical specialty (qualifier value) (SNOMED CT#394658006) |
- | Sequence | Category | Code | Value[x] |
* | 1 | Document Type - Investigation (SupportingInfo Category#INV) | Angiography (SNOMED CT#77343006) | See above (DocumentReference/DocumentReference-example-01) |
- | Sequence | Diagnosis[x] | Type |
* | 1 | Cardiac arrest, unspecified (ICD-10#I46.9) | Final diagnosis (discharge) (contextual qualifier) (qualifier value) (SNOMED CT#89100005) |
procedure
sequence: 1
procedure: Angiography (SNOMED CT#77343006)
procedure
sequence: 2
procedure: Angioplasty of blood vessel (SNOMED CT#418285008)
- | Sequence | Focal | Coverage | PreAuthRef |
* | 1 | true | See above (Coverage/Coverage-example-01) | 123456 |
item
sequence: 1
careTeamSequence: 1
productOrService: Angiography (SNOMED CT#77343006)
serviced: 2023-12-09
UnitPrices
- Value Currency * 10000.00 INR Nets
- Value Currency * 10000.00 INR
item
sequence: 2
careTeamSequence: 1
productOrService: Angioplasty of blood vessel (SNOMED CT#418285008)
UnitPrices
- Value Currency * 40000 INR Nets
- Value Currency * 40000 INR
item
sequence: 3
careTeamSequence: 1
productOrService: Intensive care unit (SNOMED CT#309904001)
serviced: 2023-12-11
quantity: 10 day
UnitPrices
- Value Currency * 2000 INR Nets
- Value Currency * 20000 INR
item
sequence: 4
careTeamSequence: 1
productOrService: Aspirin 75 mg oral tablet (SNOMED CT#319775004)
UnitPrices
- Value Currency * 100 INR Nets
- Value Currency * 100 INR
- | Value | Currency |
* | 70100 | INR |
Generated Narrative: DocumentReference
Resource DocumentReference "DocumentReference-example-01"
Profile: DocumentReference
status: current
docStatus: final
subject: See above (Patient/Patient-example-01)
content
Attachments
- ContentType Language Data Title Creation * application/pdf en-IN (base64 data - 80793 bytes) Adhar Card PDF 2019-05-29 14:58:58+0530
Generated Narrative: DocumentReference
Resource DocumentReference "DocumentReference-example-02"
Profile: DocumentReference
status: current
docStatus: final
subject: See above (Patient/Patient-example-01)
content
Attachments
- ContentType Language Data Title Creation * application/pdf en-IN (base64 data - 80793 bytes) Adhar Card PDF 2019-05-29 14:58:58+0530