Bundle TaskBundleForReprocessResponse-example-01 of type collection

Entry 1 - fullUrl = Task/Task-example-01

Resource Task:

Generated Narrative: Task

Resource Task "Task-example-01"

Profile: Task

status: COMPLETED

intent: ORDER

code: Activate/approve the focal resource (Task Codes#approve)

description: Start processing of Claim No. - 761234674365

authoredOn: 2023-12-08 08:25:05+1000

requester: See above (Organization/Organization-example-01)

owner: See above (Organization/Organization-example-02)

Outputs

-	Type	Value[x]
*	Original Response (Financial Task Input Type Codes#origresponse)	See above (ClaimResponse/ClaimResponse-settlement-example-01)

Entry 2 - fullUrl = ClaimResponse/ClaimResponse-settlement-example-01

Resource ClaimResponse:

Generated Narrative: ClaimResponse

Resource ClaimResponse "ClaimResponse-settlement-example-01"

Profile: ClaimResponse

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)

created: 2023-12-30 15:32:26+0530

insurer: See above (Organization/Organization-example-01)

requestor: See above (Organization/Organization-example-02)

request: See above (Claim/Claim-settlement-example-01)

outcome: COMPLETE

disposition: The claim will be processed within 30 days of this notice.

preAuthRef: 123456

payeeType: Provider (Payee Type Codes#provider)

addItem

itemSequence: 1

productOrService: Angiography (SNOMED CT#77343006)

quantity: 2 Angiography

Nets

-	Value	Currency
*	20000.00	INR

adjudication

addItem

itemSequence: 2

productOrService: Angioplasty of blood vessel (SNOMED CT#418285008)

Nets

-	Value	Currency
*	50000	INR

adjudication

addItem

itemSequence: 3

productOrService: Intensive care unit (SNOMED CT#309904001)

quantity: 10 day

UnitPrices

-	Value	Currency
*	2000	INR

Nets

-	Value	Currency
*	20000	INR

adjudication

addItem

itemSequence: 4

productOrService: Aspirin 75 mg oral tablet (SNOMED CT#319775004)

UnitPrices

-	Value	Currency
*	100	INR

Nets

-	Value	Currency
*	100	INR

adjudication

total

category: Submitted Amount (Adjudication Value Codes#submitted)

Amounts

-	Value	Currency
*	90100	INR

Insurances

-	Sequence	Focal	Coverage
*	1	true	See above (Coverage/Coverage-example-01)

Entry 3 - fullUrl = Claim/Claim-settlement-example-01

Resource Claim:

Generated Narrative: Claim

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)

Relateds

-	Claim	Relationship
*	See above (Claim/Claim-enhancement-example-01)	Settlement (Related Claim Relationship Code#settlement)

prescription: See above (MedicationRequest/MedicationRequest-example-01)

CareTeams

-	Sequence	Provider	Role
*	1	See above (Practitioner/Practitioner-example-01)	Healthcare professional (occupation) (SNOMED CT#223366009)

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)

Diagnoses

-	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)

Insurances

-	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

Totals

-	Value	Currency
*	90100	INR

Entry 4 - fullUrl = Patient/Patient-example-01

Resource Patient:

Adarsh Agrawal Male, DoB: 1981-01-12 ( Adhaar number: 7225-4829-5255)

Entry 5 - fullUrl = Organization/Organization-example-01

Resource Organization:

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.

Contacts

-	Telecom
*	+91 243 2634 1234, contact@xyz.org

Entry 6 - fullUrl = Organization/Organization-example-02

Resource Organization:

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.

Contacts

-	Telecom
*	+91 243 2634 1278, contact@xyz.org

Entry 7 - fullUrl = MedicationRequest/MedicationRequest-example-01

Resource MedicationRequest:

Generated Narrative: MedicationRequest

Resource MedicationRequest "MedicationRequest-example-01"

Profile: MedicationRequest

status: ACTIVE

intent: ORDER

subject: See above (Patient/Patient-example-01)

authoredOn: 2023-12-11

requester: See above (Practitioner/Practitioner-example-01)

DosageInstructions

-	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)

Entry 8 - fullUrl = Practitioner/Practitioner-example-01

Resource Practitioner:

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

Entry 9 - fullUrl = Coverage/Coverage-example-01

Resource Coverage:

Generated Narrative: Coverage

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: id: ABC123456BI007

beneficiary: See above (Patient/Patient-example-01)

relationship: Self (SubscriberPolicyholder Relationship Codes#self)

period: ?? --> 2026-03-17

Entry 10 - fullUrl = Condition/Condition-example-01

Resource Condition:

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

Entry 11 - fullUrl = Claim/Claim-enhancement-example-01

Resource Claim:

Generated Narrative: Claim

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)

Relateds

-	Claim	Relationship
*	See above (Claim/Claim-preauth-example-01)	Enhancement (Related Claim Relationship Code#enhancement)

CareTeams

-	Sequence	Provider	Role
*	1	See above (Practitioner/Practitioner-example-01)	Healthcare professional (occupation) (SNOMED CT#223366009)

SupportingInfos

-	Sequence	Category	Code	Value[x]
*	1	Document Type - Investigation (SupportingInfo Category#INV)	Angiography (SNOMED CT#77343006)	See above (DocumentReference/DocumentReference-example-02)

Diagnoses

-	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)

Insurances

-	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

Totals

-	Value	Currency
*	20000	INR

Entry 12 - fullUrl = Claim/Claim-preauth-example-01

Resource Claim:

Generated Narrative: Claim

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)

CareTeams

-	Sequence	Provider	Role
*	1	See above (Practitioner/Practitioner-example-01)	Healthcare professional (occupation) (SNOMED CT#223366009)

SupportingInfos

-	Sequence	Category	Code	Value[x]
*	1	Document Type - Investigation (SupportingInfo Category#INV)	Angiography (SNOMED CT#77343006)	See above (DocumentReference/DocumentReference-example-01)

Diagnoses

-	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)

Insurances

-	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

Totals

-	Value	Currency
*	70100	INR

Entry 13 - fullUrl = DocumentReference/DocumentReference-example-01

Resource DocumentReference:

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)	Angeography pdf	2019-05-29 14:58:58+0530

Entry 14 - fullUrl = DocumentReference/DocumentReference-example-02

Resource DocumentReference:

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)	Angeography pdf	2019-05-29 14:58:58+0530