TaskBundleForReprocessResponse-example-01
type: Bundle
node role: treeRoot
id:
  v: TaskBundleForReprocessResponse-example-01
meta:
  version id:
    v: 1
  last updated:
    v: 2023-09-07T15:32:26.605+05:30
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/TaskBundle
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/TaskBundle
  security:
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-Confidentiality
    code:
      v: V
    display:
      v: very restricted
identifier:
  system:
    v: http://hip.in
type:
  v: collection
timestamp:
  v: 2023-09-07T15:32:26.605+05:30
entry:
  full url:
    v: Task/Task-example-01
  resource: Task-example-01
entry:
  full url:
    v: ClaimResponse/ClaimResponse-settlement-example-01
  resource: ClaimResponse-settlement-example-01
entry:
  full url:
    v: Claim/Claim-settlement-example-01
  resource: Claim-settlement-example-01
entry:
  full url:
    v: Patient/Patient-example-01
  resource: Patient-example-01
entry:
  full url:
    v: Organization/Organization-example-01
  resource: Organization-example-01
entry:
  full url:
    v: Organization/Organization-example-02
  resource: Organization-example-02
entry:
  full url:
    v: MedicationRequest/MedicationRequest-example-01
  resource: MedicationRequest-example-01
entry:
  full url:
    v: Practitioner/Practitioner-example-01
  resource: Practitioner-example-01
entry:
  full url:
    v: Coverage/Coverage-example-01
  resource: Coverage-example-01
entry:
  full url:
    v: Condition/Condition-example-01
  resource: Condition-example-01
entry:
  full url:
    v: Claim/Claim-enhancement-example-01
  resource: Claim-enhancement-example-01
entry:
  full url:
    v: Claim/Claim-preauth-example-01
  resource: Claim-preauth-example-01
entry:
  full url:
    v: DocumentReference/DocumentReference-example-01
  resource: DocumentReference-example-01
entry:
  full url:
    v: DocumentReference/DocumentReference-example-02
  resource: DocumentReference-example-02

Task-example-01
type: Task
id:
  v: Task-example-01
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Task
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Task
text:
  status:
    v: generated
  div: 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)
status:
  v: completed
intent:
  v: order
code:
  coding:
    system:
      v: http://hl7.org/fhir/CodeSystem/task-code
    code:
      v: approve
description:
  v: Start processing of Claim No. - 761234674365
authored on:
  v: 2023-12-08T08:25:05+10:00
requester:
  link: https://nrces.in/ndhm/fhir/r4/Organization/Organization-example-01
  reference:
    v: Organization/Organization-example-01
owner:
  link: https://nrces.in/ndhm/fhir/r4/Organization/Organization-example-02
  reference:
    v: Organization/Organization-example-02
output:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/financialtaskinputtype
      code:
        v: origresponse
  value: Reference
    link: https://nrces.in/ndhm/fhir/r4/ClaimResponse/ClaimResponse-settlement-example-01
    reference:
      v: ClaimResponse/ClaimResponse-settlement-example-01

ClaimResponse-settlement-example-01
type: ClaimResponse
id:
  v: ClaimResponse-settlement-example-01
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse
text:
  status:
    v: generated
  div: 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 category: Eligible Amount (Adjudication Value Codes#eligible) reason: Covered (SNOMED CT#255334000) amount ₹20,000.00 (INR) addItem itemSequence: 2 productOrService: Angioplasty of blood vessel (SNOMED CT#418285008) Nets - Value Currency * 50000 INR adjudication category: Eligible Amount (Adjudication Value Codes#eligible) reason: Covered (SNOMED CT#255334000) amount ₹50,000.00 (INR) addItem itemSequence: 3 productOrService: Intensive care unit (SNOMED CT#309904001) quantity: 10 day UnitPrices - Value Currency * 2000 INR Nets - Value Currency * 20000 INR adjudication category: Eligible Amount (Adjudication Value Codes#eligible) reason: Covered (SNOMED CT#255334000) amount ₹20,000.00 (INR) addItem itemSequence: 4 productOrService: Aspirin 75 mg oral tablet (SNOMED CT#319775004) UnitPrices - Value Currency * 100 INR Nets - Value Currency * 100 INR adjudication category: Eligible Amount (Adjudication Value Codes#eligible) reason: Covered (SNOMED CT#255334000) amount ₹100.00 (INR) total category: Submitted Amount (Adjudication Value Codes#submitted) Amounts - Value Currency * 90100 INR Insurances - Sequence Focal Coverage * 1 true See above (Coverag…
status:
  v: active
type:
  coding: http://snomed.info/id/737481003
    system:
      v: http://snomed.info/sct
    code:
      v: 737481003
    display:
      v: Inpatient care management (procedure)
sub type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/ex-claimsubtype
    code:
      v: emergency
use:
  v: claim
patient:
  link: https://nrces.in/ndhm/fhir/r4/Patient/Patient-example-01
  reference:
    v: Patient/Patient-example-01
created:
  v: 2023-12-30T15:32:26.605+05:30
insurer:
  link: https://nrces.in/ndhm/fhir/r4/Organization/Organization-example-01
  reference:
    v: Organization/Organization-example-01
requestor:
  link: https://nrces.in/ndhm/fhir/r4/Organization/Organization-example-02
  reference:
    v: Organization/Organization-example-02
request:
  link: https://nrces.in/ndhm/fhir/r4/Claim/Claim-settlement-example-01
  reference:
    v: Claim/Claim-settlement-example-01
outcome:
  v: complete
disposition:
  v: The claim will be processed within 30 days of this notice.
pre auth ref:
  v: 123456
payee type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/payeetype
    code:
      v: provider
add item:
  item sequence:
    v: 1
  product or service:
    coding: http://snomed.info/id/77343006
      system:
        v: http://snomed.info/sct
      code:
        v: 77343006
      display:
        v: Angiography
  quantity:
    value:
      v: 2
    unit:
      v: Angiography
  net:
    value:
      v: 20000.00
    currency:
      v: INR
  adjudication:
    reason:
      coding: http://snomed.info/id/255334000
    amount:
      value:
        v: 20000.00
      currency:
        v: INR
add item:
  item sequence:
    v: 2
  product or service:
    coding: http://snomed.info/id/418285008
      system:
        v: http://snomed.info/sct
      code:
        v: 418285008
      display:
        v: Angioplasty of blood vessel
  net:
    value:
      v: 50000
    currency:
      v: INR
  adjudication:
    reason:
      coding: http://snomed.info/id/255334000
    amount:
      value:
        v: 50000
      currency:
        v: INR
add item:
  item sequence:
    v: 3
  product or service:
    coding: http://snomed.info/id/309904001
      system:
        v: http://snomed.info/sct
      code:
        v: 309904001
      display:
        v: Intensive care unit
  quantity:
    value:
      v: 10
    unit:
      v: day
  unit price:
    value:
      v: 2000
    currency:
      v: INR
  net:
    value:
      v: 20000
    currency:
      v: INR
  adjudication:
    reason:
      coding: http://snomed.info/id/255334000
    amount:
      value:
        v: 20000
      currency:
        v: INR
add item:
  item sequence:
    v: 4
  product or service:
    coding: http://snomed.info/id/319775004
      system:
        v: http://snomed.info/sct
      code:
        v: 319775004
      display:
        v: Aspirin 75 mg oral tablet
  unit price:
    value:
      v: 100
    currency:
      v: INR
  net:
    value:
      v: 100
    currency:
      v: INR
  adjudication:
    reason:
      coding: http://snomed.info/id/255334000
    amount:
      value:
        v: 100
      currency:
        v: INR
total:
  category:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/adjudication
      code:
        v: submitted
  amount:
    value:
      v: 90100
    currency:
      v: INR
insurance:
  sequence:
    v: 1
  focal:
    v: true
  coverage:
    link: https://nrces.in/ndhm/fhir/r4/Coverage/Coverage-example-01
    reference:
      v: Coverage/Coverage-example-01

Claim-settlement-example-01
type: Claim
id:
  v: Claim-settlement-example-01
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim
text:
  status:
    v: generated
  div: 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 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) 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 …
identifier:
  system:
    v: https://irdai.gov.in
  value:
    v: 7612345
status:
  v: active
type:
  coding: http://snomed.info/id/737481003
    system:
      v: http://snomed.info/sct
    code:
      v: 737481003
    display:
      v: Inpatient care management (procedure)
sub type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/ex-claimsubtype
    code:
      v: emergency
use:
  v: claim
patient:
  link: https://nrces.in/ndhm/fhir/r4/Patient/Patient-example-01
  reference:
    v: Patient/Patient-example-01
billable period:
  start:
    v: 2023-12-09T11:01:00+05:00
  end:
    v: 2023-12-30T11:01:00+05:00
created:
  v: 2023-12-30T11:01:00+05:00
insurer:
  link: https://nrces.in/ndhm/fhir/r4/Organization/Organization-example-01
  reference:
    v: Organization/Organization-example-01
provider:
  link: https://nrces.in/ndhm/fhir/r4/Organization/Organization-example-02
  reference:
    v: Organization/Organization-example-02
priority:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/processpriority
    code:
      v: normal
related:
  claim:
    link: https://nrces.in/ndhm/fhir/r4/Claim/Claim-enhancement-example-01
    reference:
      v: Claim/Claim-enhancement-example-01
  relationship:
    coding:
      system:
        v: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-related-claim-relationship-code
      code:
        v: settlement
      display:
        v: Settlement
prescription:
  link: https://nrces.in/ndhm/fhir/r4/MedicationRequest/MedicationRequest-example-01
  reference:
    v: MedicationRequest/MedicationRequest-example-01
care team:
  sequence:
    v: 1
  provider:
    link: https://nrces.in/ndhm/fhir/r4/Practitioner/Practitioner-example-01
    reference:
      v: Practitioner/Practitioner-example-01
  role:
    coding: http://snomed.info/id/223366009
      system:
        v: http://snomed.info/sct
      code:
        v: 223366009
      display:
        v: Healthcare professional (occupation)
  qualification:
    coding: http://snomed.info/id/394658006
      system:
        v: http://snomed.info/sct
      code:
        v: 394658006
      display:
        v: Clinical specialty (qualifier value)
supporting info:
  sequence:
    v: 1
  category:
    coding:
      system:
        v: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category
      code:
        v: INV
      display:
        v: Document Type - Investigation
  code:
    coding: http://snomed.info/id/77343006
      system:
        v: http://snomed.info/sct
      code:
        v: 77343006
      display:
        v: Angiography
  value: Reference
    link: https://nrces.in/ndhm/fhir/r4/DocumentReference/DocumentReference-example-01
    reference:
      v: DocumentReference/DocumentReference-example-01
supporting info:
  sequence:
    v: 2
  category:
    coding:
      system:
        v: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category
      code:
        v: INV
      display:
        v: Document Type - Investigation
  code:
    coding: http://snomed.info/id/77343006
      system:
        v: http://snomed.info/sct
      code:
        v: 77343006
      display:
        v: Angiography
  value: Reference
    link: https://nrces.in/ndhm/fhir/r4/DocumentReference/DocumentReference-example-02
    reference:
      v: DocumentReference/DocumentReference-example-02
diagnosis:
  sequence:
    v: 1
  diagnosis: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/sid/icd-10
      code:
        v: I46.9
      display:
        v: Cardiac arrest, unspecified
  type:
    coding: http://snomed.info/id/89100005
      system:
        v: http://snomed.info/sct
      code:
        v: 89100005
      display:
        v: Final diagnosis (discharge) (contextual qualifier) (qualifier value)
procedure:
  sequence:
    v: 1
  procedure: CodeableConcept
    coding: http://snomed.info/id/77343006
      system:
        v: http://snomed.info/sct
      code:
        v: 77343006
      display:
        v: Angiography
procedure:
  sequence:
    v: 2
  procedure: CodeableConcept
    coding: http://snomed.info/id/418285008
      system:
        v: http://snomed.info/sct
      code:
        v: 418285008
      display:
        v: Angioplasty of blood vessel
insurance:
  sequence:
    v: 1
  focal:
    v: true
  coverage:
    link: https://nrces.in/ndhm/fhir/r4/Coverage/Coverage-example-01
    reference:
      v: Coverage/Coverage-example-01
  pre auth ref:
    v: 123456
item:
  sequence:
    v: 1
  care team sequence:
    v: 1

Patient-example-01
type: Patient
id:
  v: Patient-example-01
meta:
  version id:
    v: 1
  last updated:
    v: 2023-09-07T14:58:58.181+05:30
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient
text:
  status:
    v: generated
  div: Generated Narrative: Patient 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
identifier:
  type:
    coding:
      system:
        v: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code
      code:
        v: ADN
      display:
        v: Adhaar number
  system:
    v: https://uidai.gov.in/
  value:
    v: 7225-4829-5255
name:
  text:
    v: Adarsh Agrawal
telecom:
  system:
    v: phone
  value:
    v: +919818512600
  use:
    v: home
gender:
  v: male
birth date:
  v: 1981-01-12

Organization-example-01
type: Organization
id:
  v: Organization-example-01
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization
text:
  status:
    v: generated
  div: 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
identifier:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0203
      code:
        v: PRN
      display:
        v: Provider number
  system:
    v: https://facility.ndhm.gov.in
  value:
    v: 4567878
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/organization-type
    code:
      v: ins
    display:
      v: Insurance Company
name:
  v: XYZ Insurance Co. Ltd.
telecom:
  system:
    v: phone
  value:
    v: +91 243 2634 1234
  use:
    v: work
telecom:
  system:
    v: email
  use:
    v: work

Organization-example-02
type: Organization
id:
  v: Organization-example-02
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization
text:
  status:
    v: generated
  div: 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
identifier:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0203
      code:
        v: PRN
      display:
        v: Provider number
  system:
    v: https://facility.ndhm.gov.in
  value:
    v: 45675454
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/organization-type
    code:
      v: prov
    display:
      v: Healthcare Provider
name:
  v: XYZ Hospital Co. Ltd.
telecom:
  system:
    v: phone
  value:
    v: +91 243 2634 1278
  use:
    v: work
telecom:
  system:
    v: email
  use:
    v: work

MedicationRequest-example-01
type: MedicationRequest
id:
  v: MedicationRequest-example-01
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/MedicationRequest
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/MedicationRequest
text:
  status:
    v: generated
  div: 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) 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)
status:
  v: active
intent:
  v: order
medication: CodeableConcept
  coding: http://snomed.info/id/319775004
    system:
      v: http://snomed.info/sct
    code:
      v: 319775004
    display:
      v: Aspirin 75 mg oral tablet
subject:
  link: https://nrces.in/ndhm/fhir/r4/Patient/Patient-example-01
  reference:
    v: Patient/Patient-example-01
authored on:
  v: 2023-12-11
requester:
  link: https://nrces.in/ndhm/fhir/r4/Practitioner/Practitioner-example-01
  reference:
    v: Practitioner/Practitioner-example-01
reason code:
  coding: http://snomed.info/id/410429000
    system:
      v: http://snomed.info/sct
    code:
      v: 410429000
    display:
      v: Cardiac arrest
reason reference:
  link: https://nrces.in/ndhm/fhir/r4/Condition/Condition-example-01
  reference:
    v: Condition/Condition-example-01
dosage instruction:
  text:
    v: One tablet at once
  additional instruction:
    coding: http://snomed.info/id/311504000
      system:
        v: http://snomed.info/sct
      code:
        v: 311504000
      display:
        v: With or after food
  timing:
    repeat:
      frequency:
        v: 1
      period:
        v: 1
      period unit:
        v: d
  route:
    coding: http://snomed.info/id/26643006
      system:
        v: http://snomed.info/sct
      code:
        v: 26643006
      display:
        v: Oral Route
  method:
    coding: http://snomed.info/id/421521009
      system:
        v: http://snomed.info/sct
      code:
        v: 421521009
      display:
        v: Swallow

Practitioner-example-01
type: Practitioner
id:
  v: Practitioner-example-01
meta:
  version id:
    v: 1
  last updated:
    v: 2023-09-07T14:58:58.181+05:30
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner
text:
  status:
    v: generated
  div: 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
identifier:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0203
      code:
        v: MD
      display:
        v: Medical License number
  system:
    v: https://doctor.ndhm.gov.in
  value:
    v: 21-1521-3828-3227
name:
  text:
    v: Dr. Aayush Agrawal

Coverage-example-01
type: Coverage
id:
  v: Coverage-example-01
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Coverage
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Coverage
text:
  status:
    v: generated
  div: 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: ABC123456BI007 beneficiary: See above (Patient/Patient-example-01) relationship: Self (SubscriberPolicyholder Relationship Codes#self) period: ?? --> 2026-03-17 payor: See above (Organization/Organization-example-01)
identifier:
  system:
    v: https://xyzinsurance.in/policynumber/
  value:
    v: 235037120
status:
  v: active
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/coverage-selfpay
    code:
      v: pay
    display:
      v: PAY
subscriber:
  link: https://nrces.in/ndhm/fhir/r4/Patient/Patient-example-01
  reference:
    v: Patient/Patient-example-01
subscriber id:
  v: ABC123456BI007
beneficiary:
  link: https://nrces.in/ndhm/fhir/r4/Patient/Patient-example-01
  reference:
    v: Patient/Patient-example-01
relationship:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/subscriber-relationship
    code:
      v: self
period:
  end:
    v: 2026-03-17
payor:
  link: https://nrces.in/ndhm/fhir/r4/Organization/Organization-example-01
  reference:
    v: Organization/Organization-example-01

Condition-example-01
type: Condition
id:
  v: Condition-example-01
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Condition
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Condition
text:
  status:
    v: generated
  div: 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 recorder: See above (Practitioner/Practitioner-example-01)
code:
  coding:
    system:
      v: http://hl7.org/fhir/sid/icd-10
    code:
      v: I46.9
    display:
      v: Cardiac arrest, unspecified
subject:
  link: https://nrces.in/ndhm/fhir/r4/Patient/Patient-example-01
  reference:
    v: Patient/Patient-example-01
onset:
  v: 1days
recorder:
  link: https://nrces.in/ndhm/fhir/r4/Practitioner/Practitioner-example-01
  reference:
    v: Practitioner/Practitioner-example-01

Claim-enhancement-example-01
type: Claim
id:
  v: Claim-enhancement-example-01
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim
text:
  status:
    v: generated
  div: 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 Qualification * 1 See above (Practitioner/Practitioner-example-01) Healthcare professional (occupation) (SNOMED CT#223366009) Clinical specialty (qualifier value) (SNOMED CT#394658006) 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
identifier:
  system:
    v: https://irdai.gov.in
  value:
    v: 7612345
status:
  v: active
type:
  coding: http://snomed.info/id/737481003
    system:
      v: http://snomed.info/sct
    code:
      v: 737481003
    display:
      v: Inpatient care management (procedure)
sub type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/ex-claimsubtype
    code:
      v: emergency
use:
  v: preauthorization
patient:
  link: https://nrces.in/ndhm/fhir/r4/Patient/Patient-example-01
  reference:
    v: Patient/Patient-example-01
billable period:
  start:
    v: 2023-12-09T11:01:00+05:00
  end:
    v: 2023-12-30T11:01:00+05:00
created:
  v: 2023-12-13T11:01:00+05:00
insurer:
  link: https://nrces.in/ndhm/fhir/r4/Organization/Organization-example-01
  reference:
    v: Organization/Organization-example-01
provider:
  link: https://nrces.in/ndhm/fhir/r4/Organization/Organization-example-02
  reference:
    v: Organization/Organization-example-02
priority:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/processpriority
    code:
      v: normal
related:
  claim:
    link: https://nrces.in/ndhm/fhir/r4/Claim/Claim-preauth-example-01
    reference:
      v: Claim/Claim-preauth-example-01
  relationship:
    coding:
      system:
        v: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-related-claim-relationship-code
      code:
        v: enhancement
      display:
        v: Enhancement
care team:
  sequence:
    v: 1
  provider:
    link: https://nrces.in/ndhm/fhir/r4/Practitioner/Practitioner-example-01
    reference:
      v: Practitioner/Practitioner-example-01
  role:
    coding: http://snomed.info/id/223366009
      system:
        v: http://snomed.info/sct
      code:
        v: 223366009
      display:
        v: Healthcare professional (occupation)
  qualification:
    coding: http://snomed.info/id/394658006
      system:
        v: http://snomed.info/sct
      code:
        v: 394658006
      display:
        v: Clinical specialty (qualifier value)
supporting info:
  sequence:
    v: 1
  category:
    coding:
      system:
        v: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category
      code:
        v: INV
      display:
        v: Document Type - Investigation
  code:
    coding: http://snomed.info/id/77343006
      system:
        v: http://snomed.info/sct
      code:
        v: 77343006
      display:
        v: Angiography
  value: Reference
    link: https://nrces.in/ndhm/fhir/r4/DocumentReference/DocumentReference-example-02
    reference:
      v: DocumentReference/DocumentReference-example-02
diagnosis:
  sequence:
    v: 1
  diagnosis: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/sid/icd-10
      code:
        v: I46.9
      display:
        v: Cardiac arrest, unspecified
  type:
    coding: http://snomed.info/id/89100005
      system:
        v: http://snomed.info/sct
      code:
        v: 89100005
      display:
        v: Final diagnosis (discharge) (contextual qualifier) (qualifier value)
procedure:
  sequence:
    v: 1
  procedure: CodeableConcept
    coding: http://snomed.info/id/77343006
      system:
        v: http://snomed.info/sct
      code:
        v: 77343006
      display:
        v: Angiography
procedure:
  sequence:
    v: 2
  procedure: CodeableConcept
    coding: http://snomed.info/id/418285008
      system:
        v: http://snomed.info/sct
      code:
        v: 418285008
      display:
        v: Angioplasty of blood vessel
insurance:
  sequence:
    v: 1
  focal:
    v: true
  coverage:
    link: https://nrces.in/ndhm/fhir/r4/Coverage/Coverage-example-01
    reference:
      v: Coverage/Coverage-example-01
  pre auth ref:
    v: 123456
item:
  sequence:
    v: 1
  care team sequence:
    v: 1
  product or service:
    coding: http://snomed.info/id/77343006
      system:
        v: http://snomed.info/sct
      code:
        v: 77343006
      display:
        v: Angiography
  serviced:
    v: 2023-12-09
  unit price:
    value:
      v: 10000.00
    currency:
      v: INR
  net:
    value:
      v: 10000.00
    currency:
      v: INR
item:
  sequence:
    v: 2
  care team sequence:
    v: 1
  product or service:
    coding: http://snomed.info/id/418285008
      system:
        v: http://snomed.info/sct

Claim-preauth-example-01
type: Claim
id:
  v: Claim-preauth-example-01
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim
text:
  status:
    v: generated
  div: 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 Qualification * 1 See above (Practitioner/Practitioner-example-01) Healthcare professional (occupation) (SNOMED CT#223366009) Clinical specialty (qualifier value) (SNOMED CT#394658006) 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: 20…
identifier:
  system:
    v: https://irdai.gov.in
  value:
    v: 7612345
status:
  v: active
type:
  coding: http://snomed.info/id/737481003
    system:
      v: http://snomed.info/sct
    code:
      v: 737481003
    display:
      v: Inpatient care management (procedure)
sub type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/ex-claimsubtype
    code:
      v: emergency
use:
  v: preauthorization
patient:
  link: https://nrces.in/ndhm/fhir/r4/Patient/Patient-example-01
  reference:
    v: Patient/Patient-example-01
billable period:
  start:
    v: 2023-12-09T11:01:00+05:00
  end:
    v: 2023-12-30T11:01:00+05:00
created:
  v: 2023-12-11T11:01:00+05:00
insurer:
  link: https://nrces.in/ndhm/fhir/r4/Organization/Organization-example-01
  reference:
    v: Organization/Organization-example-01
provider:
  link: https://nrces.in/ndhm/fhir/r4/Organization/Organization-example-02
  reference:
    v: Organization/Organization-example-02
priority:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/processpriority
    code:
      v: normal
prescription:
  link: https://nrces.in/ndhm/fhir/r4/MedicationRequest/MedicationRequest-example-01
  reference:
    v: MedicationRequest/MedicationRequest-example-01
care team:
  sequence:
    v: 1
  provider:
    link: https://nrces.in/ndhm/fhir/r4/Practitioner/Practitioner-example-01
    reference:
      v: Practitioner/Practitioner-example-01
  role:
    coding: http://snomed.info/id/223366009
      system:
        v: http://snomed.info/sct
      code:
        v: 223366009
      display:
        v: Healthcare professional (occupation)
  qualification:
    coding: http://snomed.info/id/394658006
      system:
        v: http://snomed.info/sct
      code:
        v: 394658006
      display:
        v: Clinical specialty (qualifier value)
supporting info:
  sequence:
    v: 1
  category:
    coding:
      system:
        v: https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category
      code:
        v: INV
      display:
        v: Document Type - Investigation
  code:
    coding: http://snomed.info/id/77343006
      system:
        v: http://snomed.info/sct
      code:
        v: 77343006
      display:
        v: Angiography
  value: Reference
    link: https://nrces.in/ndhm/fhir/r4/DocumentReference/DocumentReference-example-01
    reference:
      v: DocumentReference/DocumentReference-example-01
diagnosis:
  sequence:
    v: 1
  diagnosis: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/sid/icd-10
      code:
        v: I46.9
      display:
        v: Cardiac arrest, unspecified
  type:
    coding: http://snomed.info/id/89100005
      system:
        v: http://snomed.info/sct
      code:
        v: 89100005
      display:
        v: Final diagnosis (discharge) (contextual qualifier) (qualifier value)
procedure:
  sequence:
    v: 1
  procedure: CodeableConcept
    coding: http://snomed.info/id/77343006
      system:
        v: http://snomed.info/sct
      code:
        v: 77343006
      display:
        v: Angiography
procedure:
  sequence:
    v: 2
  procedure: CodeableConcept
    coding: http://snomed.info/id/418285008
      system:
        v: http://snomed.info/sct
      code:
        v: 418285008
      display:
        v: Angioplasty of blood vessel
insurance:
  sequence:
    v: 1
  focal:
    v: true
  coverage:
    link: https://nrces.in/ndhm/fhir/r4/Coverage/Coverage-example-01
    reference:
      v: Coverage/Coverage-example-01
  pre auth ref:
    v: 123456
item:
  sequence:
    v: 1
  care team sequence:
    v: 1
  product or service:
    coding: http://snomed.info/id/77343006
      system:
        v: http://snomed.info/sct
      code:
        v: 77343006
      display:
        v: Angiography
  serviced:
    v: 2023-12-09
  unit price:
    value:
      v: 10000.00
    currency:
      v: INR
  net:
    value:
      v: 10000.00
    currency:
      v: INR
item:
  sequence:
    v: 2
  care team sequence:
    v: 1
  product or service:
    coding: http://snomed.info/id/418285008
      system:
        v: http://snomed.info/sct
      code:
        v: 418285008
      display:
        v: Angioplasty of blood vessel
  unit price:
    value:
      v: 40000

DocumentReference-example-01
type: DocumentReference
id:
  v: DocumentReference-example-01
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/DocumentReference
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/DocumentReference
text:
  status:
    v: generated
  div: 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
status:
  v: current
doc status:
  v: final
subject:
  link: https://nrces.in/ndhm/fhir/r4/Patient/Patient-example-01
  reference:
    v: Patient/Patient-example-01
content:
  attachment:
    content type:
      v: application/pdf
    language:
      v: en-IN
    title:
      v: Angeography pdf
    creation:
      v: 2019-05-29T14:58:58.181+05:30

DocumentReference-example-02
type: DocumentReference
id:
  v: DocumentReference-example-02
meta:
  profile:
    v: https://nrces.in/ndhm/fhir/r4/StructureDefinition/DocumentReference
    link: https://nrces.in/ndhm/fhir/r4/StructureDefinition/DocumentReference
text:
  status:
    v: generated
  div: 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
status:
  v: current
doc status:
  v: final
subject:
  link: https://nrces.in/ndhm/fhir/r4/Patient/Patient-example-01
  reference:
    v: Patient/Patient-example-01
content:
  attachment:
    content type:
      v: application/pdf
    language:
      v: en-IN
    title:
      v: Angeography pdf
    creation:
      v: 2019-05-29T14:58:58.181+05:30

v: eligible

v: Eligible Amount

v: 255334000

v: Covered

v: eligible

v: Eligible Amount

v: 255334000

v: Covered

v: eligible

v: Eligible Amount

v: 255334000

v: Covered

v: eligible

v: Eligible Amount

v: 255334000

v: Covered

coding: http://snomed.info/id/77343006
  system:
    v: http://snomed.info/sct
  code:
    v: 77343006
  display:
    v: Angiography

v: 2023-12-09

value:
  v: 2
unit:
  v: Angiography

value:
  v: 10000.00
currency:
  v: INR

value:
  v: 20000.00
currency:
  v: INR

sequence:
  v: 2
care team sequence:
  v: 1
product or service:
  coding: http://snomed.info/id/418285008
    system:
      v: http://snomed.info/sct
    code:
      v: 418285008
    display:
      v: Angioplasty of blood vessel
unit price:
  value:
    v: 50000
  currency:
    v: INR
net:
  value:
    v: 50000
  currency:
    v: INR

sequence:
  v: 3
care team sequence:
  v: 1
product or service:
  coding: http://snomed.info/id/309904001
    system:
      v: http://snomed.info/sct
    code:
      v: 309904001
    display:
      v: Intensive care unit
serviced:
  v: 2023-12-11
quantity:
  value:
    v: 10
  unit:
    v: day
unit price:
  value:
    v: 2000
  currency:
    v: INR
net:
  value:
    v: 20000
  currency:
    v: INR

sequence:
  v: 4
care team sequence:
  v: 1
product or service:
  coding: http://snomed.info/id/319775004
    system:
      v: http://snomed.info/sct
    code:
      v: 319775004
    display:
      v: Aspirin 75 mg oral tablet
quantity:
  value:
    v: 10
  unit:
    v: tablet
unit price:
  value:
    v: 10
  currency:
    v: INR
net:
  value:
    v: 100
  currency:
    v: INR

value:
  v: 90100
currency:
  v: INR

v: 418285008

v: Angioplasty of blood vessel

value:
  v: 10000
currency:
  v: INR

value:
  v: 10000
currency:
  v: INR

value:
  v: 20000
currency:
  v: INR

v: INR

value:
  v: 40000
currency:
  v: INR

sequence:
  v: 3
care team sequence:
  v: 1
product or service:
  coding: http://snomed.info/id/309904001
    system:
      v: http://snomed.info/sct
    code:
      v: 309904001
    display:
      v: Intensive care unit
serviced:
  v: 2023-12-11
quantity:
  value:
    v: 10
  unit:
    v: day
unit price:
  value:
    v: 2000
  currency:
    v: INR
net:
  value:
    v: 20000
  currency:
    v: INR

sequence:
  v: 4
care team sequence:
  v: 1
product or service:
  coding: http://snomed.info/id/319775004
    system:
      v: http://snomed.info/sct
    code:
      v: 319775004
    display:
      v: Aspirin 75 mg oral tablet
unit price:
  value:
    v: 100
  currency:
    v: INR
net:
  value:
    v: 100
  currency:
    v: INR

value:
  v: 70100
currency:
  v: INR