FHIR Implementation Guide for ABDM
5.0.0 - active India

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FHIR Implementation Guide for ABDM - Local Development build (v5.0.0). See the Directory of published versions

Example Claim: Claim/Claim-settlement-example-01

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

provider: Organization/example-03 "Maharashtra State Government"

priority: Normal (Process Priority Codes#normal)

Relateds

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

prescription: MedicationRequest/example-03

CareTeams

-SequenceProviderRoleQualification
*1Practitioner/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: DocumentReference/example-03

supportingInfo

sequence: 2

category: Document Type - Investigation (SupportingInfo Category#INV)

code: Angiography (SNOMED CT#77343006)

value: DocumentReference/example-03

Diagnoses

-SequenceDiagnosis[x]Type
*1Cardiac 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

-SequenceFocalCoveragePreAuthRef
*1trueCoverage/example-02123456

item

sequence: 1

careTeamSequence: 1

productOrService: Angiography (SNOMED CT#77343006)

serviced: 2023-12-09

quantity: 2 Angiography

UnitPrices

-ValueCurrency
*10000.00INR

Nets

-ValueCurrency
*20000.00INR

item

sequence: 2

careTeamSequence: 1

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

UnitPrices

-ValueCurrency
*50000INR

Nets

-ValueCurrency
*50000INR

item

sequence: 3

careTeamSequence: 1

productOrService: Intensive care unit (SNOMED CT#309904001)

serviced: 2023-12-11

quantity: 10 day

UnitPrices

-ValueCurrency
*2000INR

Nets

-ValueCurrency
*20000INR

item

sequence: 4

careTeamSequence: 1

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

quantity: 10 tablet

UnitPrices

-ValueCurrency
*10INR

Nets

-ValueCurrency
*100INR

Totals

-ValueCurrency
*90100INR