Generated Narrative: ClaimResponse

status: active

type: Inpatient care management (procedure) (SNOMED CT#737481003)

subType: Emergency Claim (Example Claim SubType Codes#emergency)

use: claim

patient: Patient/example-01 ""

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

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

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

request: 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