FHIR Implementation Guide for ABDM
6.0.0 - active
FHIR Implementation Guide for ABDM
6.0.0 - active
This page is part of the FHIR Implementation Guide for ABDM (v6.0.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
{
"resourceType" : "Claim",
"id" : "Claim-settlement-example-01",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Claim</b><a name=\"Claim-settlement-example-01\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Claim "Claim-settlement-example-01" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-Claim.html\">Claim</a></p></div><p><b>identifier</b>: <code>https://irdai.gov.in</code>/7612345</p><p><b>status</b>: active</p><p><b>type</b>: Inpatient care management (procedure) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#737481003)</span></p><p><b>subType</b>: Emergency Claim <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-ex-claimsubtype.html\">Example Claim SubType Codes</a>#emergency)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient-example-01.html\">Patient/example-01</a> ""</p><p><b>billablePeriod</b>: 2023-12-09 11:01:00+0500 --> 2023-12-30 11:01:00+0500</p><p><b>created</b>: 2023-12-30 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Organization-example-02.html\">Organization/example-02</a> "XYZ Insurance Co. Ltd."</p><p><b>provider</b>: <a href=\"Organization-example-03.html\">Organization/example-03</a> "XYZ Hospital Co. Ltd."</p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><h3>Relateds</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Claim</b></td><td><b>Relationship</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Claim-Claim-enhancement-example-01.html\">Claim/Claim-enhancement-example-01</a></td><td>Settlement <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndhm-related-claim-relationship-code.html\">Related Claim Relationship Code</a>#settlement)</span></td></tr></table><p><b>prescription</b>: <a href=\"MedicationRequest-example-03.html\">MedicationRequest/example-03</a></p><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td><td><b>Role</b></td><td><b>Qualification</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Practitioner-example-01.html\">Practitioner/example-01</a> ""</td><td>Healthcare professional (occupation) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#223366009)</span></td><td>Clinical specialty (qualifier value) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#394658006)</span></td></tr></table><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: Document Type - Investigation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndhm-supportinginfo-category.html\">SupportingInfo Category</a>#INV)</span></p><p><b>code</b>: Angiography <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#77343006)</span></p><p><b>value</b>: <a href=\"DocumentReference-example-03.html\">DocumentReference/example-03</a></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 2</p><p><b>category</b>: Document Type - Investigation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndhm-supportinginfo-category.html\">SupportingInfo Category</a>#INV)</span></p><p><b>code</b>: Angiography <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#77343006)</span></p><p><b>value</b>: <a href=\"DocumentReference-example-03.html\">DocumentReference/example-03</a></p></blockquote><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>Cardiac arrest, unspecified <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-icd10.html\">ICD-10</a>#I46.9)</span></td><td>Final diagnosis (discharge) (contextual qualifier) (qualifier value) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#89100005)</span></td></tr></table><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 1</p><p><b>procedure</b>: Angiography <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#77343006)</span></p></blockquote><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 2</p><p><b>procedure</b>: Angioplasty of blood vessel <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#418285008)</span></p></blockquote><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td><td><b>PreAuthRef</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-example-01.html\">Coverage/example-01</a></td><td>123456</td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: Angiography <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#77343006)</span></p><p><b>serviced</b>: 2023-12-09</p><p><b>quantity</b>: 2 Angiography</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000.00</td><td>INR</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20000.00</td><td>INR</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 2</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: Angioplasty of blood vessel <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#418285008)</span></p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>50000</td><td>INR</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>50000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 3</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: Intensive care unit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#309904001)</span></p><p><b>serviced</b>: 2023-12-11</p><p><b>quantity</b>: 10 day</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>2000</td><td>INR</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 4</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: Aspirin 75 mg oral tablet <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#319775004)</span></p><p><b>quantity</b>: 10 tablet</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10</td><td>INR</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>100</td><td>INR</td></tr></table></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>90100</td><td>INR</td></tr></table></div>"
},
"identifier" : [
{
"system" : "https://irdai.gov.in",
"value" : "7612345"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "737481003",
"display" : "Inpatient care management (procedure)"
}
]
},
"subType" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-claimsubtype",
"code" : "emergency"
}
]
},
"use" : "claim",
"patient" : {
🔗 "reference" : "Patient/example-01"
},
"billablePeriod" : {
"start" : "2023-12-09T11:01:00+05:00",
"end" : "2023-12-30T11:01:00+05:00"
},
"created" : "2023-12-30T11:01:00+05:00",
"insurer" : {
🔗 "reference" : "Organization/example-02"
},
"provider" : {
🔗 "reference" : "Organization/example-03"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "normal"
}
]
},
"related" : [
{
"claim" : {
🔗 "reference" : "Claim/Claim-enhancement-example-01"
},
"relationship" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-related-claim-relationship-code",
"code" : "settlement",
"display" : "Settlement"
}
]
}
}
],
"prescription" : {
🔗 "reference" : "MedicationRequest/example-03"
},
"careTeam" : [
{
"sequence" : 1,
"provider" : {
🔗 "reference" : "Practitioner/example-01"
},
"role" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "223366009",
"display" : "Healthcare professional (occupation)"
}
]
},
"qualification" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "394658006",
"display" : "Clinical specialty (qualifier value)"
}
]
}
}
],
"supportingInfo" : [
{
"sequence" : 1,
"category" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category",
"code" : "INV",
"display" : "Document Type - Investigation"
}
]
},
"code" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "77343006",
"display" : "Angiography"
}
]
},
"valueReference" : {
🔗 "reference" : "DocumentReference/example-03"
}
},
{
"sequence" : 2,
"category" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category",
"code" : "INV",
"display" : "Document Type - Investigation"
}
]
},
"code" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "77343006",
"display" : "Angiography"
}
]
},
"valueReference" : {
🔗 "reference" : "DocumentReference/example-03"
}
}
],
"diagnosis" : [
{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/icd-10",
"code" : "I46.9",
"display" : "Cardiac arrest, unspecified"
}
]
},
"type" : [
{
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "89100005",
"display" : "Final diagnosis (discharge) (contextual qualifier) (qualifier value)"
}
]
}
]
}
],
"procedure" : [
{
"sequence" : 1,
"procedureCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "77343006",
"display" : "Angiography"
}
]
}
},
{
"sequence" : 2,
"procedureCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "418285008",
"display" : "Angioplasty of blood vessel"
}
]
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
🔗 "reference" : "Coverage/example-01"
},
"preAuthRef" : [
"123456"
]
}
],
"item" : [
{
"sequence" : 1,
"careTeamSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "77343006",
"display" : "Angiography"
}
]
},
"servicedDate" : "2023-12-09",
"quantity" : {
"value" : 2,
"unit" : "Angiography"
},
"unitPrice" : {
"value" : 10000.00,
"currency" : "INR"
},
"net" : {
"value" : 20000.00,
"currency" : "INR"
}
},
{
"sequence" : 2,
"careTeamSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "418285008",
"display" : "Angioplasty of blood vessel"
}
]
},
"unitPrice" : {
"value" : 50000,
"currency" : "INR"
},
"net" : {
"value" : 50000,
"currency" : "INR"
}
},
{
"sequence" : 3,
"careTeamSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "309904001",
"display" : "Intensive care unit"
}
]
},
"servicedDate" : "2023-12-11",
"quantity" : {
"value" : 10,
"unit" : "day"
},
"unitPrice" : {
"value" : 2000,
"currency" : "INR"
},
"net" : {
"value" : 20000,
"currency" : "INR"
}
},
{
"sequence" : 4,
"careTeamSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "319775004",
"display" : "Aspirin 75 mg oral tablet"
}
]
},
"quantity" : {
"value" : 10,
"unit" : "tablet"
},
"unitPrice" : {
"value" : 10,
"currency" : "INR"
},
"net" : {
"value" : 100,
"currency" : "INR"
}
}
],
"total" : {
"value" : 90100,
"currency" : "INR"
}
}