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
<Claim xmlns="http://hl7.org/fhir">
<id value="Claim-settlement-example-01"/>
<meta>
<profile value="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim"/>
</meta>
<text>
<status value="generated"/>
<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>
</text>
<identifier>
<system value="https://irdai.gov.in"/>
<value value="7612345"/>
</identifier>
<status value="active"/>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="737481003"/>
<display value="Inpatient care management (procedure)"/>
</coding>
</type>
<subType>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/ex-claimsubtype"/>
<code value="emergency"/>
</coding>
</subType>
<use value="claim"/>
<patient>🔗
<reference value="Patient/example-01"/>
</patient>
<billablePeriod>
<start value="2023-12-09T11:01:00+05:00"/>
<end value="2023-12-30T11:01:00+05:00"/>
</billablePeriod>
<created value="2023-12-30T11:01:00+05:00"/>
<insurer>🔗
<reference value="Organization/example-02"/>
</insurer>
<provider>🔗
<reference value="Organization/example-03"/>
</provider>
<priority>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
<code value="normal"/>
</coding>
</priority>
<related>
<claim>🔗
<reference value="Claim/Claim-enhancement-example-01"/>
</claim>
<relationship>
<coding>
<system
value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-related-claim-relationship-code"/>
<code value="settlement"/>
<display value="Settlement"/>
</coding>
</relationship>
</related>
<prescription>🔗
<reference value="MedicationRequest/example-03"/>
</prescription>
<careTeam>
<sequence value="1"/>
<provider>🔗
<reference value="Practitioner/example-01"/>
</provider>
<role>
<coding>
<system value="http://snomed.info/sct"/>
<code value="223366009"/>
<display value="Healthcare professional (occupation)"/>
</coding>
</role>
<qualification>
<coding>
<system value="http://snomed.info/sct"/>
<code value="394658006"/>
<display value="Clinical specialty (qualifier value)"/>
</coding>
</qualification>
</careTeam>
<supportingInfo>
<sequence value="1"/>
<category>
<coding>
<system
value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category"/>
<code value="INV"/>
<display value="Document Type - Investigation"/>
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="77343006"/>
<display value="Angiography"/>
</coding>
</code>
<valueReference>🔗
<reference value="DocumentReference/example-03"/>
</valueReference>
</supportingInfo>
<supportingInfo>
<sequence value="2"/>
<category>
<coding>
<system
value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category"/>
<code value="INV"/>
<display value="Document Type - Investigation"/>
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="77343006"/>
<display value="Angiography"/>
</coding>
</code>
<valueReference>🔗
<reference value="DocumentReference/example-03"/>
</valueReference>
</supportingInfo>
<diagnosis>
<sequence value="1"/>
<diagnosisCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/sid/icd-10"/>
<code value="I46.9"/>
<display value="Cardiac arrest, unspecified"/>
</coding>
</diagnosisCodeableConcept>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="89100005"/>
<display
value="Final diagnosis (discharge) (contextual qualifier) (qualifier value)"/>
</coding>
</type>
</diagnosis>
<procedure>
<sequence value="1"/>
<procedureCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="77343006"/>
<display value="Angiography"/>
</coding>
</procedureCodeableConcept>
</procedure>
<procedure>
<sequence value="2"/>
<procedureCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="418285008"/>
<display value="Angioplasty of blood vessel"/>
</coding>
</procedureCodeableConcept>
</procedure>
<insurance>
<sequence value="1"/>
<focal value="true"/>
<coverage>🔗
<reference value="Coverage/example-01"/>
</coverage>
<preAuthRef value="123456"/>
</insurance>
<item>
<sequence value="1"/>
<careTeamSequence value="1"/>
<productOrService>
<coding>
<system value="http://snomed.info/sct"/>
<code value="77343006"/>
<display value="Angiography"/>
</coding>
</productOrService>
<servicedDate value="2023-12-09"/>
<quantity>
<value value="2"/>
<unit value="Angiography"/>
</quantity>
<unitPrice>
<value value="10000.00"/>
<currency value="INR"/>
</unitPrice>
<net>
<value value="20000.00"/>
<currency value="INR"/>
</net>
</item>
<item>
<sequence value="2"/>
<careTeamSequence value="1"/>
<productOrService>
<coding>
<system value="http://snomed.info/sct"/>
<code value="418285008"/>
<display value="Angioplasty of blood vessel"/>
</coding>
</productOrService>
<unitPrice>
<value value="50000"/>
<currency value="INR"/>
</unitPrice>
<net>
<value value="50000"/>
<currency value="INR"/>
</net>
</item>
<item>
<sequence value="3"/>
<careTeamSequence value="1"/>
<productOrService>
<coding>
<system value="http://snomed.info/sct"/>
<code value="309904001"/>
<display value="Intensive care unit"/>
</coding>
</productOrService>
<servicedDate value="2023-12-11"/>
<quantity>
<value value="10"/>
<unit value="day"/>
</quantity>
<unitPrice>
<value value="2000"/>
<currency value="INR"/>
</unitPrice>
<net>
<value value="20000"/>
<currency value="INR"/>
</net>
</item>
<item>
<sequence value="4"/>
<careTeamSequence value="1"/>
<productOrService>
<coding>
<system value="http://snomed.info/sct"/>
<code value="319775004"/>
<display value="Aspirin 75 mg oral tablet"/>
</coding>
</productOrService>
<quantity>
<value value="10"/>
<unit value="tablet"/>
</quantity>
<unitPrice>
<value value="10"/>
<currency value="INR"/>
</unitPrice>
<net>
<value value="100"/>
<currency value="INR"/>
</net>
</item>
<total>
<value value="90100"/>
<currency value="INR"/>
</total>
</Claim>