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
<ClaimResponse xmlns="http://hl7.org/fhir">
<id value="ClaimResponse-preauthorization-example-01"/>
<meta>
<profile
value="https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: ClaimResponse</b><a name="ClaimResponse-preauthorization-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 ClaimResponse "ClaimResponse-preauthorization-example-01" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ClaimResponse.html">ClaimResponse</a></p></div><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>: preauthorization</p><p><b>patient</b>: <a href="Patient-example-01.html">Patient/example-01</a> ""</p><p><b>created</b>: 2023-12-12 15:32:26+0530</p><p><b>insurer</b>: <a href="Organization-example-02.html">Organization/example-02</a> "XYZ Insurance Co. Ltd."</p><p><b>requestor</b>: <a href="Organization-example-03.html">Organization/example-03</a> "XYZ Hospital Co. Ltd."</p><p><b>request</b>: <a href="Claim-Claim-preauthorization-example-01.html">Claim/Claim-preauthorization-example-01</a></p><p><b>outcome</b>: complete</p><p><b>disposition</b>: The enclosed services are authorized for your provision within 30 days of this notice.</p><p><b>preAuthRef</b>: 123456</p><p><b>payeeType</b>: Provider <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-payeetype.html">Payee Type Codes</a>#provider)</span></p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: Eligible Amount <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html">Adjudication Value Codes</a>#eligible)</span></p><p><b>reason</b>: Covered <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#255334000)</span></p><h3>Amounts</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></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 2</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: Eligible Amount <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html">Adjudication Value Codes</a>#eligible)</span></p><p><b>reason</b>: Covered <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#255334000)</span></p><h3>Amounts</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>40000</td><td>INR</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 3</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: Eligible Amount <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html">Adjudication Value Codes</a>#eligible)</span></p><p><b>reason</b>: Covered <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#255334000)</span></p><h3>Amounts</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><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 4</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: Eligible Amount <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html">Adjudication Value Codes</a>#eligible)</span></p><p><b>reason</b>: Covered <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#255334000)</span></p><h3>Amounts</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></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: Submitted Amount <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html">Adjudication Value Codes</a>#submitted)</span></p><h3>Amounts</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>70100</td><td>INR</td></tr></table></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></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></tr></table></div>
</text>
<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="preauthorization"/>
<patient>🔗
<reference value="Patient/example-01"/>
</patient>
<created value="2023-12-12T15:32:26.605+05:30"/>
<insurer>🔗
<reference value="Organization/example-02"/>
</insurer>
<requestor>🔗
<reference value="Organization/example-03"/>
</requestor>
<request>🔗
<reference value="Claim/Claim-preauthorization-example-01"/>
</request>
<outcome value="complete"/>
<disposition
value="The enclosed services are authorized for your provision within 30 days of this notice."/>
<preAuthRef value="123456"/>
<payeeType>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/payeetype"/>
<code value="provider"/>
</coding>
</payeeType>
<item>
<itemSequence value="1"/>
<adjudication>
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="eligible"/>
<display value="Eligible Amount"/>
</coding>
</category>
<reason>
<coding>
<system value="http://snomed.info/sct"/>
<code value="255334000"/>
<display value="Covered"/>
</coding>
</reason>
<amount>
<value value="10000.00"/>
<currency value="INR"/>
</amount>
</adjudication>
</item>
<item>
<itemSequence value="2"/>
<adjudication>
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="eligible"/>
<display value="Eligible Amount"/>
</coding>
</category>
<reason>
<coding>
<system value="http://snomed.info/sct"/>
<code value="255334000"/>
<display value="Covered"/>
</coding>
</reason>
<amount>
<value value="40000"/>
<currency value="INR"/>
</amount>
</adjudication>
</item>
<item>
<itemSequence value="3"/>
<adjudication>
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="eligible"/>
<display value="Eligible Amount"/>
</coding>
</category>
<reason>
<coding>
<system value="http://snomed.info/sct"/>
<code value="255334000"/>
<display value="Covered"/>
</coding>
</reason>
<amount>
<value value="20000"/>
<currency value="INR"/>
</amount>
</adjudication>
</item>
<item>
<itemSequence value="4"/>
<adjudication>
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="eligible"/>
<display value="Eligible Amount"/>
</coding>
</category>
<reason>
<coding>
<system value="http://snomed.info/sct"/>
<code value="255334000"/>
<display value="Covered"/>
</coding>
</reason>
<amount>
<value value="100"/>
<currency value="INR"/>
</amount>
</adjudication>
</item>
<total>
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="submitted"/>
</coding>
</category>
<amount>
<value value="70100"/>
<currency value="INR"/>
</amount>
</total>
<insurance>
<sequence value="1"/>
<focal value="true"/>
<coverage>🔗
<reference value="Coverage/example-01"/>
</coverage>
</insurance>
</ClaimResponse>