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
Generated Narrative: ClaimResponse
Resource ClaimResponse "ClaimResponse-predetermination-example-01"
Profile: ClaimResponse
status: active
type: Inpatient care management (procedure) (SNOMED CT#737481003)
subType: Emergency Claim (Example Claim SubType Codes#emergency)
use: predetermination
patient: Patient/example-01 ""
created: 2023-12-12 15:32:26+0530
insurer: Organization/example-02 "XYZ Insurance Co. Ltd."
requestor: Organization/example-03 "XYZ Hospital Co. Ltd."
request: Claim/Claim-predetermination-example-01
outcome: complete
preAuthRef: 123456
payeeType: Provider (Payee Type Codes#provider)
item
itemSequence: 1
adjudication
category: Eligible Amount (Adjudication Value Codes#eligible)
reason: Covered (SNOMED CT#255334000)
Amounts
Value Currency 10000.00 INR
item
itemSequence: 2
adjudication
category: Eligible Amount (Adjudication Value Codes#eligible)
reason: Covered (SNOMED CT#255334000)
Amounts
Value Currency 40000 INR
item
itemSequence: 3
adjudication
category: Eligible Amount (Adjudication Value Codes#eligible)
reason: Covered (SNOMED CT#255334000)
Amounts
Value Currency 20000 INR
item
itemSequence: 4
adjudication
category: Eligible Amount (Adjudication Value Codes#eligible)
reason: Covered (SNOMED CT#255334000)
Amounts
Value Currency 100 INR
total
category: Submitted Amount (Adjudication Value Codes#submitted)
Amounts
Value Currency 70100 INR
| Sequence | Focal | Coverage |
| 1 | true | Coverage/example-01 |