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" : "ClaimResponse",
"id" : "ClaimResponse-settlement-example-01",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ClaimResponse</b><a name=\"ClaimResponse-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 ClaimResponse "ClaimResponse-settlement-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>: claim</p><p><b>patient</b>: <a href=\"Patient-example-01.html\">Patient/example-01</a> ""</p><p><b>created</b>: 2023-12-30 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-settlement-example-01.html\">Claim/Claim-settlement-example-01</a></p><p><b>outcome</b>: complete</p><p><b>disposition</b>: The claim will be processed 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>20000.00</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>50000</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>90100</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>"
},
"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"
},
"created" : "2023-12-30T15:32:26.605+05:30",
"insurer" : {
🔗 "reference" : "Organization/example-02"
},
"requestor" : {
🔗 "reference" : "Organization/example-03"
},
"request" : {
🔗 "reference" : "Claim/Claim-settlement-example-01"
},
"outcome" : "complete",
"disposition" : "The claim will be processed within 30 days of this notice.",
"preAuthRef" : "123456",
"payeeType" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/payeetype",
"code" : "provider"
}
]
},
"item" : [
{
"itemSequence" : 1,
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible",
"display" : "Eligible Amount"
}
]
},
"reason" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "255334000",
"display" : "Covered"
}
]
},
"amount" : {
"value" : 20000.00,
"currency" : "INR"
}
}
]
},
{
"itemSequence" : 2,
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible",
"display" : "Eligible Amount"
}
]
},
"reason" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "255334000",
"display" : "Covered"
}
]
},
"amount" : {
"value" : 50000,
"currency" : "INR"
}
}
]
},
{
"itemSequence" : 3,
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible",
"display" : "Eligible Amount"
}
]
},
"reason" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "255334000",
"display" : "Covered"
}
]
},
"amount" : {
"value" : 20000,
"currency" : "INR"
}
}
]
},
{
"itemSequence" : 4,
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible",
"display" : "Eligible Amount"
}
]
},
"reason" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "255334000",
"display" : "Covered"
}
]
},
"amount" : {
"value" : 100,
"currency" : "INR"
}
}
]
}
],
"total" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "submitted"
}
]
},
"amount" : {
"value" : 90100,
"currency" : "INR"
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
🔗 "reference" : "Coverage/example-01"
}
}
]
}