Simple Institutional Service Claim

{
  "resourceType": "Claim",
  "id": "960150",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Claim</div>"

  "resourceType" : "Claim",
  "id" : "960150",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Claim</div>"

  },
  "identifier": [
    {
      "system": "http://happyhospital.com/claim",
      "value": "9612345"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "institutional"
      }
    ]

  "identifier" : [{
    "system" : "http://happyhospital.com/claim",
    "value" : "9612345"
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "institutional"
    }]

  },
  "subType": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/ex-claimsubtype",
        "code": "emergency"
      }
    ]

  "subType" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/ex-claimsubtype",
      "code" : "emergency"
    }]

  },
  "use": "claim",
  "patient": {
    "reference": "Patient/1"

  "use" : "claim",
  "subject" : {
    "reference" : "Patient/1"

  },
  "created": "2014-08-16",
  "enterer": {
    "identifier": {
      "system": "http://jurisdiction.org/facilities/HOSP1234/users",
      "value": "UC1234"

  "created" : "2014-08-16",
  "enterer" : {
    "identifier" : {
      "system" : "http://jurisdiction.org/facilities/HOSP1234/users",
      "value" : "UC1234"

    }
  },
  "insurer": {
    "reference": "Organization/2"

  "insurer" : {
    "reference" : "Organization/2"

  },
  "provider": {
    "reference": "Organization/1"

  "provider" : {
    "reference" : "Organization/1"

  },
  "priority": {
    "coding": [
      {
        "code": "normal"
      }
    ]

  "priority" : {
    "coding" : [{
      "code" : "normal"
    }]

  },
  "payee": {
    "type": {
      "coding": [
        {
          "code": "provider"
        }
      ]

  "payee" : {
    "type" : {
      "coding" : [{
        "code" : "provider"
      }]

    }
  },
  "facility": {
    "identifier": {
      "system": "http://jurisdiction.org/facilities",
      "value": "HOSP1234"

  "facility" : {
    "identifier" : {
      "system" : "http://jurisdiction.org/facilities",
      "value" : "HOSP1234"

    }
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/example"
      }
    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "code": "654456"
          }
        ]
      }
    }
  ],
  "procedure": [
    {
      "sequence": 1,
      "type": [
        {
          "coding": [
            {
              "code": "primary"
            }
          ]
        }
      ],
      "date": "2014-08-16",
      "procedureCodeableConcept": {
        "coding": [
          {
            "code": "SDI9901"
          }
        ],
        "text": "Subcutaneous diagnostic implant"
      },
      "udi": [
        {
          "reference": "Device/example"
        }
      ]

  "careTeam" : [{
    "sequence" : 1,
    "provider" : {
      "reference" : "Practitioner/example"

    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/9876B1"
      }

  }],
  "diagnosis" : [{
    "sequence" : 1,
    "diagnosisCodeableConcept" : {
      "coding" : [{
        "code" : "654456"
      }]

    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/ex-serviceproduct",
            "code": "exam"
          }
        ]
      },
      "servicedDate": "2014-08-16",
      "unitPrice": {
        "value": 125.00,
        "currency": "USD"
      },
      "net": {
        "value": 125.00,
        "currency": "USD"
      },
      "encounter": [
        {
          "reference": "Encounter/example"
        }
      ]

  }],
  "procedure" : [{
    "sequence" : 1,
    "type" : [{
      "coding" : [{
        "code" : "primary"
      }]
    }],
    "date" : "2014-08-16",
    "procedureCodeableConcept" : {
      "coding" : [{
        "code" : "SDI9901"
      }],
      "text" : "Subcutaneous diagnostic implant"
    },
    "udi" : [{
      "reference" : "Device/example"
    }]
  }],
  "insurance" : [{
    "sequence" : 1,
    "focal" : true,
    "coverage" : {
      "reference" : "Coverage/9876B1"

    }
  ],
  "total": {
    "value": 125.00,
    "currency": "USD"

  }],
  "item" : [{
    "sequence" : 1,
    "careTeamSequence" : [1],
    "productOrService" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/ex-serviceproduct",
        "code" : "exam"
      }]
    },
    "servicedDate" : "2014-08-16",
    "unitPrice" : {
      "value" : 125.00,
      "currency" : "USD"
    },
    "net" : {
      "value" : 125.00,
      "currency" : "USD"
    },
    "encounter" : [{
      "reference" : "Encounter/example"
    }]
  }],
  "total" : {
    "value" : 125.00,
    "currency" : "USD"

  }
}