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Claim-example-oral-contained-identifier.json

Example Claim/100155 (JSON)

Maturity Level : N/A
Responsible Owner: Financial Management Work Group Ballot Standards Status : Informative Compartments : Device , Encounter , Group , Patient , Practitioner , RelatedPerson

Raw JSON ( canonical form + also see JSON Format Specification )

SOA Dental Claim using identifiers and Contained

{
  "resourceType": "Claim",
  "id": "100155",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.</div>"

  "resourceType" : "Claim",
  "id" : "100155",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.</div>"

  },
  "contained": [
    {
      "resourceType": "Patient",
      "id": "patient-1",
      "name": [
        {
          "use": "official",
          "family": "Donald",
          "given": [
            "Duck"
          ]
        }
      ],
      "gender": "male",
      "birthDate": "1986-05-17",
      "address": [
        {
          "use": "home",
          "line": [
            "1234 Main Street"
          ],
          "city": "Vancouver",
          "postalCode": "V2H1Y3",
          "country": "CAD"
        }
      ]
    }
  ],
  "identifier": [
    {
      "system": "http://happyvalley.com/claim",
      "value": "12347"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/ex-claimtype",
        "code": "oral"
      }
    ]

  "contained" : [{
    "resourceType" : "Patient",
    "id" : "patient-1",
    "name" : [{
      "use" : "official",
      "family" : "Donald",
      "given" : ["Duck"]
    }],
    "gender" : "male",
    "birthDate" : "1986-05-17",
    "address" : [{
      "use" : "home",
      "line" : ["1234 Main Street"],
      "city" : "Vancouver",
      "postalCode" : "V2H1Y3",
      "country" : "CAD"
    }]
  }],
  "identifier" : [{
    "system" : "http://happyvalley.com/claim",
    "value" : "12347"
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "oral"
    }]

  },
  "use": "complete",
  "patient": {
    "reference": "#patient-1"

  "use" : "claim",
  "subject" : {
    "reference" : "#patient-1"

  },
  "created": "2014-08-16",
  "insurer": {
    "identifier": {
      "system": "http://www.jurisdiction.com/insurers",
      "value": "123456"

  "created" : "2014-08-16",
  "insurer" : {
    "identifier" : {
      "system" : "http://www.jurisdiction.com/insurers",
      "value" : "123456"

    }
  },
  "organization": {
    "identifier": {
      "system": "http://www.jurisdiction.com/careorganizations",
      "value": "HOSP12345"

  "provider" : {
    "identifier" : {
      "system" : "http://www.jurisdiction.com/careorganizations",
      "value" : "HOSP12345"

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

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

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

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

    }
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "identifier": {
          "system": "http://www.jurisdiction.com/providerId",
          "value": "MD98765"
        }

  "careTeam" : [{
    "sequence" : 1,
    "provider" : {
      "identifier" : {
        "system" : "http://www.jurisdiction.com/providerId",
        "value" : "MD98765"

      }
    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "code": "123456"
          }
        ]
      }

  }],
  "diagnosis" : [{
    "sequence" : 1,
    "diagnosisCodeableConcept" : {
      "coding" : [{
        "code" : "123456"
      }]

    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "http://www.jurisdiction.com/nationalplan/123AB345"
      }

  }],
  "insurance" : [{
    "sequence" : 1,
    "focal" : true,
    "coverage" : {
      "reference" : "http://www.jurisdiction.com/nationalplan/123AB345"

    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamLinkId": [
        1
      ],
      "service": {
        "coding": [
          {
            "code": "1200"
          }
        ]
      },
      "servicedDate": "2014-08-16",
      "unitPrice": {
        "value": 135.57,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "net": {
        "value": 135.57,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }

  }],
  "item" : [{
    "sequence" : 1,
    "careTeamSequence" : [1],
    "productOrService" : {
      "coding" : [{
        "code" : "1200"
      }]
    },
    "servicedDate" : "2014-08-16",
    "unitPrice" : {
      "value" : 135.57,
      "currency" : "USD"
    },
    "net" : {
      "value" : 135.57,
      "currency" : "USD"

    }
  ]

  }]

}

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.