Financial
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Maturity Level : N/A | Standards Status : Informative |
Compartments
:
|
Raw JSON ( canonical form + also see JSON Format Specification )
Knowledge
Repository
Base
Capability
Statement
Primary
insurance
response
to
a
3Tier
Vision
Claim
{
"resourceType": "CapabilityStatement",
"id": "knowledge-repository",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <h2>Knowledge Repository Service Conformance Statement</h2>\n <div>\n <p>Basic conformance statement for a Knowledge Repository Service. A server can support more functionality\n than defined here, but this is the minimum amount</p>\n\n </div>\n <table>\n <tr>\n <td>Mode</td>\n <td>SERVER</td>\n </tr>\n <tr>\n <td>Description</td>\n <td>RESTful Knowledge Repository Server</td>\n </tr>\n <tr>\n <td>Transaction</td>\n <td/>\n </tr>\n <tr>\n <td>System History</td>\n <td/>\n </tr>\n <tr>\n <td>System Search</td>\n <td/>\n </tr>\n </table>\n <table>\n <tr>\n <th>\n <b>Resource Type</b>\n </th>\n <th>\n <b>Profile</b>\n </th>\n <th>\n <b>Read</b>\n </th>\n <th>\n <b>V-Read</b>\n </th>\n <th>\n <b>Search</b>\n </th>\n <th>\n <b>Update</b>\n </th>\n <th>\n <b>Updates</b>\n </th>\n <th>\n <b>Create</b>\n </th>\n <th>\n <b>Delete</b>\n </th>\n <th>\n <b>History</b>\n </th>\n </tr>\n </table>\n </div>"
"resourceType" : "ClaimResponse",
"id" : "R3502",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the ClaimResponse</div>"
},
"url": "http://hl7.org/fhir/knowledge-repository",
"name": "Knowledge Repository Service Conformance Statement",
"status": "draft",
"date": "2017-02-25",
"publisher": "HL7, Inc",
"contact": [
{
"name": "FHIR Project",
"telecom": [
{
"system": "other",
"value": "http://hl7.org/fhir"
}
]
"identifier" : [{
"system" : "http://thebenefitcompany.com/claimresponse",
"value" : "CR6532875367"
}],
"status" : "active",
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "vision"
}]
},
"use" : "claim",
"patient" : {
"reference" : "Patient/1"
},
"created" : "2014-08-16",
"insurer" : {
"reference" : "Organization/2"
},
"requestor" : {
"reference" : "Organization/1"
},
"request" : {
"identifier" : {
"system" : "http://happysight.com/claim",
"value" : "6612346"
}
],
"description": "Basic conformance statement for a Knowledge Repository Service. A server can support more functionality than defined here, but this is the minimum amount",
"kind": "capability",
"software": {
"name": "ACME Knowledge Repository Service"
},
"fhirVersion": "4.0.1",
"format": [
"json",
"xml"
],
"rest": [
"outcome" : "complete",
"disposition" : "Claim settled as per contract.",
"payeeType" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/payeetype",
"code" : "provider"
}]
},
"item" : [{
"itemSequence" : 1,
"adjudication" : [{
"category" : {
"coding" : [{
"code" : "eligible"
}]
},
"amount" : {
"value" : 235.40,
"currency" : "USD"
}
},
{
"mode": "server",
"documentation": "RESTful Knowledge Repository Service",
"security": {
"cors": true,
"service": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/restful-security-service",
"code": "Certificates"
}
]
}
]
"category" : {
"coding" : [{
"code" : "copay"
}]
},
"resource": [
"amount" : {
"value" : 20.00,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [{
"code" : "eligpercent"
}]
},
"value" : 80.00
},
{
"category" : {
"coding" : [{
"code" : "benefit"
}]
},
"amount" : {
"value" : 172.32,
"currency" : "USD"
}
}],
"detail" : [{
"detailSequence" : 1,
"noteNumber" : [1],
"adjudication" : [{
"category" : {
"coding" : [{
"code" : "eligible"
}]
},
"amount" : {
"value" : 100.00,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [{
"code" : "copay"
}]
},
"amount" : {
"value" : 20.00,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [{
"code" : "eligpercent"
}]
},
"value" : 80.00
},
{
"category" : {
"coding" : [{
"code" : "benefit"
}]
},
"amount" : {
"value" : 80.00,
"currency" : "USD"
}
}]
},
{
"detailSequence" : 2,
"noteNumber" : [1],
"adjudication" : [{
"category" : {
"coding" : [{
"code" : "eligible"
}]
},
"amount" : {
"value" : 110.00,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [{
"code" : "eligpercent"
}]
},
"value" : 80.00
},
{
"category" : {
"coding" : [{
"code" : "benefit"
}]
},
"amount" : {
"value" : 88.00,
"currency" : "USD"
}
}],
"subDetail" : [{
"subDetailSequence" : 1,
"noteNumber" : [1],
"adjudication" : [{
"category" : {
"coding" : [{
"code" : "eligible"
}]
},
"amount" : {
"value" : 60.00,
"currency" : "USD"
}
},
{
"type": "Library",
"profile": "StructureDefinition/Library",
"interaction": [
{
"code": "read",
"documentation": "Read allows clients to get the logical definitions of the libraries"
},
{
"code": "search-type",
"documentation": "Search allows clients to filter libraries based on a provided search parameter"
}
],
"searchParam": [
{
"name": "description",
"definition": "http://hl7.org/fhir/SearchParameter/Library-description",
"type": "string"
},
{
"name": "identifier",
"definition": "http://hl7.org/fhir/SearchParameter/Library-identifier",
"type": "token"
},
{
"name": "status",
"definition": "http://hl7.org/fhir/SearchParameter/Library-status",
"type": "token"
},
{
"name": "title",
"definition": "http://hl7.org/fhir/SearchParameter/Library-title",
"type": "string"
},
{
"name": "topic",
"definition": "http://hl7.org/fhir/SearchParameter/Library-topic",
"type": "token"
},
{
"name": "version",
"definition": "http://hl7.org/fhir/SearchParameter/Library-version",
"type": "string"
},
{
"name": "composed-of",
"definition": "http://hl7.org/fhir/SearchParameter/Library-composed-of",
"type": "reference"
},
{
"name": "depends-on",
"definition": "http://hl7.org/fhir/SearchParameter/Library-depends-on",
"type": "reference"
},
{
"name": "derived-from",
"definition": "http://hl7.org/fhir/SearchParameter/Library-derived-from",
"type": "reference"
},
{
"name": "predecessor",
"definition": "http://hl7.org/fhir/SearchParameter/Library-predecessor",
"type": "reference"
},
{
"name": "successor",
"definition": "http://hl7.org/fhir/SearchParameter/Library-successor",
"type": "reference"
}
]
"category" : {
"coding" : [{
"code" : "eligpercent"
}]
},
"value" : 80.00
},
{
"type": "PlanDefinition",
"profile": "StructureDefinition/PlanDefinition",
"interaction": [
{
"code": "read",
"documentation": "Read allows clients to get the logical definitions of the plan definitions"
},
{
"code": "search-type",
"documentation": "Search allows clients to filter plan definitions based on a provided search parameter"
}
],
"searchParam": [
{
"name": "description",
"definition": "http://hl7.org/fhir/SearchParameter/PlanDefinition-description",
"type": "string"
},
{
"name": "identifier",
"definition": "http://hl7.org/fhir/SearchParameter/PlanDefinition-identifier",
"type": "token"
},
{
"name": "status",
"definition": "http://hl7.org/fhir/SearchParameter/PlanDefinition-status",
"type": "token"
},
{
"name": "title",
"definition": "http://hl7.org/fhir/SearchParameter/PlanDefinition-title",
"type": "string"
},
{
"name": "topic",
"definition": "http://hl7.org/fhir/SearchParameter/PlanDefinition-topic",
"type": "token"
},
{
"name": "version",
"definition": "http://hl7.org/fhir/SearchParameter/PlanDefinition-version",
"type": "string"
},
{
"name": "composed-of",
"definition": "http://hl7.org/fhir/SearchParameter/PlanDefinition-composed-of",
"type": "reference"
},
{
"name": "depends-on",
"definition": "http://hl7.org/fhir/SearchParameter/PlanDefinition-depends-on",
"type": "reference"
},
{
"name": "derived-from",
"definition": "http://hl7.org/fhir/SearchParameter/PlanDefinition-derived-from",
"type": "reference"
},
{
"name": "predecessor",
"definition": "http://hl7.org/fhir/SearchParameter/PlanDefinition-predecessor",
"type": "reference"
},
{
"name": "successor",
"definition": "http://hl7.org/fhir/SearchParameter/PlanDefinition-successor",
"type": "reference"
}
]
"category" : {
"coding" : [{
"code" : "benefit"
}]
},
"amount" : {
"value" : 48.00,
"currency" : "USD"
}
}]
},
{
"subDetailSequence" : 2,
"adjudication" : [{
"category" : {
"coding" : [{
"code" : "eligible"
}]
},
"amount" : {
"value" : 30.00,
"currency" : "USD"
}
},
{
"type": "ActivityDefinition",
"profile": "StructureDefinition/ActivityDefinition",
"interaction": [
{
"code": "read",
"documentation": "Read allows clients to get the logical definitions of the activity definitions"
},
{
"code": "search-type",
"documentation": "Search allows clients to filter activity definitions based on a provided search parameter"
}
],
"searchParam": [
{
"name": "description",
"definition": "http://hl7.org/fhir/SearchParameter/ActivityDefinition-description",
"type": "string"
},
{
"name": "identifier",
"definition": "http://hl7.org/fhir/SearchParameter/ActivityDefinition-identifier",
"type": "token"
},
{
"name": "status",
"definition": "http://hl7.org/fhir/SearchParameter/ActivityDefinition-status",
"type": "token"
},
{
"name": "title",
"definition": "http://hl7.org/fhir/SearchParameter/ActivityDefinition-title",
"type": "string"
},
{
"name": "topic",
"definition": "http://hl7.org/fhir/SearchParameter/ActivityDefinition-topic",
"type": "token"
},
{
"name": "version",
"definition": "http://hl7.org/fhir/SearchParameter/ActivityDefinition-version",
"type": "string"
},
{
"name": "composed-of",
"definition": "http://hl7.org/fhir/SearchParameter/ActivityDefinition-composed-of",
"type": "reference"
},
{
"name": "depends-on",
"definition": "http://hl7.org/fhir/SearchParameter/ActivityDefinition-depends-on",
"type": "reference"
},
{
"name": "derived-from",
"definition": "http://hl7.org/fhir/SearchParameter/ActivityDefinition-derived-from",
"type": "reference"
},
{
"name": "predecessor",
"definition": "http://hl7.org/fhir/SearchParameter/ActivityDefinition-predecessor",
"type": "reference"
},
{
"name": "successor",
"definition": "http://hl7.org/fhir/SearchParameter/ActivityDefinition-successor",
"type": "reference"
}
]
"category" : {
"coding" : [{
"code" : "eligpercent"
}]
},
"value" : 80.00
},
{
"type": "Measure",
"profile": "StructureDefinition/Measure",
"interaction": [
{
"code": "read",
"documentation": "Read allows clients to get the logical definitions of the measures"
},
{
"code": "search-type",
"documentation": "Search allows clients to filter measures based on a provided search parameter"
}
],
"searchParam": [
{
"name": "description",
"definition": "http://hl7.org/fhir/SearchParameter/Measure-description",
"type": "string"
},
{
"name": "identifier",
"definition": "http://hl7.org/fhir/SearchParameter/Measure-identifier",
"type": "token"
},
{
"name": "status",
"definition": "http://hl7.org/fhir/SearchParameter/Measure-status",
"type": "token"
},
{
"name": "title",
"definition": "http://hl7.org/fhir/SearchParameter/Measure-title",
"type": "string"
},
{
"name": "topic",
"definition": "http://hl7.org/fhir/SearchParameter/Measure-topic",
"type": "token"
},
{
"name": "version",
"definition": "http://hl7.org/fhir/SearchParameter/Measure-version",
"type": "string"
},
{
"name": "composed-of",
"definition": "http://hl7.org/fhir/SearchParameter/Measure-composed-of",
"type": "reference"
},
{
"name": "depends-on",
"definition": "http://hl7.org/fhir/SearchParameter/Measure-depends-on",
"type": "reference"
},
{
"name": "derived-from",
"definition": "http://hl7.org/fhir/SearchParameter/Measure-derived-from",
"type": "reference"
},
{
"name": "predecessor",
"definition": "http://hl7.org/fhir/SearchParameter/Measure-predecessor",
"type": "reference"
},
{
"name": "successor",
"definition": "http://hl7.org/fhir/SearchParameter/Measure-successor",
"type": "reference"
}
]
"category" : {
"coding" : [{
"code" : "benefit"
}]
},
"amount" : {
"value" : 24.00,
"currency" : "USD"
}
}]
},
{
"subDetailSequence" : 3,
"noteNumber" : [1],
"adjudication" : [{
"category" : {
"coding" : [{
"code" : "eligible"
}]
},
"amount" : {
"value" : 10.00,
"currency" : "USD"
}
},
{
"type": "Questionnaire",
"profile": "StructureDefinition/Questionnaire",
"interaction": [
{
"code": "read",
"documentation": "Read allows clients to get the logical definitions of the measures"
},
{
"code": "search-type",
"documentation": "Search allows clients to filter measures based on a provided search parameter"
}
],
"searchParam": [
{
"name": "code",
"definition": "http://hl7.org/fhir/SearchParameter/Questionnaire-code",
"type": "token"
},
{
"name": "context",
"definition": "http://hl7.org/fhir/SearchParameter/Questionnaire-context",
"type": "token"
},
{
"name": "date",
"definition": "http://hl7.org/fhir/SearchParameter/Questionnaire-date",
"type": "date"
},
{
"name": "identifier",
"definition": "http://hl7.org/fhir/SearchParameter/Questionnaire-identifier",
"type": "token"
},
{
"name": "publisher",
"definition": "http://hl7.org/fhir/SearchParameter/Questionnaire-publisher",
"type": "string"
},
{
"name": "status",
"definition": "http://hl7.org/fhir/SearchParameter/Questionnaire-status",
"type": "token"
},
{
"name": "title",
"definition": "http://hl7.org/fhir/SearchParameter/Questionnaire-title",
"type": "string"
},
{
"name": "version",
"definition": "http://hl7.org/fhir/SearchParameter/Questionnaire-version",
"type": "string"
}
]
}
],
"operation": [
"category" : {
"coding" : [{
"code" : "eligpercent"
}]
},
"value" : 80.00
},
{
"name": "data-requirements",
"definition": "OperationDefinition/Library-data-requirements"
"category" : {
"coding" : [{
"code" : "benefit"
}]
},
"amount" : {
"value" : 8.00,
"currency" : "USD"
}
}]
}]
},
{
"detailSequence" : 3,
"noteNumber" : [1],
"adjudication" : [{
"category" : {
"coding" : [{
"code" : "eligible"
}]
},
"amount" : {
"value" : 200.00,
"currency" : "USD"
}
]
},
{
"category" : {
"coding" : [{
"code" : "eligpercent"
}]
},
"value" : 80.00
},
{
"category" : {
"coding" : [{
"code" : "benefit"
}]
},
"amount" : {
"value" : 14.00,
"currency" : "USD"
}
}]
}]
}],
"total" : [{
"category" : {
"coding" : [{
"code" : "submitted"
}]
},
"amount" : {
"value" : 235.40,
"currency" : "USD"
}
]
},
{
"category" : {
"coding" : [{
"code" : "benefit"
}]
},
"amount" : {
"value" : 182.00,
"currency" : "USD"
}
}],
"payment" : {
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/ex-paymenttype",
"code" : "complete"
}]
},
"adjustment" : {
"value" : 75.00,
"currency" : "USD"
},
"adjustmentReason" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/payment-adjustment-reason",
"code" : "a002",
"display" : "Prior Overpayment"
}]
},
"date" : "2014-08-16",
"amount" : {
"value" : 107.00,
"currency" : "USD"
},
"identifier" : {
"system" : "http://thebenefitcompany.com/paymentidentifier",
"value" : "201416-123456"
}
},
"processNote" : [{
"number" : 1,
"type" : "display",
"text" : "After hours surcharge declined",
"language" : {
"coding" : [{
"system" : "urn:ietf:bcp:47",
"code" : "en-CA"
}]
}
}]
}
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.
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