Claim Example: claim-example-oral-identifier

Narrative

This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.

Example XML

<?xml version="1.0" encoding="UTF-8"?>

<Claim xmlns="http://hl7.org/fhir">
    <id value="100154"/>
    <text>
        <status value="generated"/>
        <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>
    </text>

    <identifier>
        <system value="http://happyvalley.com/claim"/>
        <value value="12347"/>
    </identifier>

    <status value = "active"/>

    <type>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
            <code value="oral"/>
        </coding>
    </type>

    <use value="claim"/>

    <subject>
        <identifier>
            <system value="http://www.jurisdiction.com/nationalId"/>
            <value value="123AB345"/>
        </identifier>
    </subject>

    <created value="2014-08-16"/>

    <insurer>
        <identifier>
            <system value="http://www.jurisdiction.com/insurers"/>
            <value value="123456"/>
        </identifier>
    </insurer>

    <provider>
        <identifier>
            <system value="http://www.jurisdiction.com/careorganizations"/>
            <value value="HOSP12345"/>
        </identifier>
    </provider>

    <priority>
        <coding>
            <code value="normal"/>
        </coding>
    </priority>

    <payee>
        <type>
            <coding>
                <code value="provider"/>
            </coding>
        </type>
    </payee>

    <careTeam>
        <sequence value="1"/>
        <provider>
            <identifier>
                <system value="http://www.jurisdiction.com/providerId"/>
                <value value="MD98765"/>
            </identifier>
        </provider>
    </careTeam>

    <diagnosis>
        <sequence value="1"/>
        <diagnosisCodeableConcept>
            <coding>
                <code value="123456"/>
            </coding>
        </diagnosisCodeableConcept>
    </diagnosis>

    <insurance>
        <sequence value="1"/>
        <focal value="true"/>
        <coverage>
            <identifier>
                <system value="http://www.jurisdiction.com/nationalplan"/>
                <value value="123AB345"/>
            </identifier>
        </coverage>
    </insurance>

    <item>
        <sequence value="1"/>
        <careTeamSequence value="1"/>
        <productOrService>
            <coding>
                <code value="1200"/>
            </coding>
        </productOrService>
        <servicedDate value="2014-08-16"/>
        <unitPrice>
            <value value="135.57"/>
            <currency value="USD"/>
        </unitPrice>
        <net>
            <value value="135.57"/>
            <currency value="USD"/>
        </net>
    </item>
</Claim>