Claim-example-institutional.json

Simple Institutional Service Claim

{
  "resourceType": "Claim",
  "id": "960150",
  "text": {
    "status": "generated",
    "div": "<div>A human-readable rendering of the Claim</div>"
  },
  "type": "institutional",
  "identifier": [
    {
      "system": "http://happyhospital.com/claim",
      "value": "9612345"
    }
  ],
  "created": "2014-08-16",
  "targetReference": {
    "reference": "Organization/2"
  },
  "organizationReference": {
    "reference": "Organization/1"
  },
  "use": "complete",
  "priority": {
    "code": "normal"
  },
  "entererIdentifier": {
    "system": "http://jurisdiction.org/facilities/HOSP1234/users",
    "value": "UC1234"
  },
  "facilityIdentifier": {
    "system": "http://jurisdiction.org/facilities",
    "value": "HOSP1234"
  },
  "payee": {
    "type": {
      "code": "provider"
    }
  },
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosis": {
        "code": "654456"
      }
    }
  ],
  "patientReference": {
    "reference": "Patient/1"
  },
  "coverage": [
    {
      "sequence": 1,
      "focal": true,
      "coverageReference": {
        "reference": "Coverage/9876B1"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "type": {
        "code": "service"
      },
      "providerReference": {
        "reference": "Practitioner/example"
      },
      "service": {
        "system": "http://hl7.org/fhir/ex-serviceproduct",
        "code": "exam"
      },
      "servicedDate": "2014-08-16",
      "unitPrice": {
        "value": 125.00,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "net": {
        "value": 125.00,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    }
  ],
  "total": {
    "value": 125.00,
    "system": "urn:iso:std:iso:4217",
    "code": "USD"
  }
}