Claim-example-oral-identifier.json

SOA Dental Claim using identifiers

{
  "resourceType": "Claim",
  "id": "100154",
  "text": {
    "status": "generated",
    "div": "<div>This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.</div>"
  },
  "type": "oral",
  "identifier": [
    {
      "system": "http://happyvalley.com/claim",
      "value": "12347"
    }
  ],
  "created": "2014-08-16",
  "targetIdentifier": {
    "system": "http://www.jurisdiction.com/insurers",
    "value": "123456"
  },
  "organizationIdentifier": {
    "system": "http://www.jurisdiction.com/careorganizations",
    "value": "HOSP12345"
  },
  "use": "complete",
  "priority": {
    "code": "normal"
  },
  "payee": {
    "type": {
      "code": "provider"
    }
  },
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosis": {
        "code": "123456"
      }
    }
  ],
  "patientIdentifier": {
    "system": "http://www.jurisdiction.com/nationalId",
    "value": "123AB345"
  },
  "coverage": [
    {
      "sequence": 1,
      "focal": true,
      "coverageIdentifier": {
        "system": "http://www.jurisdiction.com/nationalplan",
        "value": "123AB345"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "type": {
        "code": "service"
      },
      "providerIdentifier": {
        "system": "http://www.jurisdiction.com/providerId",
        "value": "MD98765"
      },
      "service": {
        "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"
      }
    }
  ]
}