Claim-example-oral-identifier.xml

SOA Dental Claim using identifiers (id = "100154")

<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://hl7.org/fhir/ex-claimtype"/>
    <code value="oral"/>
   </coding>
  </type>
  
  <use value="complete"/>

  <patient>
  <identifier>
      <system value="http://www.jurisdiction.com/nationalId"/>
      <value value="123AB345"/>
  </identifier>
  </patient>
    
  <created value="2014-08-16"/>
  
  <insurer>
  <identifier>
      <system value="http://www.jurisdiction.com/insurers"/>
      <value value="123456"/>
  </identifier>
  </insurer>
  
  <organization>
  <identifier>
      <system value="http://www.jurisdiction.com/careorganizations"/>
      <value value="HOSP12345"/>
  </identifier>
  </organization>
  
  <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"/>
    <careTeamLinkId value="1"/>
    <service>
   <coding>
      <code value="1200"/>
   </coding>
    </service>
    <servicedDate value="2014-08-16"/>
    <unitPrice>
      <value value="135.57"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="135.57"/>
      <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/>
    </net>
  </item>
</Claim>