This page is part of the FHIR Specification (v5.0.0-ballot: FHIR R5 Ballot Preview). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2
Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson |
Raw JSON (canonical form + also see JSON Format Specification)
Simple Institutional Service Claim
{ "resourceType": "Claim", "id": "960150", "text": { "status": "generated", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Claim</div>" }, "identifier": [ { "system": "http://happyhospital.com/claim", "value": "9612345" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "institutional" } ] }, "subType": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/ex-claimsubtype", "code": "emergency" } ] }, "use": "claim", "patient": { "reference": "Patient/1" }, "created": "2014-08-16", "enterer": { "identifier": { "system": "http://jurisdiction.org/facilities/HOSP1234/users", "value": "UC1234" } }, "insurer": { "reference": "Organization/2" }, "provider": { "reference": "Organization/1" }, "priority": { "coding": [ { "code": "normal" } ] }, "payee": { "type": { "coding": [ { "code": "provider" } ] } }, "facility": { "identifier": { "system": "http://jurisdiction.org/facilities", "value": "HOSP1234" } }, "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner/example" } } ], "diagnosis": [ { "sequence": 1, "diagnosisCodeableConcept": { "coding": [ { "code": "654456" } ] } } ], "procedure": [ { "sequence": 1, "type": [ { "coding": [ { "code": "primary" } ] } ], "date": "2014-08-16", "procedureCodeableConcept": { "coding": [ { "code": "SDI9901" } ], "text": "Subcutaneous diagnostic implant" }, "udi": [ { "reference": "Device/example" } ] } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "Coverage/9876B1" } } ], "item": [ { "sequence": 1, "careTeamSequence": [ 1 ], "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/ex-serviceproduct", "code": "exam" } ] }, "servicedDate": "2014-08-16", "unitPrice": { "value": 125.00, "currency": "USD" }, "net": { "value": 125.00, "currency": "USD" }, "encounter": [ { "reference": "Encounter/example" } ] } ], "total": { "value": 125.00, "currency": "USD" } }
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.