Rich Institutional Service Claim

{
  "resourceType" : "Claim",
  "id" : "960151",
  "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" : "96123451"
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "institutional"
    }]
  },
  "use" : "claim",
  "patient" : {
    "reference" : "Patient/1"
  },
  "billablePeriod" : {
    "start" : "2014-08-15",
    "end" : "2014-08-16"
  },
  "created" : "2014-08-16",
  "enterer" : {
    "identifier" : {
      "system" : "http://jurisdiction.org/facilities/HOSP1234/users",
      "value" : "UC1234"
    }
  },
  "insurer" : {
    "reference" : "Organization/2"
  },
  "provider" : {
    "identifier" : {
      "system" : "http://npid.org/providerid",
      "value" : "NJ12345"
    }
  },
  "priority" : {
    "coding" : [{
      "code" : "normal"
    }]
  },
  "payee" : {
    "type" : {
      "coding" : [{
        "code" : "provider"
      }]
    }
  },
  "facility" : {
    "identifier" : {
      "system" : "http://jurisdiction.org/facilities",
      "value" : "HOSP1234"
    }
  },
  "diagnosisRelatedGroup" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup",
      "code" : "400",
      "display" : "Head trauma - concussion"
    }]
  },
  "careTeam" : [{
    "sequence" : 1,
    "provider" : {
      "reference" : "Practitioner/example"
    },
    "responsible" : true,
    "role" : {
      "coding" : [{
        "system" : "http://example.org/fhir/CodeSystem/claim-careteamrole",
        "code" : "primary"
      }]
    },
    "specialty" : {
      "coding" : [{
        "system" : "http://example.org/fhir/CodeSystem/provider-qualification",
        "code" : "physician"
      }]
    }
  }],
  "supportingInfo" : [{
    "sequence" : 1,
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
        "code" : "employmentimpacted"
      }]
    },
    "timingPeriod" : {
      "start" : "2014-08-16",
      "end" : "2014-08-16"
    }
  },
  {
    "sequence" : 2,
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
        "code" : "hospitalized"
      }]
    },
    "timingPeriod" : {
      "start" : "2014-08-15",
      "end" : "2014-08-16"
    }
  }],
  "diagnosis" : [{
    "sequence" : 1,
    "diagnosisCodeableConcept" : {
      "coding" : [{
        "code" : "654456"
      }]
    },
    "type" : [{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
        "code" : "admitting"
      }]
    }]
  }],
  "insurance" : [{
    "sequence" : 1,
    "focal" : true,
    "coverage" : {
      "reference" : "Coverage/9876B1"
    },
    "businessArrangement" : "BA987123",
    "preAuthRef" : ["PA2014G56473"]
  }],
  "accident" : {
    "date" : "2014-07-09",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActIncidentCode",
        "code" : "SPT",
        "display" : "Sporting Accident"
      }]
    },
    "locationAddress" : {
      "text" : "Grouse Mountain Ski Hill"
    }
  },
  "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"
    }
  }],
  "total" : {
    "value" : 125.00,
    "currency" : "USD"
  }
}