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13.6.7 Resource Claim - Examples

Financial Management icon Work GroupMaturity Level: N/AStandards Status: InformativeSecurity Category: Patient Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson

Example Name id Format
Simple dental Claim 100150 XML JSON Turtle
Average dental Claim with Information (Missing Teeth and Student) 100151 XML JSON Turtle
SOA Dental Claim (Contained) 100152 XML JSON Turtle
SOA Dental Claim using identifiers 100154 XML JSON Turtle
SOA Dental Claim using identifiers and Contained 100155 XML JSON Turtle
PreAuthorization with Bridge and Crown 100156 XML JSON Turtle
PreAuthorization with Orthodontic Treatment Plan 100153 XML JSON Turtle
Simple Vision Claim 660150 XML JSON Turtle
Glasses Claim 660151 XML JSON Turtle
Glasses Claim, 3 Tier, Secondary Coverage 660152 XML JSON Turtle
Simple Institutional Service Claim 960150 XML JSON Turtle
Rich Institutional Service Claim 960151 XML JSON Turtle
Simple Professional Service Claim 860150 XML JSON Turtle
Simple Pharmacy Service Claim 760150 XML JSON Turtle
Simple Pharmacy Medication Claim 760151 XML JSON Turtle
Simple Pharmacy Compound Claim 760152 XML JSON Turtle
Simple US Medical Surgery Claim MED-00050 XML JSON Turtle
 

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.