Da Vinci Postable Remittance
1.0.0 - STU 1 United States of America flag

This page is part of the DaVinci Postable Remittance FHIR Implementation Guide (v1.0.0: STU 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: ExampleSearchResult - JSON Representation

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{
  "resourceType" : "Parameters",
  "id" : "ExampleSearchResult",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-pr/StructureDefinition/searchResultParameters"
    ]
  },
  "parameter" : [
    {
      "name" : "TIN",
      "valueString" : "123485858"
    },
    {
      "name" : "Payer",
      "part" : [
        {
          "name" : "PayerID",
          "valueString" : "52415"
        },
        {
          "name" : "PayerName",
          "valueString" : "Acme Payment Inc"
        }
      ]
    },
    {
      "name" : "Claim",
      "part" : [
        {
          "name" : "ProviderClaimID",
          "valueString" : "12345V54321"
        },
        {
          "name" : "ClaimReceivedDate",
          "valueDate" : "2023-10-05"
        },
        {
          "name" : "ProviderID",
          "valueString" : "52415"
        },
        {
          "name" : "PayerClaimID",
          "valueString" : "TYU7894562"
        },
        {
          "name" : "PaymentInfo",
          "part" : [
            {
              "name" : "PaymentDate",
              "valueDate" : "2023-11-02"
            },
            {
              "name" : "PaymentNumber",
              "valueString" : "A12385858"
            },
            {
              "name" : "PaymentAmount",
              "valueMoney" : {
                "value" : 30,
                "currency" : "USD"
              }
            },
            {
              "name" : "Remittance",
              "part" : [
                {
                  "name" : "RemittanceAdviceIdentifier",
                  "valueString" : "A123456BCDEF"
                },
                {
                  "name" : "RemittanceAdviceType",
                  "valueCode" : "application/EDI-X12"
                },
                {
                  "name" : "RemittanceAdviceDate",
                  "valueDate" : "2023-11-02"
                },
                {
                  "name" : "RemittanceAdviceFileSize",
                  "valueInteger" : 1536
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name" : "Claim",
      "part" : [
        {
          "name" : "ProviderClaimID",
          "valueString" : "12345V54321"
        },
        {
          "name" : "ClaimReceivedDate",
          "valueDate" : "2023-10-04"
        },
        {
          "name" : "ProviderID",
          "valueString" : "52415"
        },
        {
          "name" : "PayerClaimID",
          "valueString" : "TYU7894566"
        },
        {
          "name" : "PaymentInfo",
          "part" : [
            {
              "name" : "PaymentDate",
              "valueDate" : "2023-11-03"
            },
            {
              "name" : "PaymentNumber",
              "valueString" : "A12385859"
            },
            {
              "name" : "PaymentAmount",
              "valueMoney" : {
                "value" : 30,
                "currency" : "USD"
              }
            },
            {
              "name" : "Remittance",
              "part" : [
                {
                  "name" : "RemittanceAdviceIdentifier",
                  "valueString" : "A123456BCDXY"
                },
                {
                  "name" : "RemittanceAdviceType",
                  "valueCode" : "application/EDI-X12"
                },
                {
                  "name" : "RemittanceAdviceDate",
                  "valueDate" : "2023-11-04"
                },
                {
                  "name" : "RemittanceAdviceFileSize",
                  "valueInteger" : 2048
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "name" : "Patient",
      "part" : [
        {
          "name" : "DateOfBirth",
          "valueDate" : "1970-11-27"
        },
        {
          "name" : "PatientID",
          "valueString" : "M12345513215"
        },
        {
          "name" : "PatientFirstName",
          "valueString" : "Adam"
        },
        {
          "name" : "PatientLastName",
          "valueString" : "Patient"
        }
      ]
    }
  ]
}