QI-Core Implementation Guide
5.0.0-ballot - STU Ballot US

This page is part of the Quality Improvement Core Framework (v5.0.0-ballot: STU 5 Ballot 1) based on FHIR R4. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions

Example Claim: Claim example

Generated Narrative: Claim

Resource Claim "example"

Profile: QICoreClaim

identifier: id: 6612346

status: active

type: Vision (Claim Type Codes#vision)

use: claim

patient: Patient/example " CHALMERS"

created: 2014-08-16

insurer: Organization/example "Health Level Seven International"

provider: Practitioner/example " CAREFUL"

priority: Normal (Process Priority Codes#normal)

prescription: MedicationRequest/example

Payees

-TypeParty
*Provider (ClaimPayeeTypeCodes#provider)Practitioner/example " CAREFUL"

CareTeams

-SequenceProvider
*1Practitioner/example " CAREFUL"

Diagnoses

-SequenceDiagnosis[x]
*1654321 (CodeSystem#654321)

Insurances

-SequenceFocalCoverage
*1trueCoverage/example

item

sequence: 1

careTeamSequence: 1

productOrService: glasses (ex-visionservice#glasses)

serviced: 2014-08-16

detail

sequence: 1

productOrService: frame (ex-visionservice#frame)

detail

sequence: 2

productOrService: lens (ex-visionservice#lens)

quantity: 2

detail

sequence: 3

productOrService: fst (ex-visionservice#fst)

factor: 0.07