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 ClaimResponse: ClaimResponse example

Generated Narrative: ClaimResponse

Resource ClaimResponse "example"

Profile: QICore Claim Response

status: active

type: Vision (Claim Type Codes#vision)

use: preauthorization

patient: Patient/example " CHALMERS"

created: 2018-02-24

insurer: Organization/example "Health Level Seven International"

requestor: Practitioner/example " CAREFUL"

request: Claim/example

outcome: queued

item

itemSequence: 1

adjudication

category: Submitted Amount (Adjudication Value Codes#submitted)