QI-Core Implementation Guide
6.0.0 - STU6 United States of America flag

This page is part of the Quality Improvement Core Framework (v6.0.0: STU6 (v6.0.0)) 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

Example ClaimResponse: ClaimResponse example

Generated Narrative: ClaimResponse

Resource ClaimResponse "example"

Profile: QICore ClaimResponse

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)

Amounts

-ValueCurrency
*235.40USD