QI-Core Implementation Guide
7.0.0 - STU 7 United States of America flag

This page is part of the Quality Improvement Core Framework (v7.0.0: STU7 (v7.0.0)) 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

Page standards status: Informative

status: Active

type: Vision

use: Preauthorization

patient: Jim Chalmers Male, DoB: 1974-12-25 ( Medical record number (use: usual, period: 2001-05-06 --> (ongoing)))

created: 2018-02-24

insurer: Organization Health Level Seven International

requestor: Practitioner Adam Careful

request: Claim: identifier = http://example.org/claim#6612346; status = active; type = Vision; use = claim; created = 2014-08-16; priority = Normal

outcome: Queued

item

itemSequence: 1

adjudication

category: Submitted Amount

Amounts

-ValueCurrency
*235.40United States dollar