QI-Core Implementation Guide
7.0.2 - STU 7

QI-Core Implementation Guide - Downloaded Version 7.0.2 See the Directory of published versions

## : ClaimResponse example - JSON Representation

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    {
      "resourceType" : "ClaimResponse",
      "id" : "example",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse"
        ]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse example</b></p><a name=\"example\"> </a><a name=\"hcexample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-qicore-claimresponse.html\">QICore ClaimResponse</a></p></div><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type vision}\">Vision</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-example.html\">Jim Chalmers  Male, DoB: 1974-12-25 ( Medical record number\u00a0(use:\u00a0usual,\u00a0period:\u00a02001-05-06 --&gt; (ongoing)))</a></p><p><b>created</b>: 2018-02-24</p><p><b>insurer</b>: <a href=\"Organization-example.html\">Organization Health Level Seven International</a></p><p><b>requestor</b>: <a href=\"Practitioner-example.html\">Practitioner Adam Careful </a></p><p><b>request</b>: <a href=\"Claim-example.html\">Claim: identifier = http://example.org/claim#6612346; status = active; type = Vision; use = claim; created = 2014-08-16; priority = Normal</a></p><p><b>outcome</b>: Queued</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>235.40</td><td>United States dollar</td></tr></table></blockquote></blockquote></div>"
      },
      "status" : "active",
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
            "code" : "vision"
          }
        ]
      },
      "use" : "preauthorization",
      "patient" : {
        🔗 "reference" : "Patient/example"
      },
      "created" : "2018-02-24",
      "insurer" : {
        🔗 "reference" : "Organization/example"
      },
      "requestor" : {
        🔗 "reference" : "Practitioner/example"
      },
      "request" : {
        🔗 "reference" : "Claim/example"
      },
      "outcome" : "queued",
      "item" : [
        {
          "itemSequence" : 1,
          "adjudication" : [
            {
              "category" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
                    "code" : "submitted"
                  }
                ]
              },
              "amount" : {
                "value" : 235.40,
                "currency" : "USD"
              }
            }
          ]
        }
      ]
    }