QI-Core Implementation Guide
7.0.2 - STU 7

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

## Example ClaimResponse: ClaimResponse example

Page standards status: Informative

Profile: QICore ClaimResponse

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

> > - | Value | Currency
> > * | 235.40 | United States dollar