Claim-example-oral-identifier.xml

SOA Dental Claim using identifiers (id = "100154")

<Claim xmlns="http://hl7.org/fhir">
  <id value="100154"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">This example assumes a national health care scheme where patients, providers and organizations
       have known business identifiers.</div> 
  </text> 
  
  <identifier> 
    <system value="http://happyvalley.com/claim"/> 
    <value value="12347"/> 
  </identifier> 
  
  <status value="active"/> 

  <type> 
   <coding> 
    <system value="http://hl7.org/fhir/ex-claimtype"/> 
    <code value="oral"/> 
   </coding> 
  </type> 
  
  <use value="complete"/> 

  <patient> 
  <identifier> 
      <system value="http://www.jurisdiction.com/nationalId"/> 
      <value value="123AB345"/> 
  </identifier> 
  </patient> 
    
  <created value="2014-08-16"/> 
  
  <insurer> 
  <identifier> 
      <system value="http://www.jurisdiction.com/insurers"/> 
      <value value="123456"/> 
  </identifier> 
  </insurer> 
  
  <organization> 
  <identifier> 
      <system value="http://www.jurisdiction.com/careorganizations"/> 
      <value value="HOSP12345"/> 
  </identifier> 
  </organization> 
  
  <priority> 
   <coding> 
    <code value="normal"/> 
   </coding> 
  </priority> 
  
  <payee> 
    <type> 
   <coding> 
      <code value="provider"/> 
     </coding> 
  </type> 
  </payee> 

    <careTeam> 
    <sequence value="1"/> 
      <provider> 
     <identifier> 
        <system value="http://www.jurisdiction.com/providerId"/> 
        <value value="MD98765"/> 
     </identifier> 
      </provider> 
    </careTeam> 
  
  <diagnosis> 
    <sequence value="1"/> 
    <diagnosisCodeableConcept> 
   <coding> 
      <code value="123456"/> 
     </coding> 
  </diagnosisCodeableConcept> 
  </diagnosis> 
  
  <insurance> 
    <sequence value="1"/> 
    <focal value="true"/> 
    <coverage> 
   <identifier> 
      <system value="http://www.jurisdiction.com/nationalplan"/> 
      <value value="123AB345"/> 
   </identifier> 
    </coverage> 
  </insurance> 
  
  <item> 
    <sequence value="1"/> 
    <careTeamSequence value="1"/> 
    <service> 
   <coding> 
      <code value="1200"/> 
   </coding> 
    </service> 
    <servicedDate value="2014-08-16"/> 
    <unitPrice> 
      <value value="135.57"/> 
      <system value="urn:iso:std:iso:4217"/> 
      <code value="USD"/> 
    </unitPrice> 
    <net> 
      <value value="135.57"/> 
      <system value="urn:iso:std:iso:4217"/> 
      <code value="USD"/> 
    </net> 
  </item> 
</Claim>