This page is part of the FHIR Specification v6.0.0-ballot1: Release 6 Ballot (1st Draft) (see Ballot Notes). The current version is 5.0.0. For a full list of available versions, see the Directory of published versions
Simple Professional Service Claim
{
"resourceType" : "Claim",
"id" : "860150",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Claim</div>"
},
"identifier" : [{
"system" : "http://happypdocs.com/claim",
"value" : "8612345"
}],
"status" : "active",
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "professional"
}]
},
"use" : "claim",
"patient" : {
"reference" : "Patient/1"
},
"created" : "2014-08-16",
"insurer" : {
"reference" : "Organization/2"
},
"provider" : {
"reference" : "Organization/1"
},
"priority" : {
"coding" : [{
"code" : "normal"
}]
},
"payee" : {
"type" : {
"coding" : [{
"code" : "provider"
}]
}
},
"careTeam" : [{
"sequence" : 1,
"provider" : {
"reference" : "Practitioner/example"
}
}],
"diagnosis" : [{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [{
"code" : "654456"
}]
}
}],
"insurance" : [{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "Coverage/9876B1"
}
}],
"item" : [{
"sequence" : 1,
"careTeamSequence" : [1],
"productOrService" : {
"coding" : [{
"system" : "http://hl7.org/fhir/ex-serviceproduct",
"code" : "exam"
}]
},
"servicedDate" : "2014-08-16",
"unitPrice" : {
"value" : 75.00,
"currency" : "USD"
},
"net" : {
"value" : 75.00,
"currency" : "USD"
}
}]
}
Usage note: every effort has been made to ensure that the
examples are correct and useful, but they are not a normative part
of the specification.