Claim - FHIR v4.3.0

Release 4B

This page is part of the FHIR Specification (v4.3.0: R4B - STU). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

13.6.6 Resource Claim - Examples

Financial Management

Work Group

Maturity Level: N/A

Standards Status: Informative

Security Category: Patient

Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson

Example Name	id	Format
Simple dental Claim	100150	XML	JSON	Turtle
Average dental Claim with Information (Missing Teeth and Student)	100151	XML	JSON	Turtle
SOA Dental Claim (Contained)	100152	XML	JSON	Turtle
SOA Dental Claim using identifiers	100154	XML	JSON	Turtle
SOA Dental Claim using identifiers and Contained	100155	XML	JSON	Turtle
PreAuthorization with Bridge and Crown	100156	XML	JSON	Turtle
PreAuthorization with Orthodontic Treatment Plan	100153	XML	JSON	Turtle
Simple Vision Claim	660150	XML	JSON	Turtle
Glasses Claim	660151	XML	JSON	Turtle
Glasses Claim, 3 Tier, Secondary Coverage	660152	XML	JSON	Turtle
Simple Institutional Service Claim	960150	XML	JSON	Turtle
Rich Institutional Service Claim	960151	XML	JSON	Turtle
Simple Professional Service Claim	860150	XML	JSON	Turtle
Simple Pharmacy Service Claim	760150	XML	JSON	Turtle
Simple Pharmacy Medication Claim	760151	XML	JSON	Turtle
Simple Pharmacy Compound Claim	760152	XML	JSON	Turtle
Simple US Medical Surgery Claim	MED-00050	XML	JSON	Turtle

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.