Electronic Long-Term Services and Supports (eLTSS) Release 1 - US Realm
2.0.0 - STU2 United States of America flag

This page is part of the electronic Long-Term Services and Supports Implementation Guide (v2.0.0: STU2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Example Claim: claim1

Page standards status: Informative

Generated Narrative: Claim

ResourceClaim "claim1" Version"1" Updated"2020-09-03 10:16:03-0400"

Information Source: #KZ0jzPjXDrhCiMif!

Profile: Claim_eltss

status: active

type: Professional (Claim Type Codes#professional)

use: claim

patient: Patient/patientBSJ1 " SMITH-JOHNSON"

created: 2020-05-01

provider: Organization/funding1 "Texas Department of Community Health"

priority: Normal (Process Priority Codes#normal)

Insurances

-SequenceFocalCoverage
*1trueCoverage/coverage1

item

sequence: 1

productOrService: T2003 (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes#T2003)

UnitPrices

-ValueCurrency
*60USD

Nets

-ValueCurrency
*600USD