Kenya eClaims FHIR IG - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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: ClaimResponse - Example - JSON Representation

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{
  "resourceType" : "ClaimResponse",
  "id" : "a236b53e-0144-41f4-a3d9-99a3fed76c35",
  "meta" : {
    "versionId" : "2",
    "lastUpdated" : "2025-01-04T11:03:06+03:00",
    "source" : "#e4fd6c167838fdfb",
    "profile" : [
      🔗 "https://example.com/fhir/StructureDefinition/eclaims-claimresponse"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse a236b53e-0144-41f4-a3d9-99a3fed76c35</b></p><a name=\"a236b53e-0144-41f4-a3d9-99a3fed76c35\"> </a><a name=\"hca236b53e-0144-41f4-a3d9-99a3fed76c35\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">version: 2; Last updated: 2025-01-04 11:03:06+0300; </p><p style=\"margin-bottom: 0px\">Information Source: #e4fd6c167838fdfb</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-eclaims-claimresponse.html\">ClaimResponse Profile</a></p></div><p><b>com/fhir/StructureDefinition/claim-state-extension</b>: <span title=\"Codes:{https://uat-mis.apeiro-digital.com/fhir/CodeSystem/claim-state approved}\">Approved</span></p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"http://hl7.org/fhir/us/core/STU4/Patient-example.html\">Amy V. Shaw  Female, DoB: 1987-02-20 ( Medical Record Number:\u00a01032702\u00a0(use:\u00a0usual,\u00a0))</a></p><p><b>created</b>: 2025-01-04 11:00:00+0300</p><p><b>insurer</b>: <a href=\"Organization/insurer-example\">Organization/insurer-example</a></p><p><b>request</b>: <a href=\"Claim-f6dc7f9e-1558-4b92-adbd-447771c7b2f9.html\">Claim: identifier = https://uat-mis.apeiro-digital.com/fhir/claim#f6dc7f9e-1558-4b92-adbd-447771c7b2f9; status = active; type = Institutional; subType = op; use = preauthorization; billablePeriod = 2025-01-04 --&gt; 2025-01-05; created = 2025-01-03; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:\">benefit</span></p><p><b>reason</b>: <span title=\"Codes:\">Auto Approved.</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>50</td><td>KSH</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:\">submitted</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>50</td><td>KSH</td></tr></table></blockquote></div>"
  },
  "extension" : [
    {
      "url" : "https://uat-mis.apeiro-digital.com/fhir/StructureDefinition/claim-state-extension",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "https://uat-mis.apeiro-digital.com/fhir/CodeSystem/claim-state",
            "code" : "approved",
            "display" : "Approved"
          }
        ]
      }
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "professional",
        "display" : "Professional"
      }
    ]
  },
  "use" : "claim",
  "patient" : {
    "reference" : "Patient/example"
  },
  "created" : "2025-01-04T11:00:00+03:00",
  "insurer" : {
    "reference" : "Organization/insurer-example"
  },
  "request" : {
    🔗 "reference" : "Claim/f6dc7f9e-1558-4b92-adbd-447771c7b2f9"
  },
  "outcome" : "complete",
  "item" : [
    {
      "itemSequence" : 1,
      "adjudication" : [
        {
          "category" : {
            "text" : "benefit"
          },
          "reason" : {
            "text" : "Auto Approved."
          },
          "amount" : {
            "value" : 50,
            "currency" : "KSH"
          }
        }
      ]
    }
  ],
  "total" : [
    {
      "category" : {
        "text" : "submitted"
      },
      "amount" : {
        "value" : 50,
        "currency" : "KSH"
      }
    }
  ]
}