Finance and Insurance Service (FAIS)
1.0.0 - trial-use
Finance and Insurance Service (FAIS)
1.0.0 - trial-use
This page is part of the IHE ITI Finance and Insurance Services (v1.0.0: Publication) 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
<Bundle xmlns="http://hl7.org/fhir">
<id value="ex-claim-bundle-3"/>
<meta>
<profile
value="https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim.Bundle"/>
</meta>
<type value="collection"/>
<entry>
<fullUrl value="https://profiles.ihe.net/ITI/FAIS/Claim/ex-claim-3"/>
<resource>
<Claim>
<id value="ex-claim-3"/>
<meta>
<profile
value="https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Claim_ex-claim-3"> </a><p class="res-header-id"><b>Generated Narrative: Claim ex-claim-3</b></p><a name="ex-claim-3"> </a><a name="hcex-claim-3"> </a><a name="ex-claim-3-en-US"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}">Institutional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href="Patient-ex-beneficiary-1.html">Purity Atieno Female, DoB: 2000-05-04</a></p><p><b>created</b>: 2024-07-15 03:00:00+0000</p><p><b>enterer</b>: <a href="Practitioner-ex-doctor-2.html">Practitioner Kalu Kalu </a></p><p><b>insurer</b>: <a href="Organization-ex-insurer-1.html">Organization National Health Insurance Scheme</a></p><p><b>provider</b>: <a href="Practitioner-ex-doctor-2.html">Practitioner Kalu Kalu </a></p><p><b>priority</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}">Normal</span></p><h3>Payees</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}">Provider</span></td><td><a href="Organization-ex-network-1.html">Organization National Health Hospital System</a></td></tr></table><p><b>facility</b>: <a href="Location-ex-hospital-2.html">Location Local Hospital</a></p><h3>Diagnoses</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style="display: none">*</td><td>1</td><td><span title="Codes:{http://id.who.int/icd/release/11/mms XH1VB1}">Hybrid oncocytic chromophobe tumour</span></td></tr></table><h3>Procedures</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Procedure[x]</b></td></tr><tr><td style="display: none">*</td><td>1</td><td><span title="Codes:{http://loinc.org 21946-9}">Chemotherapy treatment Cancer</span></td></tr></table><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>true</td><td><a href="Coverage-ex-coverage-1.html">Coverage: status = active; type = public healthcare; subscriberId = 05710b56-4448-11ef-b676-774a043da147; relationship = Self; period = 2024-01-01 --> 2024-12-31</a></td></tr></table></div>
</text>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="institutional"/>
</coding>
</type>
<use value="claim"/>
<patient>🔗
<reference value="Patient/ex-beneficiary-1"/>
</patient>
<created value="2024-07-15T03:00:00Z"/>
<enterer>🔗
<reference value="Practitioner/ex-doctor-2"/>
</enterer>
<insurer>🔗
<reference value="Organization/ex-insurer-1"/>
</insurer>
<provider>🔗
<reference value="Practitioner/ex-doctor-2"/>
</provider>
<priority>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/processpriority"/>
<code value="normal"/>
</coding>
</priority>
<payee>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/payeetype"/>
<code value="provider"/>
</coding>
</type>
<party>🔗
<reference value="Organization/ex-network-1"/>
</party>
</payee>
<facility>🔗
<reference value="Location/ex-hospital-2"/>
</facility>
<diagnosis>
<sequence value="1"/>
<diagnosisCodeableConcept>
<coding>
<system value="http://id.who.int/icd/release/11/mms"/>
<code value="XH1VB1"/>
<display value="Hybrid oncocytic chromophobe tumour"/>
</coding>
</diagnosisCodeableConcept>
</diagnosis>
<procedure>
<sequence value="1"/>
<procedureCodeableConcept>
<coding>
<system value="http://loinc.org"/>
<code value="21946-9"/>
<display value="Chemotherapy treatment Cancer"/>
</coding>
</procedureCodeableConcept>
</procedure>
<insurance>
<sequence value="1"/>
<focal value="true"/>
<coverage>🔗
<reference value="Coverage/ex-coverage-1"/>
</coverage>
</insurance>
</Claim>
</resource>
</entry>
<entry>
<fullUrl
value="https://profiles.ihe.net/ITI/FAIS/Patient/ex-beneficiary-1"/>
<resource>
<Patient>
<id value="ex-beneficiary-1"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_ex-beneficiary-1"> </a><p class="res-header-id"><b>Generated Narrative: Patient ex-beneficiary-1</b></p><a name="ex-beneficiary-1"> </a><a name="hcex-beneficiary-1"> </a><a name="ex-beneficiary-1-en-US"> </a><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">Purity Atieno Female, DoB: 2000-05-04</p><hr/></div>
</text>
<name>
<family value="Atieno"/>
<given value="Purity"/>
</name>
<gender value="female"/>
<birthDate value="2000-05-04"/>
</Patient>
</resource>
</entry>
<entry>
<fullUrl
value="https://profiles.ihe.net/ITI/FAIS/Practitioner/ex-doctor-2"/>
<resource>
<Practitioner>
<id value="ex-doctor-2"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_ex-doctor-2"> </a><p class="res-header-id"><b>Generated Narrative: Practitioner ex-doctor-2</b></p><a name="ex-doctor-2"> </a><a name="hcex-doctor-2"> </a><a name="ex-doctor-2-en-US"> </a><p><b>name</b>: Kalu Kalu </p></div>
</text>
<name>
<family value="Kalu"/>
<given value="Kalu"/>
</name>
</Practitioner>
</resource>
</entry>
<entry>
<fullUrl
value="https://profiles.ihe.net/ITI/FAIS/Organization/ex-insurer-1"/>
<resource>
<Organization>
<id value="ex-insurer-1"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_ex-insurer-1"> </a><p class="res-header-id"><b>Generated Narrative: Organization ex-insurer-1</b></p><a name="ex-insurer-1"> </a><a name="hcex-insurer-1"> </a><a name="ex-insurer-1-en-US"> </a><p><b>name</b>: National Health Insurance Scheme</p></div>
</text>
<name value="National Health Insurance Scheme"/>
</Organization>
</resource>
</entry>
<entry>
<fullUrl
value="https://profiles.ihe.net/ITI/FAIS/Organization/ex-network-1"/>
<resource>
<Organization>
<id value="ex-network-1"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_ex-network-1"> </a><p class="res-header-id"><b>Generated Narrative: Organization ex-network-1</b></p><a name="ex-network-1"> </a><a name="hcex-network-1"> </a><a name="ex-network-1-en-US"> </a><p><b>name</b>: National Health Hospital System</p></div>
</text>
<name value="National Health Hospital System"/>
</Organization>
</resource>
</entry>
<entry>
<fullUrl
value="https://profiles.ihe.net/ITI/FAIS/Location/ex-hospital-2"/>
<resource>
<Location>
<id value="ex-hospital-2"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Location_ex-hospital-2"> </a><p class="res-header-id"><b>Generated Narrative: Location ex-hospital-2</b></p><a name="ex-hospital-2"> </a><a name="hcex-hospital-2"> </a><a name="ex-hospital-2-en-US"> </a><p><b>name</b>: Local Hospital</p></div>
</text>
<name value="Local Hospital"/>
</Location>
</resource>
</entry>
<entry>
<fullUrl
value="https://profiles.ihe.net/ITI/FAIS/Coverage/ex-coverage-1"/>
<resource>
<Coverage>
<id value="ex-coverage-1"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Coverage_ex-coverage-1"> </a><p class="res-header-id"><b>Generated Narrative: Coverage ex-coverage-1</b></p><a name="ex-coverage-1"> </a><a name="hcex-coverage-1"> </a><a name="ex-coverage-1-en-US"> </a><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode PUBLICPOL}">public healthcare</span></p><p><b>policyHolder</b>: <a href="Patient-ex-beneficiary-1.html">Purity Atieno Female, DoB: 2000-05-04</a></p><p><b>subscriber</b>: <a href="Patient-ex-beneficiary-1.html">Purity Atieno Female, DoB: 2000-05-04</a></p><p><b>subscriberId</b>: 05710b56-4448-11ef-b676-774a043da147</p><p><b>beneficiary</b>: <a href="Patient-ex-beneficiary-1.html">Purity Atieno Female, DoB: 2000-05-04</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}">Self</span></p><p><b>period</b>: 2024-01-01 --> 2024-12-31</p><p><b>payor</b>: <a href="Organization-ex-insurer-1.html">Organization National Health Insurance Scheme</a></p></div>
</text>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="PUBLICPOL"/>
<display value="public healthcare"/>
</coding>
</type>
<policyHolder>🔗
<reference value="Patient/ex-beneficiary-1"/>
</policyHolder>
<subscriber>🔗
<reference value="Patient/ex-beneficiary-1"/>
</subscriber>
<subscriberId value="05710b56-4448-11ef-b676-774a043da147"/>
<beneficiary>🔗
<reference value="Patient/ex-beneficiary-1"/>
</beneficiary>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
<code value="self"/>
<display value="Self"/>
</coding>
</relationship>
<period>
<start value="2024-01-01"/>
<end value="2024-12-31"/>
</period>
<payor>🔗
<reference value="Organization/ex-insurer-1"/>
</payor>
</Coverage>
</resource>
</entry>
</Bundle>
IG © 2024+ IHE IT Infrastructure Technical Committee. Package ihe.iti.fais#1.0.0 based on FHIR 4.0.1. Generated 2024-11-13
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