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
{
"resourceType" : "Bundle",
"id" : "ex-claim-response-acc-bundle-3",
"meta" : {
"profile" : [
🔗 "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse.Bundle"
]
},
"type" : "collection",
"entry" : [
{
"fullUrl" : "https://profiles.ihe.net/ITI/FAIS/ClaimResponse/ex-claim-response-acc-3",
"resource" : {
"resourceType" : "ClaimResponse",
"id" : "ex-claim-response-acc-3",
"meta" : {
"profile" : [
🔗 "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_ex-claim-response-acc-3\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse ex-claim-response-acc-3</b></p><a name=\"ex-claim-response-acc-3\"> </a><a name=\"hcex-claim-response-acc-3\"> </a><a name=\"ex-claim-response-acc-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>: 2024-07-16 03:00:00+0000</p><p><b>insurer</b>: <a href=\"Organization-ex-insurer-1.html\">Organization National Health Insurance Scheme</a></p><p><b>request</b>: <a href=\"Claim-ex-claim-3.html\">Claim: status = active; type = Institutional; use = claim; created = 2024-07-15 03:00:00+0000; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Accepted</p><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>"
},
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "institutional"
}
]
},
"use" : "claim",
"patient" : {
🔗 "reference" : "Patient/ex-beneficiary-1"
},
"created" : "2024-07-16T03:00:00Z",
"insurer" : {
🔗 "reference" : "Organization/ex-insurer-1"
},
"request" : {
🔗 "reference" : "Claim/ex-claim-3"
},
"outcome" : "complete",
"disposition" : "Accepted",
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
🔗 "reference" : "Coverage/ex-coverage-1"
}
}
]
}
},
{
"fullUrl" : "https://profiles.ihe.net/ITI/FAIS/Patient/ex-beneficiary-1",
"resource" : {
"resourceType" : "Patient",
"id" : "ex-beneficiary-1",
"text" : {
"status" : "generated",
"div" : "<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>"
},
"name" : [
{
"family" : "Atieno",
"given" : [
"Purity"
]
}
],
"gender" : "female",
"birthDate" : "2000-05-04"
}
},
{
"fullUrl" : "https://profiles.ihe.net/ITI/FAIS/Claim/ex-claim-3",
"resource" : {
"resourceType" : "Claim",
"id" : "ex-claim-3",
"meta" : {
"profile" : [
🔗 "https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.Claim"
]
},
"text" : {
"status" : "generated",
"div" : "<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>"
},
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "institutional"
}
]
},
"use" : "claim",
"patient" : {
🔗 "reference" : "Patient/ex-beneficiary-1"
},
"created" : "2024-07-15T03:00:00Z",
"enterer" : {
🔗 "reference" : "Practitioner/ex-doctor-2"
},
"insurer" : {
🔗 "reference" : "Organization/ex-insurer-1"
},
"provider" : {
🔗 "reference" : "Practitioner/ex-doctor-2"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "normal"
}
]
},
"payee" : {
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/payeetype",
"code" : "provider"
}
]
},
"party" : {
🔗 "reference" : "Organization/ex-network-1"
}
},
"facility" : {
🔗 "reference" : "Location/ex-hospital-2"
},
"diagnosis" : [
{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "http://id.who.int/icd/release/11/mms",
"code" : "XH1VB1",
"display" : "Hybrid oncocytic chromophobe tumour"
}
]
}
}
],
"procedure" : [
{
"sequence" : 1,
"procedureCodeableConcept" : {
"coding" : [
{
"system" : "http://loinc.org",
"code" : "21946-9",
"display" : "Chemotherapy treatment Cancer"
}
]
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
🔗 "reference" : "Coverage/ex-coverage-1"
}
}
]
}
},
{
"fullUrl" : "https://profiles.ihe.net/ITI/FAIS/Organization/ex-insurer-1",
"resource" : {
"resourceType" : "Organization",
"id" : "ex-insurer-1",
"text" : {
"status" : "generated",
"div" : "<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>"
},
"name" : "National Health Insurance Scheme"
}
},
{
"fullUrl" : "https://profiles.ihe.net/ITI/FAIS/Coverage/ex-coverage-1",
"resource" : {
"resourceType" : "Coverage",
"id" : "ex-coverage-1",
"text" : {
"status" : "generated",
"div" : "<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>"
},
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "PUBLICPOL",
"display" : "public healthcare"
}
]
},
"policyHolder" : {
🔗 "reference" : "Patient/ex-beneficiary-1"
},
"subscriber" : {
🔗 "reference" : "Patient/ex-beneficiary-1"
},
"subscriberId" : "05710b56-4448-11ef-b676-774a043da147",
"beneficiary" : {
🔗 "reference" : "Patient/ex-beneficiary-1"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self",
"display" : "Self"
}
]
},
"period" : {
"start" : "2024-01-01",
"end" : "2024-12-31"
},
"payor" : [
{
🔗 "reference" : "Organization/ex-insurer-1"
}
]
}
}
]
}
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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