Finance and Insurance Service (FAIS)
1.0.0 - trial-use International flag

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

: Use Case 4 - Example accepted pre-determination response - XML Representation

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<ClaimResponse xmlns="http://hl7.org/fhir">
  <id value="ex-predetermination-response-4"/>
  <meta>
    <profile
             value="https://profiles.ihe.net/ITI/FAIS/StructureDefinition/IHE.FAIS.ClaimResponse"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ClaimResponse ex-predetermination-response-4</b></p><a name="ex-predetermination-response-4"> </a><a name="hcex-predetermination-response-4"> </a><a name="ex-predetermination-response-4-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-predetermination-4.html">Claim: status = active; type = Institutional; use = predetermination; 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 --&gt; 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="2024-07-16T03:00:00Z"/>
  <insurer>🔗 
    <reference value="Organization/ex-insurer-1"/>
  </insurer>
  <request>🔗 
    <reference value="Claim/ex-predetermination-4"/>
  </request>
  <outcome value="complete"/>
  <disposition value="Accepted"/>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>🔗 
      <reference value="Coverage/ex-coverage-1"/>
    </coverage>
  </insurance>
</ClaimResponse>