Operation | create |
Method | POST |
Path | https://blaze.life.uni-leipzig.de/fhir/ClaimResponse |
Resource | ClaimResponse | | | | |
{
"resourceType" : "ClaimResponse",
"meta" : {
"security" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"code" : "HTEST",
"display" : "test health data"
} ]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Touchstone Test Data - ClaimResponse: Pre-authorization Vision Claim Response</p></div>"
},
"identifier" : [ {
"system" : "http://benefitsinc.com/remittance",
"value" : "3788109874-65692"
} ],
"status" : "active",
"type" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "vision"
} ]
},
"use" : "claim",
"patient" : {
"identifier" : {
"system" : "http://happysight.com/patient",
"value" : "3788109874-65692-2904979"
},
"display" : "3788109874-65692-2904979"
},
"created" : "2018-12-27",
"insurer" : {
"identifier" : {
"system" : "http://benefitsinc.com/certificate",
"value" : "Pm1Yvlg76LyrBteu4C2904979"
},
"display" : "Pm1Yvlg76LyrBteu4C2904979"
},
"request" : {
"identifier" : {
"system" : "http://happysight.com/claim",
"value" : "Pm1Yvlg76LyrBteu4C"
},
"display" : "Pm1Yvlg76LyrBteu4C"
},
"outcome" : "partial",
"disposition" : "Pre-authorization completed as per coverage Pm1Yvlg76LyrBteu4C575769.",
"payeeType" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/payeetype",
"code" : "subscriber"
} ]
},
"item" : [ {
"itemSequence" : 1,
"adjudication" : [ {
"category" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible"
} ]
},
"amount" : {
"value" : 80.0,
"currency" : "USD"
}
}, {
"category" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "copay"
} ]
},
"amount" : {
"value" : 10.0,
"currency" : "USD"
}
}, {
"category" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligpercent"
} ]
},
"value" : 50.0
}, {
"category" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "benefit"
} ]
},
"amount" : {
"value" : 35.0,
"currency" : "USD"
}
} ]
} ],
"total" : [ {
"category" : {
"coding" : [ {
"code" : "submitted"
} ]
},
"amount" : {
"value" : 80.0,
"currency" : "USD"
}
}, {
"category" : {
"coding" : [ {
"code" : "benefit"
} ]
},
"amount" : {
"value" : 35.0,
"currency" : "USD"
}
} ],
"payment" : {
"type" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/ex-paymenttype",
"code" : "partial"
} ]
},
"date" : "2018-12-27",
"amount" : {
"value" : 35.0,
"currency" : "USD"
},
"identifier" : {
"system" : "http://benefitsinc.com/paymentidentifier",
"value" : "575769-2904979"
}
}
}