Request

OperationupdateCreate ClaimResponse
MethodPUT
Pathhttps://blaze.life.uni-leipzig.de/fhir/ClaimResponse/c3ee50ac8c5c4e65afa2a46a25e965d3
ResourceClaimResponseIdc3ee50ac8c5c4e65afa2a46a25e965d3
Headers
Accept
application/fhir+json;charset=UTF-8
Content-Type
application/fhir+json;charset=UTF-8
Content
{
  "resourceType" : "ClaimResponse",
  "id" : "c3ee50ac8c5c4e65afa2a46a25e965d3",
  "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" : "3788109874-310"
  } ],
  "status" : "active",
  "type" : {
    "coding" : [ {
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "vision"
    } ]
  },
  "use" : "claim",
  "patient" : {
    "identifier" : {
      "system" : "http://happysight.com/patient",
      "value" : "3788109874-310-2904979"
    },
    "display" : "3788109874-310-2904979"
  },
  "created" : "2018-12-24",
  "insurer" : {
    "identifier" : {
      "system" : "http://benefitsinc.com/certificate",
      "value" : "Pm1Yvlg7N1I2kTTcyJCL2904979"
    },
    "display" : "Pm1Yvlg7N1I2kTTcyJCL2904979"
  },
  "request" : {
    "identifier" : {
      "system" : "http://happysight.com/claim",
      "value" : "Pm1Yvlg7N1I2kTTcyJCL"
    },
    "display" : "Pm1Yvlg7N1I2kTTcyJCL"
  },
  "outcome" : "partial",
  "disposition" : "Pre-authorization completed as per coverage Pm1Yvlg7N1I2kTTcyJCL575769.",
  "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" : "2018-12-24",
    "amount" : {
      "value" : 35.0,
      "currency" : "USD"
    },
    "identifier" : {
      "system" : "http://benefitsinc.com/paymentidentifier",
      "value" : "575769-2904979"
    }
  }
}