Operation | update ExplanationOfBenefit |
Method | PUT |
Path | https://blaze.life.uni-leipzig.de/fhir/ExplanationOfBenefit/085e6e7b618a4d2dbfcf318edc12cdc0 |
Resource | ExplanationOfBenefit | Id | 085e6e7b618a4d2dbfcf318edc12cdc0 | | |
{
"resourceType" : "ExplanationOfBenefit",
"id" : "085e6e7b618a4d2dbfcf318edc12cdc0",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the ExplanationOfBenefit</div>"
},
"identifier" : [ {
"system" : "http://www.BenefitsInc.com/fhir/explanationofbenefit",
"value" : "wqf3Df-N1I2kTTcyJCL"
} ],
"status" : "cancelled",
"type" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "oral"
} ]
},
"use" : "claim",
"patient" : {
"reference" : "Patient/C72AWRLTVT6OI5SJ"
},
"created" : "2014-08-16",
"enterer" : {
"reference" : "Practitioner/C72AWRNRPVQLSWFS"
},
"insurer" : {
"reference" : "Organization/C72AWRPS6T2D335Q"
},
"provider" : {
"reference" : "Practitioner/C72AWRNRPVQLSWFS"
},
"payee" : {
"type" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/payeetype",
"code" : "provider"
} ]
},
"party" : {
"reference" : "Organization/C72AWRSORX755ADI"
}
},
"facility" : {
"reference" : "Location/C72AWRUMRWMVQLNH"
},
"outcome" : "complete",
"disposition" : "Claim settled as per contract.",
"careTeam" : [ {
"sequence" : 1,
"provider" : {
"reference" : "Practitioner/C72AWRNRPVQLSWFS"
}
} ],
"insurance" : [ {
"focal" : true,
"coverage" : {
"reference" : "Coverage/C72AWRWLVRWI4H2E"
}
} ],
"item" : [ {
"sequence" : 1,
"careTeamSequence" : [ 1 ],
"productOrService" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code" : "1205"
} ]
},
"servicedDate" : "2014-08-16",
"unitPrice" : {
"value" : 135.57,
"currency" : "USD"
},
"net" : {
"value" : 135.57,
"currency" : "USD"
},
"adjudication" : [ {
"category" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible"
} ]
},
"amount" : {
"value" : 120.0,
"currency" : "USD"
}
}, {
"category" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligpercent"
} ]
},
"value" : 0.8
}, {
"category" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "benefit"
} ]
},
"amount" : {
"value" : 96.0,
"currency" : "USD"
}
} ]
}, {
"sequence" : 2,
"careTeamSequence" : [ 1 ],
"productOrService" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code" : "21211"
} ]
},
"servicedDate" : "2014-08-16",
"net" : {
"value" : 200.0,
"currency" : "USD"
},
"adjudication" : [ {
"category" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "benefit"
} ]
},
"amount" : {
"value" : 180.0,
"currency" : "USD"
}
} ],
"detail" : [ {
"sequence" : 1,
"productOrService" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code" : "21211"
} ]
},
"net" : {
"value" : 200.0,
"currency" : "USD"
},
"adjudication" : [ {
"category" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "benefit"
} ]
},
"amount" : {
"value" : 180.0,
"currency" : "USD"
}
} ],
"subDetail" : [ {
"sequence" : 1,
"productOrService" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code" : "1205"
} ]
},
"unitPrice" : {
"value" : 200.0,
"currency" : "USD"
},
"net" : {
"value" : 200.0,
"currency" : "USD"
},
"adjudication" : [ {
"category" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible"
} ]
},
"amount" : {
"value" : 200.0,
"currency" : "USD"
}
}, {
"category" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligpercent"
} ]
},
"value" : 0.9
}, {
"category" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "benefit"
} ]
},
"amount" : {
"value" : 180.0,
"currency" : "USD"
}
} ]
} ]
} ]
} ],
"total" : [ {
"category" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "submitted"
} ]
},
"amount" : {
"value" : 180.0,
"currency" : "USD"
}
}, {
"category" : {
"coding" : [ {
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "benefit"
} ]
},
"amount" : {
"value" : 96.0,
"currency" : "USD"
}
} ]
}