Response

Operationupdate ClaimResponse
StatusHTTP/1.1 200 OK
ResourceClaimResponseIdC72AV3N2CARURJJOVid2831
Headers
access-control-allow-origin 
*
content-length 
2476
content-type 
application/fhir+json;charset=utf-8
date 
Mon, 28 Feb 2022 14:14:37 GMT
etag 
W/"2831"
last-modified 
Mon, 28 Feb 2022 14:14:37 GMT
server 
nginx
strict-transport-security 
max-age=15768000
Content
{"patient":{"identifier":{"system":"http://happysight.com/patient","value":"3788109874-65692-2904979"},"display":"3788109874-65692-2904979"},"payeeType":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/payeetype","code":"subscriber"}]},"request":{"identifier":{"system":"http://happysight.com/claim","value":"Pm1Yvlg76LyrBteu4C"},"display":"Pm1Yvlg76LyrBteu4C"},"meta":{"versionId":"2831","lastUpdated":"2022-02-28T14:14:37.573Z","security":[{"system":"http://terminology.hl7.org/CodeSystem/v3-ActReason","code":"HTEST","display":"test health data"}]},"use":"claim","payment":{"amount":{"value":70.0,"currency":"USD"},"date":"2018-12-27","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-paymenttype","code":"complete"}]},"identifier":{"system":"http://benefitsinc.com/paymentidentifier","value":"575769-2904979"}},"item":[{"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":100.0},{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"benefit"}]},"amount":{"value":70.0,"currency":"USD"}}],"itemSequence":1}],"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"vision"}]},"created":"2018-12-27","outcome":"partial","resourceType":"ClaimResponse","disposition":"Pre-authorization completed as per coverage Pm1Yvlg76LyrBteu4C575769.","total":[{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]},"amount":{"value":80.0,"currency":"USD"}},{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"benefit"}]},"amount":{"value":70.0,"currency":"USD"}}],"insurer":{"identifier":{"system":"http://benefitsinc.com/certificate","value":"Pm1Yvlg76LyrBteu4C2904979"},"display":"Pm1Yvlg76LyrBteu4C2904979"},"status":"active","id":"C72AV3N2CARURJJO","identifier":[{"system":"http://benefitsinc.com/remittance","value":"3788109874-65692"}],"text":{"div":"<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Touchstone Test Data - ClaimResponse: Pre-authorization Vision Claim Response</p></div>","status":"generated"}}