Operation | vread ExplanationOfBenefit |
Status | HTTP/1.1 200 OK |
Resource | ExplanationOfBenefit | Id | 085e6e7b618a4d2dbfcf318edc12cdc0 | Vid | 3036 |
{"patient":{"reference":"Patient/C72AWRLTVT6OI5SJ"},"insurance":[{"focal":true,"coverage":{"reference":"Coverage/C72AWRWLVRWI4H2E"}}],"facility":{"reference":"Location/C72AWRUMRWMVQLNH"},"meta":{"versionId":"3036","lastUpdated":"2022-02-28T14:20:41.835Z"},"enterer":{"reference":"Practitioner/C72AWRNRPVQLSWFS"},"use":"claim","item":[{"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"}}],"net":{"value":135.57,"currency":"USD"},"careTeamSequence":[1],"productOrService":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-USCLS","code":"1205"}]},"servicedDate":"2014-08-16","sequence":1,"unitPrice":{"value":135.57,"currency":"USD"}},{"adjudication":[{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"benefit"}]},"amount":{"value":180.0,"currency":"USD"}}],"net":{"value":200.0,"currency":"USD"},"careTeamSequence":[1],"productOrService":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-USCLS","code":"21211"}]},"servicedDate":"2014-08-16","sequence":2,"detail":[{"adjudication":[{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"benefit"}]},"amount":{"value":180.0,"currency":"USD"}}],"net":{"value":200.0,"currency":"USD"},"productOrService":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-USCLS","code":"21211"}]},"sequence":1,"subDetail":[{"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"}}],"net":{"value":200.0,"currency":"USD"},"productOrService":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/ex-USCLS","code":"1205"}]},"sequence":1,"unitPrice":{"value":200.0,"currency":"USD"}}]}]}],"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/claim-type","code":"oral"}]},"created":"2014-08-16","outcome":"complete","resourceType":"ExplanationOfBenefit","disposition":"Claim settled as per contract.","total":[{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"submitted"}]},"amount":{"value":135.57,"currency":"USD"}},{"category":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/adjudication","code":"benefit"}]},"amount":{"value":96.0,"currency":"USD"}}],"insurer":{"reference":"Organization/C72AWRPS6T2D335Q"},"status":"active","payee":{"party":{"reference":"Organization/C72AWRSORX755ADI"},"type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/payeetype","code":"provider"}]}},"id":"085e6e7b618a4d2dbfcf318edc12cdc0","identifier":[{"system":"http://www.BenefitsInc.com/fhir/explanationofbenefit","value":"wqf3Df-N1I2kTTcyJCL"}],"provider":{"reference":"Practitioner/C72AWRNRPVQLSWFS"},"careTeam":[{"sequence":1,"provider":{"reference":"Practitioner/C72AWRNRPVQLSWFS"}}],"text":{"div":"<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the ExplanationOfBenefit</div>","status":"generated"}}