{
"resourceType": "Claim",
"billablePeriod": {
"end": "2019-06-12T00:00:00",
"start": "2019-06-01T00:00:00"
},
"created": "2019-06-12T00:00:00",
"diagnosis": [
{
"diagnosisCodeableConcept": {
"coding": [
{
"code": "ICD_CD"
}
]
},
"sequence": 1,
"type": [
{
"text": "icd_0"
}
]
}
],
"enterer": {
"reference": "Practitioner/1234abcd"
},
"facility": {
"reference": "Location/12345678"
},
"id": "code",
"identifier": [
{
"type": {
"coding": [
{
"code": "MR",
"system": "https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use": "usual",
"value": "code"
}
],
"information": [
{
"category": {
"text": "guarantee_id"
},
"sequence": 1,
"valueString": "guarantee_id"
},
{
"category": {
"text": "explanation"
},
"sequence": 2,
"valueString": "explanation"
},
{
"category": {
"text": "item_explanation"
},
"sequence": 3,
"valueString": "item_explanation"
},
{
"category": {
"text": "item_explanation"
},
"sequence": 4,
"valueString": "service_explanation"
}
],
"item": [
{
"category": {
"text": "item"
},
"informationLinkId": [
3
],
"quantity": {
"value": 4
},
"sequence": 1,
"service": {
"text": "iCode"
},
"unitPrice": {
"value": 21.1
}
},
{
"category": {
"text": "service"
},
"informationLinkId": [
4
],
"quantity": {
"value": 3
},
"sequence": 2,
"service": {
"text": "sCode"
},
"unitPrice": {
"value": 16.1
}
}
],
"patient": {
"reference": "Patient/TEST_CHF_ID"
},
"total": {
"value": 42
},
"type": {
"text": "E"
}
} |