{
"resourceType": "Bundle",
"entry": [
{
"fullUrl": "http://localhost:8001/api_fhir_r4/ClaimResponse/UUID", // Same UUID as Claim.id
"resource": {
"resourceType": "ClaimResponse",
"status": string, // Same as Claim.status
"type": {
"text": string // Same as Claim.type
},
"use": "claim", // Same as Claim.use
"patient": {
"reference": "Patient/UUID" // Same as Claim.patient
},
"created": shortdate, // Current Date
"insurer": {
"reference": "Organization/openIMIS-Claim-AI" // Value of "claim_response_organisationorganization" field from module configuration. Default: openIMIS-Claim-AI
},
"id": string, // Same as Claim.id
"request": {
"reference": "Claim/UUID", // Same UUID as Claim.id
},
"outcome": "complete", // Always as "complete"
"item": [ // One Item per Item and Service
{
"itemSequence": integer, // Increment number
"adjudication": [
{
"category": {
"coding": [
{
"code": "-2" // Always as "-2" (Rejected by AI Model)
}
],
"text": string // Always as "AI"
},
"reason": {
"coding": [
{
"code": string // result from the AI Model execution - "0": Accepted, "1": Rejected
}
],
"text": string // Description of the result as "accepted" or "rejected"
},
"amount": {
"currency": string, // Default currency defined in the Core module configuration
"value": float // Same as Claim.item.unitPrice
},
"value": float // Same as Claim.item.quantity
}
],
"extension": [
{
"url": string, // Based on Item type: "Medication" or "ActivityDefinition"
"valueReference": {
"reference": "ItemType/UUID" // Reference to either Medication or ActivityDefinition. Same as Claim.item.extension.
}
}
],
}
]
}
}
]
} |