{
"resourceType": "ClaimResponse",
"addItemcommunicationRequest": [
{
"itemSequence": [
1
],
"productOrService": {
"coding": [
{
"code": "0182"
}
]
}reference": "CommunicationRequest/576D56EF-12D2-4BA8-9640-2A37C41A2052"
},
{
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],
"productOrService": {
"coding": [
{
"code": "A1"
}
]
}
}
],
"created": "2020-06-2930",
"id": "576D56EF-12D2-4BA8-9640-2A37C41A2052",
"identifier": [
{
"type": {
"coding": [
{
"code": "ACSN",
"system": "https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use": "usual",
"value": "576D56EF-12D2-4BA8-9640-2A37C41A2052"
},
{
"type": {
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{
"code": "MR",
"system": "https://hl7.org/fhir/valueset-identifier-type.html"
}
]
},
"use": "usual",
"value": "JADH0001"
}
],
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{
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{
"amountoutcome": {
"value": 10.0
},
"category": {
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},
"reason": {
"coding": [
{
"code": "1"
16"
}
],
"text": "passed"
}
valuated"
}
],
"itemSequencepatient": 1
},
{
"adjudication": [
{
"amount": {
"value": 400.0
},
"reference": "Patient/8C90949B-D1E5-47C8-A2D7-D5ECD073F1EE"
},
"categoryrequest": {
"textreference": "general"
Claim/576D56EF-12D2-4BA8-9640-2A37C41A2052"
},
"reason"total": {[
{
"codingamount": [
{
"codecurrency": "1"
}
],
$",
"textvalue": "passed"
410.0
}
}
],
"itemSequencecategory": 2
{
} ], "outcome": {
"coding": [
{ "code": "16"
{
} ], "textcode": "valuated"
}claimed",
"patient": { "reference": "Claim/8C90949B-D1E5-47C8-A2D7-D5ECD073F1EE" }, "requestsystem": {
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},
"total": [
{
"amount": {
"currency": "$"
},
"category": {
"coding": [
{
"code": "benefithttp://terminology.hl7.org/CodeSystem/adjudication.html"
}
]
}
}
]
} |