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Code Block
languagejson
{
    "resourceType": "Bundle",
    "entry": [
        {
            "fullUrl": "http://localhost:8001/api_fhir_r4/ClaimResponse/FCD34CB1-2630-4E21-88EE-C38521C09F0DUUID", // Same UUID as Claim.id
            "resource": {
              				"resourceType": "ClaimResponse",
				"status": string, // Same as          "patientClaim.status
				"type": {
                  "reference": "Patient/UUID",					"text": string // Same as Claim.patient
              },
              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_organisation" 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       {
                      "adjudicationnumber
						"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
										}
									],
"amount									"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.unitPrice
                            },
                       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.
								}
							}
						],
					}
				]
			}
		}
	]
}
Expand
titleExample of FHIR ClaimResponse response from Claim-AI module
Code Block
languagejson
{
    "resourceType": "Bundle",
    "
category
entry": 
{
[
        {
            
"coding": [
"fullUrl": "http://localhost:8001/api_fhir_r4/ClaimResponse/FCD34CB1-2630-4E21-88EE-C38521C09F0D",
            "resource": {
				"resourceType": "ClaimResponse",
				"status": "Not Selected",
				"type": {
					 "text": "O"
				},
				"use": "claim",
				"patient": {
					"reference": "Patient/39418469-FC67-4363-BB51-B59B19FDBB47"
				},
				"created": "2021-01-18", 
				"insurer": {
					"reference": "Organization/openIMIS-Claim-AI" 
"code": "-2" // Always as "-2" (Rejected by AI Model)
				},
				"id": "FCD34CB1-2630-4E21-88EE-C38521C09F0D", 
				"request": {
					"reference": "Claim/FCD34CB1-2630-4E21-88EE-C38521C09F0D", 
				},
				"outcome": "complete", 
				"item": [ 
					{
						"itemSequence": 1, 
						"adjudication": [
							{
								"category": {
									"coding": [
										{
											"code": "-2"   
										}
									],
									"text": string        
} ], "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" }, "value": float // Same as Claim.item.quantity } ], "extension": [ { "url": "Medication", "valueReference": { "reference": "Medication/4DAFEF84-7AFA-47C6-BB51-B6D5511A8AF9" } } ], "itemSequence": 1, "noteNumber": [ 1 ] }, { "adjudication": [ { "amount": { "currency": "$", "value": 400.0 }, "category": { "coding": [ { "code": "-2", } ], "text": "AI" }, "reason": { "coding": [ { "code": 0 } ], "text": "rejected" }, "value": 1.0 } ], "extension": [ { "url": "ActivityDefinition", "valueReference": { "reference": "Medication/48DB6423-E696-45D9-B76E-CA1B7C57D738" } } ], "itemSequence": 2, "noteNumber": [ 2 ] } ], "use": "claim"
								},
								"reason": {
									"coding": [
										{
											"code": "0" 
										}
									],
									"text": "accepted"
								},
								"amount": {
									"currency": "$", 
									"value": 80.0    
								},
								"value": 1.0 
							}
						],
						"extension": [
							{
								"url": "ActivityDefinition",
								"valueReference": {
									"reference": "ActivityDefinition/3B4193F7-37EA-4B6E-BD5E-87F08752526A"
								}
							}
						],
					}
				]
			}
		}
	]
}

Module Configuration

The following module configuration is defined:

Code Block
languagejson
{
  authentication: [string] // Authentication key list. Default: []
  zip: boolean // Whether the communication payload is compressed or not. Default: False
  ai_model_file: string // AI Model file name with full path. Default: ./ai_model.pkl
  claim_response_organisation: string // Value to build the insurer reference in the ClaimResponse. Default: openIMIS-Claim-AI
}
Note

The default AI Model filename will be defined after finalizing the AI Algorithm development.

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