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The response of the API is a ClaimResponse with the adjudication results generated by the AI Model execution. In addition to FHIR Claim resource, the FHIR ClaimResponse resource contains the adjudication entry for each item in the Claim. The following structure is defined for the adjudication entry:

Code Block
languagejson
 "adjudication": [
  {
    "amount": {{
    "resourceType": "Bundle",
    "entry": [
        {
            "fullUrl": "http://localhost:8001/api_fhir_r4/ClaimResponse/FCD34CB1-2630-4E21-88EE-C38521C09F0D",
            "resource": {
              "resourceType": "ClaimResponse",
              "patient": {
                  "reference": "Patient/UUID", // Same as Claim.patient
              },
              "created": shortdate, // Current Date
              "id": string, // Same as Claim.id
              "item": [
                  {
                      "adjudication": [
                          {
                            "amount": {
                              "currency": string, // Default currency defined in the Core module configuration 
                              "value": float    // Same as Claim.item.unitPrice
                            },
                            "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"
                            },
                            "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",
                              "currencyvalueReference": string,{
// Default currency defined in the Core module configuration        "value": float    // Same as Claim.item.unitPrice     },     "categoryreference": { "Medication/48DB6423-E696-45D9-B76E-CA1B7C57D738"
                "coding": [             {}
                "code": "-2"   // Always as "-2" (Rejected by AI}
Model)             }         ],
        "text": string          // Always as "AI"itemSequence": 2,
       },     "reason": {         "codingnoteNumber": [
            {              2
   "code": string // result from the AI Model execution - "0": Accepted, "1": Rejected      ]
      }         ],   }
     "text": string        ],
 // Description of the result as "accepted" or "rejected"     },
"use": "claim"
   "value": float  // Same as Claim.item.quantity   }
]

Module Configuration

The following module configuration is defined:

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