example
type: Claim
node role: treeRoot
id:
  v: example
meta:
  profile:
    v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-claim
    l: us-quality-core-claim
language:
  v: en
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Claim example Profile: US Quality Core Claim identifier: http://example.org/claims/6612346 status: Active type: Professional use: Claim patient: Jim Chalmers Male, DoB: 1974-12-25 ( Social Security number (use: usual, period: 2001-05-06 --> (ongoing))) created: 2014-08-16 insurer: Organization Health Level Seven International provider: Practitioner Adam Careful priority: Normal Payees - Type Party * Provider Practitioner Adam Careful CareTeams - Sequence Provider * 1 Practitioner Adam Careful Diagnoses - Sequence Diagnosis[x] OnAdmission * 1 Unspecified acute appendicitis Y Insurances - Sequence Focal Coverage * 1 true Coverage: identifier = Member Number; status = active; type = Other Private Insurance; subscriberId = 12191; dependent = 0; relationship = Self; period = 2011-05-23 --> 2012-05-23; order = 9 item sequence: 1 careTeamSequence: 1 diagnosisSequence: 1 productOrService: Appendectomy serviced: 2013-04-05 UnitPrices - Value Currency * 4000.00 United States dollar
identifier:
  system:
    v: http://example.org/claims
    l: claims
  value:
    v: 6612346
status:
  v: active
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/claim-type
      l: claim-type
    code:
      v: professional
    display:
      v: Professional
use:
  v: claim
patient:
  l: example
  reference:
    v: Patient/example
created:
  v: 2014-08-16
insurer:
  l: example
  reference:
    v: Organization/example
provider:
  l: example
  reference:
    v: Practitioner/example
priority:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/processpriority
      l: processpriority
    code:
      v: normal
payee:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/payeetype
        l: payeetype
      code:
        v: provider
  party:
    l: example
    reference:
      v: Practitioner/example
care team:
  sequence:
    v: 1
  provider:
    l: example
    reference:
      v: Practitioner/example
diagnosis:
  sequence:
    v: 1
  diagnosis: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/sid/icd-10-cm
        l: icd-10-cm
      code:
        v: K35.80
      display:
        v: Unspecified acute appendicitis
  on admission:
    coding:
      system:
        v: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Coding
        l: Coding
      code:
        v: Y
insurance:
  sequence:
    v: 1
  focal:
    v: true
  coverage:
    l: example
    reference:
      v: Coverage/example
item:
  sequence:
    v: 1
  care team sequence:
    v: 1
  diagnosis sequence:
    v: 1
  product or service:
    coding:
      system:
        v: http://www.ama-assn.org/go/cpt
        l: cpt
      code:
        v: 44950
      display:
        v: Appendectomy
  serviced: Date
    v: 2013-04-05
  unit price:
    value:
      v: 4000.00
    currency:
      v: USD