example
type: ClaimResponse
node role: treeRoot
id:
  v: example
meta:
  profile:
    v: http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-claimresponse
    l: us-quality-core-claimresponse
language:
  v: en
text:
  status:
    v: generated
  div:
    v: Generated Narrative: ClaimResponse example Profile: US Quality Core ClaimResponse status: Active type: Professional use: Preauthorization patient: Jim Chalmers Male, DoB: 1974-12-25 ( Social Security number (use: usual, period: 2001-05-06 --> (ongoing))) created: 2018-02-24 insurer: Organization Health Level Seven International requestor: Practitioner Adam Careful request: Claim: identifier = http://example.org/claims#6612346; status = active; type = Professional; use = claim; created = 2014-08-16; priority = Normal outcome: Queued item itemSequence: 1 adjudication category: Submitted Amount Amounts - Value Currency * 4000.00 United States dollar detail detailSequence: 1 adjudication category: Submitted Amount Amounts - Value Currency * 4000.00 United States dollar
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: preauthorization
patient:
  l: example
  reference:
    v: Patient/example
created:
  v: 2018-02-24
insurer:
  l: example
  reference:
    v: Organization/example
requestor:
  l: example
  reference:
    v: Practitioner/example
request:
  l: example
  reference:
    v: Claim/example
outcome:
  v: queued
item:
  item sequence:
    v: 1
  adjudication:
    amount:
      value:
        v: 4000.00
      currency:
        v: USD
  detail:
    detail sequence:
      v: 1

v: submitted

system:
  v: http://terminology.hl7.org/CodeSystem/adjudication
  l: adjudication
code:
  v: submitted

v: 4000.00

v: USD