JSON Format: Claim-41bb65c4-9128-4b73-a360-75e20560e32b
Download Raw json
Validation results for Claim/41bb65c4-9128-4b73-a360-75e20560e32b
| Level | Type | Location | Message |
{
"resourceType" : "Claim",
"id" : "41bb65c4-9128-4b73-a360-75e20560e32b",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: 41bb65c4-9128-4b73-a360-75e20560e32b</p><p><b>status</b>: active</p><p><b>type</b>: Institutional <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/claim-type code 'institutional' = 'Institutional)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient-3ab28624-a549-4cb9-a32e-99e3c2c41129.html\">Jose871 Cruickshank494. Generated Summary: id: 3ab28624-a549-4cb9-a32e-99e3c2c41129; 52fb90a7-9e4f-4140-8c3c-c8afbbb3fbf9, Medical Record Number = 52fb90a7-9e4f-4140-8c3c-c8afbbb3fbf9, Social Security Number = 999-96-5270, Driver's License = S99943652, Passport Number = X37948891X; Jose871 Cruickshank494 (OFFICIAL); ph: 555-170-1696(HOME); gender: male; birthDate: Feb 20, 1940; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-MaritalStatus M}\">M</span>; </a></p><p><b>billablePeriod</b>: Oct 30, 2012, 4:16:44 PM --> Oct 30, 2012, 4:46:44 PM</p><p><b>created</b>: Oct 30, 2012, 4:46:44 PM</p><p><b>provider</b>: <a href=\"Organization-18f774ab-db01-37ba-95c4-44c4eab47089.html\">Quincy Outpatient Clinic. Generated Summary: id: 18f774ab-db01-37ba-95c4-44c4eab47089; 18f774ab-db01-37ba-95c4-44c4eab47089; active; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span>; name: Quincy Outpatient Clinic; ph: 800-865-3384</a></p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/processpriority code 'normal' = 'Normal)</span></p><p><b>facility</b>: <a href=\"Location-7653e0ab-0566-4083-95d8-c695e4735e53.html\">Quincy Outpatient Clinic. Generated Summary: id: 7653e0ab-0566-4083-95d8-c695e4735e53; status: active; name: Quincy Outpatient Clinic; ph: 800-865-3384</a></p><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 1</p><p><b>procedure</b>: <a href=\"Procedure-a2f62d0f-bfe4-4578-8cf9-c6481c5885c6.html\">Generated Summary: id: a2f62d0f-bfe4-4578-8cf9-c6481c5885c6; status: completed; <span title=\"Codes: {http://snomed.info/sct 180325003}\">Electrical cardioversion</span>; performed: Oct 30, 2012, 4:16:44 PM --> Oct 30, 2012, 4:31:44 PM</a></p></blockquote><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 2</p><p><b>procedure</b>: <a href=\"Procedure-3bebde0d-23a2-469b-8f17-29208ea4ce0d.html\">Generated Summary: id: 3bebde0d-23a2-469b-8f17-29208ea4ce0d; status: completed; <span title=\"Codes: {http://snomed.info/sct 430193006}\">Medication Reconciliation (procedure)</span>; performed: Oct 30, 2012, 4:16:44 PM --> Oct 30, 2012, 4:31:44 PM</a></p></blockquote><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>true</td><td>Medicare</td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: Encounter for check up (procedure) <span style=\"background: LightGoldenRodYellow\">(Details : {SNOMED CT code '185349003' = 'Encounter for check up (procedure)', given as 'Encounter for check up (procedure)'})</span></p><p><b>encounter</b>: <a href=\"Encounter-7d35f0d0-9a20-4989-89b8-557b81c6f841.html\">Generated Summary: id: 7d35f0d0-9a20-4989-89b8-557b81c6f841; status: finished; <span title=\"{http://terminology.hl7.org/CodeSystem/v3-ActCode AMB}\">ambulatory</span>; <span title=\"Codes: {http://snomed.info/sct 185349003}\">Encounter for check up (procedure)</span>; period: Oct 30, 2012, 4:16:44 PM --> Oct 30, 2012, 4:46:44 PM</a></p></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 2</p><p><b>procedureSequence</b>: 1</p><p><b>productOrService</b>: Electrical cardioversion <span style=\"background: LightGoldenRodYellow\">(Details : {SNOMED CT code '180325003' = 'Electrical cardioversion', given as 'Electrical cardioversion'})</span></p><p><b>net</b>: </p></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 3</p><p><b>procedureSequence</b>: 2</p><p><b>productOrService</b>: Medication Reconciliation (procedure) <span style=\"background: LightGoldenRodYellow\">(Details : {SNOMED CT code '430193006' = 'Medication Reconciliation (procedure)', given as 'Medication Reconciliation (procedure)'})</span></p><p><b>net</b>: </p></blockquote><p><b>total</b>: </p></div>"
},
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "institutional"
}
]
},
"use" : "claim",
"patient" : {
"reference" : "Patient/3ab28624-a549-4cb9-a32e-99e3c2c41129",
"display" : "Jose871 Cruickshank494"
},
"billablePeriod" : {
"start" : "2012-10-30T16:16:44-07:00",
"end" : "2012-10-30T16:46:44-07:00"
},
"created" : "2012-10-30T16:46:44-07:00",
"provider" : {
"reference" : "Organization/18f774ab-db01-37ba-95c4-44c4eab47089",
"display" : "Quincy Outpatient Clinic"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "normal"
}
]
},
"facility" : {
"reference" : "Location/7653e0ab-0566-4083-95d8-c695e4735e53",
"display" : "Quincy Outpatient Clinic"
},
"procedure" : [
{
"sequence" : 1,
"procedureReference" : {
"reference" : "Procedure/a2f62d0f-bfe4-4578-8cf9-c6481c5885c6"
}
},
{
"sequence" : 2,
"procedureReference" : {
"reference" : "Procedure/3bebde0d-23a2-469b-8f17-29208ea4ce0d"
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"display" : "Medicare"
}
}
],
"item" : [
{
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "185349003",
"display" : "Encounter for check up (procedure)"
}
],
"text" : "Encounter for check up (procedure)"
},
"encounter" : [
{
"reference" : "Encounter/7d35f0d0-9a20-4989-89b8-557b81c6f841"
}
]
},
{
"sequence" : 2,
"procedureSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "180325003",
"display" : "Electrical cardioversion"
}
],
"text" : "Electrical cardioversion"
},
"net" : {
"value" : 42236.75,
"currency" : "USD"
}
},
{
"sequence" : 3,
"procedureSequence" : [
2
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "430193006",
"display" : "Medication Reconciliation (procedure)"
}
],
"text" : "Medication Reconciliation (procedure)"
},
"net" : {
"value" : 479.51,
"currency" : "USD"
}
}
],
"total" : {
"value" : 129.16,
"currency" : "USD"
}
}
