FHIR Implementation Guide for NJSAMS

NJSAMS - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

• Narrative Content
• XML
• JSON

: MedicaidClaimComplete - JSON Representation

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{
  "resourceType" : "Claim",
  "id" : "MedicaidClaimComplete",
  "meta" : {
    "profile" : [
      🔗 "https://fhir.njsams.rutgers.edu/NJSAMS-fhir/StructureDefinition/NJSAMSClaim"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim MedicaidClaimComplete</b></p><a name=\"MedicaidClaimComplete\"> </a><a name=\"hcMedicaidClaimComplete\"> </a><a name=\"MedicaidClaimComplete-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-NJSAMSClaim.html\">NJSAMSClaim</a></p></div><p><b>PackageName</b>: Long-Term Acute Care Treatment Package</p><p><b>identifier</b>: <code>https://fhir.njsams.rutgers.edu/NJSAMS-fhir/PAuthNo</code>/xyz0987</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-PatientComplete.html\">William Smith  Other, DoB: 2000-06-11 ( http://hl7.org/fhir/sid/us-ssn#United States Social Security Number#00-00-0000)</a></p><p><b>created</b>: 2023-09-01</p><p><b>provider</b>: <a href=\"Organization-PayorSecondary.html\">Organization DC</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>SupportingInfos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Timing[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claiminformationcategory info}\">Information</span></td><td>2023-09-01 --&gt; 2023-09-07</td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-MedicaidCoverage.html\">Coverage: identifier = https://fhir.njsams.rutgers.edu/NJSAMS-fhir/sbi#12345,https://fhir.njsams.rutgers.edu/NJSAMS-fhir/CSCInitiativeID#abcd789; status = active</a></td></tr></table></div>"
  },
  "extension" : [
    {
      "url" : "https://fhir.njsams.rutgers.edu/NJSAMS-fhir/StructureDefinition/PackageName",
      "valueString" : "Long-Term Acute Care Treatment Package"
    }
  ],
  "identifier" : [
    {
      "system" : "https://fhir.njsams.rutgers.edu/NJSAMS-fhir/PAuthNo",
      "value" : "xyz0987"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "professional"
      }
    ]
  },
  "use" : "preauthorization",
  "patient" : {
    🔗 "reference" : "Patient/PatientComplete"
  },
  "created" : "2023-09-01",
  "provider" : {
    🔗 "reference" : "Organization/PayorSecondary"
  },
  "priority" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
        "code" : "normal"
      }
    ]
  },
  "supportingInfo" : [
    {
      "sequence" : 1,
      "category" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code" : "info"
          }
        ]
      },
      "timingPeriod" : {
        "start" : "2023-09-01",
        "end" : "2023-09-07"
      }
    }
  ],
  "insurance" : [
    {
      "sequence" : 1,
      "focal" : true,
      "coverage" : {
        🔗 "reference" : "Coverage/MedicaidCoverage"
      }
    }
  ]
}