FHIR Implementation Guide for NJSAMS


1.0.0 - release

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

: MedicaidClaimComplete - XML Representation

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<Claim xmlns="http://hl7.org/fhir">
  <id value="MedicaidClaimComplete"/>
  <meta>
    <profile
             value="https://fhir.njsams.rutgers.edu/NJSAMS-fhir/StructureDefinition/NJSAMSClaim"/>
  </meta>
  <text>
    <status value="extensions"/>
    <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>
  </text>
  <extension
             url="https://fhir.njsams.rutgers.edu/NJSAMS-fhir/StructureDefinition/PackageName">
    <valueString value="Long-Term Acute Care Treatment Package"/>
  </extension>
  <identifier>
    <system value="https://fhir.njsams.rutgers.edu/NJSAMS-fhir/PAuthNo"/>
    <value value="xyz0987"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="professional"/>
    </coding>
  </type>
  <use value="preauthorization"/>
  <patient>🔗 
    <reference value="Patient/PatientComplete"/>
  </patient>
  <created value="2023-09-01"/>
  <provider>🔗 
    <reference value="Organization/PayorSecondary"/>
  </provider>
  <priority>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
      <code value="normal"/>
    </coding>
  </priority>
  <supportingInfo>
    <sequence value="1"/>
    <category>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
        <code value="info"/>
      </coding>
    </category>
    <timingPeriod>
      <start value="2023-09-01"/>
      <end value="2023-09-07"/>
    </timingPeriod>
  </supportingInfo>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>🔗 
      <reference value="Coverage/MedicaidCoverage"/>
    </coverage>
  </insurance>
</Claim>