FHIR Implementation Guide for ABDM
6.5.0 - active
FHIR Implementation Guide for ABDM
6.5.0 - active
This page is part of the FHIR Implementation Guide for ABDM (v6.5.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
{
"resourceType" : "Bundle",
"id" : "ClaimBundle-predetermination-example-01",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimBundle"
],
"security" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-Confidentiality",
"code" : "V",
"display" : "very restricted"
}
]
},
"identifier" : {
"value" : "ac3c6c57-2053-4d0e-ac40-139ccccff876"
},
"type" : "collection",
"timestamp" : "2025-03-07T11:32:26.605+05:30",
"entry" : [
{
"fullUrl" : "urn:uuid:253934fe-510d-49eb-98a5-6040665e9d47",
"resource" : {
"resourceType" : "Claim",
"id" : "253934fe-510d-49eb-98a5-6040665e9d47",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_253934fe-510d-49eb-98a5-6040665e9d47\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim 253934fe-510d-49eb-98a5-6040665e9d47</b></p><a name=\"253934fe-510d-49eb-98a5-6040665e9d47\"> </a><a name=\"hc253934fe-510d-49eb-98a5-6040665e9d47\"> </a><a name=\"253934fe-510d-49eb-98a5-6040665e9d47-hi-IN\"> </a><p><b>identifier</b>: 7612345</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 737481003}\">Inpatient care management (procedure)</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Bundle-ClaimBundle-predetermination-example-01.html#urn-uuid-56656117-b031-4d82-97f4-d30d699fb40a\">Patient</a></p><p><b>billablePeriod</b>: 2025-03-07 11:01:00+0500 --> 2025-04-07 11:01:00+0500</p><p><b>created</b>: 2025-03-07 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Bundle-ClaimBundle-predetermination-example-01.html#urn-uuid-1fe25aff-9fa9-4b44-acfb-f114187fd9c7\">Organization</a></p><p><b>provider</b>: <a href=\"Bundle-ClaimBundle-predetermination-example-01.html#urn-uuid-97f8790a-89bc-45af-b7e0-2e103cb571f4\">Organization</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td><td><b>Role</b></td><td><b>Qualification</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Bundle-ClaimBundle-predetermination-example-01.html#urn-uuid-1837911c-9b5f-4564-872e-fc696b49986d\">Practitioner</a></td><td><span title=\"Codes:{http://snomed.info/sct 223366009}\">Healthcare professional (occupation)</span></td><td><span title=\"Codes:{http://snomed.info/sct 394658006}\">Clinical specialty (qualifier value)</span></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10 I46.9}\">Cardiac arrest, unspecified</span></td><td><span title=\"Codes:{http://snomed.info/sct 89100005}\">Final diagnosis (discharge) (contextual qualifier) (qualifier value)</span></td></tr></table><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 1</p><p><b>procedure</b>: <span title=\"Codes:{http://snomed.info/sct 77343006}\">Angiography</span></p></blockquote><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 2</p><p><b>procedure</b>: <span title=\"Codes:{http://snomed.info/sct 418285008}\">Angioplasty of blood vessel</span></p></blockquote><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=\"Bundle-ClaimBundle-predetermination-example-01.html#urn-uuid-4ed8a29b-0a08-45d3-8f70-f3769c3e1c03\">Coverage</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 77343006}\">Angiography</span></p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000</td><td>Indian rupee</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>10000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 2</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 418285008}\">Angioplasty of blood vessel</span></p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>40000</td><td>Indian rupee</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>40000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 3</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 309904001}\">Intensive care unit</span></p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>2000</td><td>Indian rupee</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20000</td><td>Indian rupee</td></tr></table></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>70000</td><td>Indian rupee</td></tr></table></div>"
},
"identifier" : [
{
"value" : "7612345"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "737481003",
"display" : "Inpatient care management (procedure)"
}
]
},
"use" : "predetermination",
"patient" : {
"reference" : "urn:uuid:56656117-b031-4d82-97f4-d30d699fb40a",
"display" : "Patient"
},
"billablePeriod" : {
"start" : "2025-03-07T11:01:00+05:00",
"end" : "2025-04-07T11:01:00+05:00"
},
"created" : "2025-03-07T11:01:00+05:00",
"insurer" : {
"reference" : "urn:uuid:1fe25aff-9fa9-4b44-acfb-f114187fd9c7",
"display" : "Organization"
},
"provider" : {
"reference" : "urn:uuid:97f8790a-89bc-45af-b7e0-2e103cb571f4",
"display" : "Organization"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "normal"
}
]
},
"careTeam" : [
{
"sequence" : 1,
"provider" : {
"reference" : "urn:uuid:1837911c-9b5f-4564-872e-fc696b49986d",
"display" : "Practitioner"
},
"role" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "223366009",
"display" : "Healthcare professional (occupation)"
}
]
},
"qualification" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "394658006",
"display" : "Clinical specialty (qualifier value)"
}
]
}
}
],
"diagnosis" : [
{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/icd-10",
"code" : "I46.9",
"display" : "Cardiac arrest, unspecified"
}
]
},
"type" : [
{
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "89100005",
"display" : "Final diagnosis (discharge) (contextual qualifier) (qualifier value)"
}
]
}
]
}
],
"procedure" : [
{
"sequence" : 1,
"procedureCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "77343006",
"display" : "Angiography"
}
]
}
},
{
"sequence" : 2,
"procedureCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "418285008",
"display" : "Angioplasty of blood vessel"
}
]
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "urn:uuid:4ed8a29b-0a08-45d3-8f70-f3769c3e1c03",
"display" : "Coverage"
}
}
],
"item" : [
{
"sequence" : 1,
"careTeamSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "77343006",
"display" : "Angiography"
}
]
},
"unitPrice" : {
"value" : 10000,
"currency" : "INR"
},
"net" : {
"value" : 10000,
"currency" : "INR"
}
},
{
"sequence" : 2,
"careTeamSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "418285008",
"display" : "Angioplasty of blood vessel"
}
]
},
"unitPrice" : {
"value" : 40000,
"currency" : "INR"
},
"net" : {
"value" : 40000,
"currency" : "INR"
}
},
{
"sequence" : 3,
"careTeamSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "309904001",
"display" : "Intensive care unit"
}
]
},
"unitPrice" : {
"value" : 2000,
"currency" : "INR"
},
"net" : {
"value" : 20000,
"currency" : "INR"
}
}
],
"total" : {
"value" : 70000,
"currency" : "INR"
}
}
},
{
"fullUrl" : "urn:uuid:56656117-b031-4d82-97f4-d30d699fb40a",
"resource" : {
"resourceType" : "Patient",
"id" : "56656117-b031-4d82-97f4-d30d699fb40a",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_56656117-b031-4d82-97f4-d30d699fb40a\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient 56656117-b031-4d82-97f4-d30d699fb40a</b></p><a name=\"56656117-b031-4d82-97f4-d30d699fb40a\"> </a><a name=\"hc56656117-b031-4d82-97f4-d30d699fb40a\"> </a><a name=\"56656117-b031-4d82-97f4-d30d699fb40a-hi-IN\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Adarsh Agrawal Male, DoB: 1981-01-12 ( Adhaar number: 7225-4829-5255)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Detail</td><td colspan=\"3\"><a href=\"tel:+919818512600\">+919818512600</a></td></tr></table></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code",
"code" : "ADN",
"display" : "Adhaar number"
}
]
},
"system" : "https://uidai.gov.in/",
"value" : "7225-4829-5255"
}
],
"name" : [
{
"text" : "Adarsh Agrawal"
}
],
"telecom" : [
{
"system" : "phone",
"value" : "+919818512600",
"use" : "home"
}
],
"gender" : "male",
"birthDate" : "1981-01-12"
}
},
{
"fullUrl" : "urn:uuid:1fe25aff-9fa9-4b44-acfb-f114187fd9c7",
"resource" : {
"resourceType" : "Organization",
"id" : "1fe25aff-9fa9-4b44-acfb-f114187fd9c7",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_1fe25aff-9fa9-4b44-acfb-f114187fd9c7\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization 1fe25aff-9fa9-4b44-acfb-f114187fd9c7</b></p><a name=\"1fe25aff-9fa9-4b44-acfb-f114187fd9c7\"> </a><a name=\"hc1fe25aff-9fa9-4b44-acfb-f114187fd9c7\"> </a><a name=\"1fe25aff-9fa9-4b44-acfb-f114187fd9c7-hi-IN\"> </a><p><b>identifier</b>: Registry of Hospitals in Network of Insurance (ROHINI) ID/4567878</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type ins}\">Insurance Company</span></p><p><b>name</b>: XYZ Insurance Co. Ltd.</p><p><b>telecom</b>: <a href=\"tel:+9124326341234\">+91 243 2634 1234</a>, <a href=\"mailto:contact@xyz.org\">contact@xyz.org</a></p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code",
"code" : "ROHINI",
"display" : "Registry of Hospitals in Network of Insurance (ROHINI) ID"
}
]
},
"system" : "https://rohini.iib.gov.in/",
"value" : "4567878"
}
],
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/organization-type",
"code" : "ins",
"display" : "Insurance Company"
}
]
}
],
"name" : "XYZ Insurance Co. Ltd.",
"telecom" : [
{
"system" : "phone",
"value" : "+91 243 2634 1234",
"use" : "work"
},
{
"system" : "email",
"value" : "contact@xyz.org",
"use" : "work"
}
]
}
},
{
"fullUrl" : "urn:uuid:97f8790a-89bc-45af-b7e0-2e103cb571f4",
"resource" : {
"resourceType" : "Organization",
"id" : "97f8790a-89bc-45af-b7e0-2e103cb571f4",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_97f8790a-89bc-45af-b7e0-2e103cb571f4\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization 97f8790a-89bc-45af-b7e0-2e103cb571f4</b></p><a name=\"97f8790a-89bc-45af-b7e0-2e103cb571f4\"> </a><a name=\"hc97f8790a-89bc-45af-b7e0-2e103cb571f4\"> </a><a name=\"97f8790a-89bc-45af-b7e0-2e103cb571f4-hi-IN\"> </a><p><b>identifier</b>: Provider number/45675454</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span></p><p><b>name</b>: XYZ Hospital Co. Ltd.</p><p><b>telecom</b>: <a href=\"tel:+9124326341278\">+91 243 2634 1278</a>, <a href=\"mailto:contact@xyz.org\">contact@xyz.org</a></p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PRN",
"display" : "Provider number"
}
]
},
"system" : "https://facility.ndhm.gov.in",
"value" : "45675454"
}
],
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/organization-type",
"code" : "prov",
"display" : "Healthcare Provider"
}
]
}
],
"name" : "XYZ Hospital Co. Ltd.",
"telecom" : [
{
"system" : "phone",
"value" : "+91 243 2634 1278",
"use" : "work"
},
{
"system" : "email",
"value" : "contact@xyz.org",
"use" : "work"
}
]
}
},
{
"fullUrl" : "urn:uuid:1837911c-9b5f-4564-872e-fc696b49986d",
"resource" : {
"resourceType" : "Practitioner",
"id" : "1837911c-9b5f-4564-872e-fc696b49986d",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Practitioner_1837911c-9b5f-4564-872e-fc696b49986d\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Practitioner 1837911c-9b5f-4564-872e-fc696b49986d</b></p><a name=\"1837911c-9b5f-4564-872e-fc696b49986d\"> </a><a name=\"hc1837911c-9b5f-4564-872e-fc696b49986d\"> </a><a name=\"1837911c-9b5f-4564-872e-fc696b49986d-hi-IN\"> </a><p><b>identifier</b>: Medical License number/21-1521-3828-3227</p><p><b>name</b>: Dr. Aayush Agrawal</p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MD",
"display" : "Medical License number"
}
]
},
"system" : "https://doctor.ndhm.gov.in",
"value" : "21-1521-3828-3227"
}
],
"name" : [
{
"text" : "Dr. Aayush Agrawal"
}
]
}
},
{
"fullUrl" : "urn:uuid:4ed8a29b-0a08-45d3-8f70-f3769c3e1c03",
"resource" : {
"resourceType" : "Coverage",
"id" : "4ed8a29b-0a08-45d3-8f70-f3769c3e1c03",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Coverage"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_4ed8a29b-0a08-45d3-8f70-f3769c3e1c03\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage 4ed8a29b-0a08-45d3-8f70-f3769c3e1c03</b></p><a name=\"4ed8a29b-0a08-45d3-8f70-f3769c3e1c03\"> </a><a name=\"hc4ed8a29b-0a08-45d3-8f70-f3769c3e1c03\"> </a><a name=\"4ed8a29b-0a08-45d3-8f70-f3769c3e1c03-hi-IN\"> </a><p><b>identifier</b>: <code>https://xyzinsurance.in/policynumber/</code>/235037120</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}\">health insurance plan policy</span></p><p><b>subscriber</b>: <a href=\"Bundle-ClaimBundle-predetermination-example-01.html#urn-uuid-56656117-b031-4d82-97f4-d30d699fb40a\">Patient</a></p><p><b>subscriberId</b>: ABC123456BI007</p><p><b>beneficiary</b>: <a href=\"Bundle-ClaimBundle-predetermination-example-01.html#urn-uuid-56656117-b031-4d82-97f4-d30d699fb40a\">Patient</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: ?? --> 2026-03-17</p><p><b>payor</b>: <a href=\"Bundle-ClaimBundle-predetermination-example-01.html#urn-uuid-1fe25aff-9fa9-4b44-acfb-f114187fd9c7\">Organization</a></p></div>"
},
"identifier" : [
{
"system" : "https://xyzinsurance.in/policynumber/",
"value" : "235037120"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "HIP",
"display" : "health insurance plan policy"
}
]
},
"subscriber" : {
"reference" : "urn:uuid:56656117-b031-4d82-97f4-d30d699fb40a",
"display" : "Patient"
},
"subscriberId" : "ABC123456BI007",
"beneficiary" : {
"reference" : "urn:uuid:56656117-b031-4d82-97f4-d30d699fb40a",
"display" : "Patient"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self"
}
]
},
"period" : {
"end" : "2026-03-17"
},
"payor" : [
{
"reference" : "urn:uuid:1fe25aff-9fa9-4b44-acfb-f114187fd9c7",
"display" : "Organization"
}
]
}
}
]
}