FHIR Implementation Guide for ABDM
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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

Example Bundle: ClaimResponseBundle-enhancement-example-01

Generated Narrative: Bundle ClaimResponseBundle-enhancement-example-01

Bundle ClaimResponseBundle-enhancement-example-01 of type collection

Entry 1 - fullUrl = urn:uuid:b56a1f6e-c46e-4d06-95e4-aeaf9ecf5562

Resource ClaimResponse:

Generated Narrative: ClaimResponse b56a1f6e-c46e-4d06-95e4-aeaf9ecf5562

status: Active

type: Inpatient care management (procedure)

use: Preauthorization

patient: Patient

created: 2025-03-07 15:32:26+0530

insurer: Organization

requestor: Organization

request: Claim-enhancement

outcome: complete

disposition: The enclosed services are authorized for your provision within 30 days of this notice.

preAuthRef: 98765432

preAuthPeriod: 2025-03-12 15:32:26+0530 --> 2025-04-12 15:32:26+0530

item

itemSequence: 1

adjudication

category: Submitted Amount

Amounts

-ValueCurrency
*10000INR

adjudication

category: Eligible %

reason: Product or Service requested is covered by the policy.

Amounts

-ValueCurrency
*10000INR

item

itemSequence: 2

adjudication

category: Submitted Amount

Amounts

-ValueCurrency
*10000INR

adjudication

category: Eligible %

reason: Product or Service requested is covered by the policy.

Amounts

-ValueCurrency
*10000INR

total

category: Submitted Amount

Amounts

-ValueCurrency
*20000INR

total

category: Eligible %

Amounts

-ValueCurrency
*20000INR

Insurances

-SequenceFocalCoverage
*1trueCoverage

Entry 2 - fullUrl = urn:uuid:cd1e58c5-08fa-4cac-8a46-c12d26d57f21

Resource Claim:

Generated Narrative: Claim cd1e58c5-08fa-4cac-8a46-c12d26d57f21

identifier: 7612345, 96785763

status: Active

type: Inpatient care management (procedure)

use: Preauthorization

patient: Patient

billablePeriod: 2025-03-07 11:01:00+0500 --> 2025-04-07 11:01:00+0500

created: 2025-03-13 11:01:00+0500

insurer: Organization

provider: Organization

priority: Normal

Relateds

-ClaimRelationship
*Claim-preauthPrior Claim

CareTeams

-SequenceProviderRole
*1PractitionerHealthcare professional (occupation)

Diagnoses

-SequenceDiagnosis[x]Type
*1Cardiac arrest, unspecifiedFinal diagnosis (discharge) (contextual qualifier) (qualifier value)

procedure

sequence: 1

procedure: Angiography

procedure

sequence: 2

procedure: Angioplasty of blood vessel

Insurances

-SequenceFocalCoveragePreAuthRef
*1trueCoverage123456

item

sequence: 1

careTeamSequence: 1

productOrService: Angiography

serviced: 2023-12-09

UnitPrices

-ValueCurrency
*10000INR

Nets

-ValueCurrency
*10000INR

item

sequence: 2

careTeamSequence: 1

productOrService: Angioplasty of blood vessel

UnitPrices

-ValueCurrency
*10000INR

Nets

-ValueCurrency
*10000INR

Totals

-ValueCurrency
*20000INR

Entry 3 - fullUrl = urn:uuid:d16be93a-0881-422f-a9f1-b49808449395

Resource Patient:

Generated Narrative: Patient d16be93a-0881-422f-a9f1-b49808449395

Adarsh Agrawal Male, DoB: 1981-01-12 ( Adhaar number: 7225-4829-5255)

Contact Detail+919818512600

Entry 4 - fullUrl = urn:uuid:344de91a-0662-43a5-b88e-c2cd00887244

Resource Organization:

Generated Narrative: Organization 344de91a-0662-43a5-b88e-c2cd00887244

identifier: Registry of Hospitals in Network of Insurance (ROHINI) ID/4567878

type: Insurance Company

name: XYZ Insurance Co. Ltd.

contact

telecom: +91 243 2634 1234, contact@xyz.org

Entry 5 - fullUrl = urn:uuid:de3a873e-3d69-44de-bf2b-4cb18384b07d

Resource Organization:

Generated Narrative: Organization de3a873e-3d69-44de-bf2b-4cb18384b07d

identifier: Provider number/45675454

type: Healthcare Provider

name: XYZ Hospital Co. Ltd.

contact

telecom: +91 243 2634 1278, contact@xyz.org

Entry 6 - fullUrl = urn:uuid:04c47993-b2bc-4912-849b-65ee63883f2e

Resource Practitioner:

Generated Narrative: Practitioner 04c47993-b2bc-4912-849b-65ee63883f2e

identifier: Medical License number/21-1521-3828-3227

name: Dr. Aayush Agrawal

Entry 7 - fullUrl = urn:uuid:02461bcb-aeaa-45ad-b24c-66b94272103c

Resource Coverage:

Generated Narrative: Coverage 02461bcb-aeaa-45ad-b24c-66b94272103c

identifier: https://xyzinsurance.in/policynumber//235037120

status: Active

type: health insurance plan policy

subscriber: Patient

subscriberId: ABC123456BI007

beneficiary: Patient

relationship: Self

period: ?? --> 2026-03-17

Entry 8 - fullUrl = urn:uuid:66748b1f-0dac-47da-9ded-d8908ef42338

Resource Claim:

Generated Narrative: Claim 66748b1f-0dac-47da-9ded-d8908ef42338

identifier: 7612345, 96785763

status: Active

type: Inpatient care management (procedure)

use: Preauthorization

patient: Patient

billablePeriod: 2025-03-07 11:01:00+0500 --> 2025-04-07 11:01:00+0500

created: 2023-12-11 11:01:00+0500

insurer: Organization

provider: Organization

priority: Normal

CareTeams

-SequenceProviderRole
*1PractitionerHealthcare professional (occupation)

Diagnoses

-SequenceDiagnosis[x]Type
*1Cardiac arrest, unspecifiedFinal diagnosis (discharge) (contextual qualifier) (qualifier value)

procedure

sequence: 1

procedure: Angiography

procedure

sequence: 2

procedure: Angioplasty of blood vessel

Insurances

-SequenceFocalCoverage
*1trueCoverage

item

sequence: 1

careTeamSequence: 1

productOrService: Angiography

serviced: 2023-12-09

UnitPrices

-ValueCurrency
*10000INR

Nets

-ValueCurrency
*10000INR

item

sequence: 2

careTeamSequence: 1

productOrService: Angioplasty of blood vessel

UnitPrices

-ValueCurrency
*40000INR

Nets

-ValueCurrency
*40000INR

item

sequence: 3

careTeamSequence: 1

productOrService: Intensive care unit

serviced: 2023-12-11

quantity: 10 day

UnitPrices

-ValueCurrency
*2000INR

Nets

-ValueCurrency
*20000INR

Totals

-ValueCurrency
*70000INR