Generated Narrative: Bundle ClaimResponseBundle-preauthorization-example-01

Bundle ClaimResponseBundle-preauthorization-example-01 of type collection

Entry 1 - fullUrl = urn:uuid:b7bb7467-0f45-4a86-a1e0-ca6a7c116f5f

Resource ClaimResponse:

Generated Narrative: ClaimResponse b7bb7467-0f45-4a86-a1e0-ca6a7c116f5f

status: Active

type: Inpatient care management (procedure)

use: Preauthorization

patient: Patient

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

insurer: Organization

requestor: Organization

request: Bundle: identifier = bc3c6c57-2053-4d0e-ac40-139ccccff645; type = collection; timestamp = 2025-03-08 15:32:26+0530

outcome: complete

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

preAuthRef: 123456

preAuthPeriod: 2025-03-08 15:32:26+0530 --> 2025-04-08 15:32:26+0530

payeeType: Provider

item

itemSequence: 1

adjudication

category: Submitted Amount

Amounts

-	Value	Currency
*	10000	INR

adjudication

category: Eligible %

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

Amounts

-	Value	Currency
*	10000	INR

item

itemSequence: 2

adjudication

category: Submitted Amount

Amounts

-	Value	Currency
*	40000	INR

adjudication

category: Eligible %

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

Amounts

-	Value	Currency
*	40000	INR

item

itemSequence: 3

adjudication

category: Submitted Amount

Amounts

-	Value	Currency
*	20000	INR

adjudication

category: Eligible %

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

Amounts

-	Value	Currency
*	20000	INR

total

category: Submitted Amount

Amounts

-	Value	Currency
*	70000	INR

total

category: Eligible %

Amounts

-	Value	Currency
*	70000	INR

formCode: Approval letter for Pre-authorisation

Forms

-	ContentType	Language	Data	Title
*	image/jpeg	en-IN	(base64 data - 97,336 base64 chars)	pre-auth Approval letter

Insurances

-	Sequence	Focal	Coverage
*	1	true	Coverage

Entry 2 - fullUrl = urn:uuid:31d03d24-13ad-433a-b65b-3ffcfe7c9661

Resource Claim:

Generated Narrative: Claim 31d03d24-13ad-433a-b65b-3ffcfe7c9661

identifier: 7612345, 98765432

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: 2025-03-08 11:01:00+0500

insurer: Organization

provider: Organization

priority: Normal

CareTeams

-	Sequence	Provider	Role
*	1	Practitioner	Healthcare professional (occupation)

Diagnoses

-	Sequence	Diagnosis[x]	Type
*	1	Cardiac arrest, unspecified	Final diagnosis (discharge) (contextual qualifier) (qualifier value)

procedure

sequence: 1

procedure: Angiography

procedure

sequence: 2

procedure: Angioplasty of blood vessel

Insurances

-	Sequence	Focal	Coverage
*	1	true	Coverage

item

sequence: 1

careTeamSequence: 1

productOrService: Angiography

UnitPrices

-	Value	Currency
*	10000	INR

Nets

-	Value	Currency
*	10000	INR

item

sequence: 2

careTeamSequence: 1

productOrService: Angioplasty of blood vessel

UnitPrices

-	Value	Currency
*	40000	INR

Nets

-	Value	Currency
*	40000	INR

item

sequence: 3

careTeamSequence: 1

productOrService: Intensive care unit

UnitPrices

-	Value	Currency
*	2000	INR

Nets

-	Value	Currency
*	20000	INR

Totals

-	Value	Currency
*	70000	INR

Entry 3 - fullUrl = urn:uuid:08c38863-59e6-47f0-be9b-6d86a3fe3444

Resource Patient:

Generated Narrative: Patient 08c38863-59e6-47f0-be9b-6d86a3fe3444

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

---

Contact Detail

+919818512600

Entry 4 - fullUrl = urn:uuid:790210b8-eb83-469d-a3df-5bf9a6f68c16

Resource Organization:

Generated Narrative: Organization 790210b8-eb83-469d-a3df-5bf9a6f68c16

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:e0f5ef2e-8e3b-43d7-95e0-05172d87bfa2

Resource Organization:

Generated Narrative: Organization e0f5ef2e-8e3b-43d7-95e0-05172d87bfa2

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:204077eb-f0a7-4e45-ae35-271b62789f8e

Resource Practitioner:

Generated Narrative: Practitioner 204077eb-f0a7-4e45-ae35-271b62789f8e

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

name: Dr. Aayush Agrawal

Entry 7 - fullUrl = urn:uuid:ff08ac6c-f6ca-4f3d-9e6f-05068c483895

Resource Coverage:

Generated Narrative: Coverage ff08ac6c-f6ca-4f3d-9e6f-05068c483895

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