Generated Narrative: Bundle ClaimResponseBundle-predetermination-example-01

Bundle ClaimResponseBundle-predetermination-example-01 of type collection

Entry 1 - fullUrl = urn:uuid:da33ae8f-7d0c-4729-b909-0fe991bd4c08

Resource ClaimResponse:

Generated Narrative: ClaimResponse da33ae8f-7d0c-4729-b909-0fe991bd4c08

status: Active

type: Inpatient care management (procedure)

use: Predetermination

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

outcome: complete

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

Insurances

-	Sequence	Focal	Coverage
*	1	true	Coverage

Entry 2 - fullUrl = urn:uuid:d683b789-b008-449a-8cf4-559effa3285e

Resource Claim:

Generated Narrative: Claim d683b789-b008-449a-8cf4-559effa3285e

identifier: 7612345, 98765432

status: Active

type: Inpatient care management (procedure)

use: Predetermination

patient: Patient

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

created: 2025-03-07 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:1761e489-1265-4574-a7ee-14379479c2b4

Resource Patient:

Generated Narrative: Patient 1761e489-1265-4574-a7ee-14379479c2b4

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

---

Contact Detail

+919818512600

Entry 4 - fullUrl = urn:uuid:c3b14300-76b8-461f-a0e3-f8f642535a06

Resource Organization:

Generated Narrative: Organization c3b14300-76b8-461f-a0e3-f8f642535a06

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:3edacfa8-10eb-413c-80b8-a21c2253f0e5

Resource Organization:

Generated Narrative: Organization 3edacfa8-10eb-413c-80b8-a21c2253f0e5

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:45abb9dc-8a64-4e82-ab69-6ee110bf4481

Resource Practitioner:

Generated Narrative: Practitioner 45abb9dc-8a64-4e82-ab69-6ee110bf4481

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

name: Dr. Aayush Agrawal

Entry 7 - fullUrl = urn:uuid:4f95b4e1-9f61-468b-802a-ece8094370d9

Resource Coverage:

Generated Narrative: Coverage 4f95b4e1-9f61-468b-802a-ece8094370d9

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