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
Generated Narrative: ClaimResponse ClaimResponse-predetermination-example-01
status: Active
type: Inpatient care management (procedure)
use: Predetermination
patient: ABC Male, DoB: 1981-01-12 ( Medical record number: 22-7225-4829-5255)
created: 2023-12-12 15:32:26+0530
insurer: Organization XYZ Insurance Co. Ltd.
requestor: Organization XYZ Hospital Co. Ltd.
outcome: Processing Complete
preAuthRef: 123456
payeeType: Provider
item
itemSequence: 1
adjudication
category: Submitted Amount
Amounts
Value Currency 10000 Indian rupee adjudication
category: Eligible %
reason: Product or Service requested is covered by the policy.
Amounts
Value Currency 10000 Indian rupee
item
itemSequence: 2
adjudication
category: Submitted Amount
Amounts
Value Currency 40000 Indian rupee adjudication
category: Eligible %
reason: Product or Service requested is covered by the policy.
Amounts
Value Currency 40000 Indian rupee
item
itemSequence: 3
adjudication
category: Submitted Amount
Amounts
Value Currency 20000 Indian rupee adjudication
category: Eligible %
reason: Product or Service requested is covered by the policy.
Amounts
Value Currency 20000 Indian rupee
total
category: Submitted Amount
Amounts
Value Currency 70000 Indian rupee
total
category: Eligible %
Amounts
Value Currency 70000 Indian rupee