{ "resourceType" : "ClaimResponse", "meta" : { "source" : "https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A", "profile" : ["https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/NzPharmacyClaimResponse"], "tag" : [{ "system" : "https://hub.services.digital.health.nz/ns/correlation-id", "code" : "123e4567-e89b-12d3-a456-426614174011" }] }, "text" : { "status" : "extensions", "div" : "

Generated Narrative: ClaimResponse NzPharmacyClaimResponseExample

Information Source: https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A

Profile: New Zealand Pharmacy Claim Response

Tag:

identifier: https://standards.digital.health.nz/ns/claim-response-identifier/a1b2c3d4-e5f6-7890-abcd-ef1234567890\u00a0(use:\u00a0official)

status: Active

type: pharmacy

subType: ICP

use: Claim

patient: Identifier: NHI/ZZZ0008

created: 2025-01-01 00:00:00+0000

insurer: Identifier: HPIOrganization/G0K357-H

requestor: Identifier: HPIOrganization/GZZ999-9

request: Claim: extension = AG12345,Community Residential Care,AG54321; identifier = https://provider-org-name.co.nz/ns/claim-identifier#C123456\u00a0(use:\u00a0official); status = active; type = pharmacy; subType = ICPSA; use = claim; billablePeriod = 2025-01-01 --> 2025-01-01; created = 2025-01-01 00:00:00+1300; priority = Normal

outcome: Processing Complete

item

Shared Care Product Or Service: PU1234

Shared Care Review Outcome

  • decision: Approved

itemSequence: 1

adjudication

category: Amount Paid

reason: policy

Amounts

-ValueCurrency
*100New Zealand dollar

detail

Pharmacy Claim Item Detail Product Or Service: 123456

Pharmacy Claim Item Detail Review Outcome

  • decision: Approved

Shared Care Claim Trace Number: https://example.com/system/UUID-123456

detailSequence: 1

adjudication

category: Drug Cost

reason: policy

Amounts

-ValueCurrency
*50New Zealand dollar

adjudication

category: Pharmaceutical Subsidy

Amounts

-ValueCurrency
*30New Zealand dollar

adjudication

category: Amount Paid

Amounts

-ValueCurrency
*100New Zealand dollar

payment

type: Complete

date: 2025-01-01

Amounts

-ValueCurrency
*100New Zealand dollar

Errors

-ItemSequenceDetailSequenceCode
*11NHI number cannot be found in our records
" }, "identifier" : [{ "use" : "official", "system" : "https://standards.digital.health.nz/ns/claim-response-identifier", "value" : "a1b2c3d4-e5f6-7890-abcd-ef1234567890" }], "status" : "active", "type" : { "coding" : [{ "system" : "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/nz-claim-type", "code" : "pharmacy" }] }, "subType" : { "coding" : [{ "system" : "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/nz-claim-subtypes", "code" : "ICP" }] }, "use" : "claim", "patient" : { "type" : "Patient", "identifier" : { "system" : "https://standards.digital.health.nz/ns/nhi-id", "value" : "ZZZ0008" } }, "created" : "2025-01-01T00:00:00-00:00", "insurer" : { "type" : "Organization", "identifier" : { "system" : "https://standards.digital.health.nz/ns/hpi-organisation-id", "value" : "G0K357-H" } }, "requestor" : { "type" : "Organization", "identifier" : { "system" : "https://standards.digital.health.nz/ns/hpi-organisation-id", "value" : "GZZ999-9" } }, "request" : { "reference" : "Claim/NzPharmacyClaimExample2" }, "outcome" : "complete", "item" : [{ "extension" : [{ "url" : "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service", "valueCodeableConcept" : { "coding" : [{ "system" : "https://standards.digital.health.nz/ns/purchase-unit", "code" : "PU1234" }] } }, { "extension" : [{ "url" : "decision", "valueCodeableConcept" : { "coding" : [{ "system" : "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-cs", "code" : "approved" }] } }], "url" : "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome" }], "itemSequence" : 1, "adjudication" : [{ "category" : { "coding" : [{ "system" : "https://standards.digital.health.nz/ns/pharmacy-adjudication-category", "code" : "amountpaid" }] }, "reason" : { "coding" : [{ "system" : "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/adjudication-reason-codes", "code" : "policy" }] }, "amount" : { "value" : 100, "currency" : "NZD" } }], "detail" : [{ "extension" : [{ "url" : "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service", "valueCodeableConcept" : { "coding" : [{ "system" : "https://standards.digital.health.nz/ns/pharmacode", "code" : "123456" }] } }, { "extension" : [{ "url" : "decision", "valueCodeableConcept" : { "coding" : [{ "system" : "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-cs", "code" : "approved" }] } }], "url" : "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome" }, { "url" : "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number", "valueIdentifier" : { "system" : "https://example.com/system", "value" : "UUID-123456" } }], "detailSequence" : 1, "adjudication" : [{ "category" : { "coding" : [{ "system" : "https://standards.digital.health.nz/ns/pharmacy-adjudication-category", "code" : "drugcost" }] }, "reason" : { "coding" : [{ "system" : "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/adjudication-reason-codes", "code" : "policy" }] }, "amount" : { "value" : 50, "currency" : "NZD" } }, { "category" : { "coding" : [{ "system" : "https://standards.digital.health.nz/ns/pharmacy-adjudication-category", "code" : "pharmaceuticalsubsidy" }] }, "amount" : { "value" : 30, "currency" : "NZD" } }, { "category" : { "coding" : [{ "system" : "https://standards.digital.health.nz/ns/pharmacy-adjudication-category", "code" : "amountpaid" }] }, "amount" : { "value" : 100, "currency" : "NZD" } }] }] }], "payment" : { "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/ex-paymenttype", "code" : "complete" }] }, "date" : "2025-01-01", "amount" : { "value" : 100, "currency" : "NZD" } }, "error" : [{ "itemSequence" : 1, "detailSequence" : 1, "code" : { "coding" : [{ "system" : "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs", "code" : "DET055.002" }], "text" : "NHI number cannot be found in our records" } }] }