{ "resourceType" : "ClaimResponse", "meta" : { "source" : "https://standards.digital.health.nz/ns/hpi-facility-id/F12345-A", "profile" : ["https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/SharedCareClaimResponse"], "tag" : [{ "system" : "https://hub.services.digital.health.nz/ns/correlation-id", "code" : "xxxxxxxx-xxxx-xxxx-xxxx-xxxxxxxxxxxx" }] }, "text" : { "status" : "extensions", "div" : "

Generated Narrative: ClaimResponse NzTelehealthClaimResponseExample

Information Source: https://standards.digital.health.nz/ns/hpi-facility-id/F12345-A

Profile: NZ SharedCare Claim Response

Tag:

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

status: Active

type: Professional

subType: Telehealth

use: Claim

patient: Identifier: NHI/ZZZ0008

created: 2025-01-15 10:30:00+0000

insurer: Identifier: HPIOrganization/G0K357-H

requestor: Identifier: HPIOrganization/GZZ999-J\u00a0(use:\u00a0official)

request: Claim: extension = AGRS-202sdfg4-00121,https://example.org/fhir/trace-number#7890; identifier = https://provider-org-name.co.nz/ns/claim-identifier#C123456\u00a0(use:\u00a0official); status = active; type = professional; subType = Telehealth; use = claim; billablePeriod = 2025-01-01 00:00:00+1300 --> 2025-01-02 00:00:00+1300; created = 2025-01-01 00:00:00+1300; priority = Normal

outcome: Processing Complete

item

Shared Care Product Or Service: COGP0068

Shared Care Claim Trace Number: https://standards.digital.health.nz/ns/claim-response-item-identifier/cd7b6e0d-c554-4786-a52d-3efd1c187c1a

Shared Care Review Outcome

  • decision: Approved
  • reason: Record of encounter was found in our system.

itemSequence: 1

adjudication

category: Benefit Amount

reason: policy

Amounts

-ValueCurrency
*100New Zealand dollar

value: 1

total

category: Benefit Amount

Amounts

-ValueCurrency
*100New Zealand dollar

payment

type: Complete

date: 2025-01-01

Amounts

-ValueCurrency
*100New Zealand dollar

Errors

-Code
*Claim validation failed: Missing required service date
" }, "identifier" : [{ "use" : "official", "system" : "https://standards.digital.health.nz/ns/claim-response-identifier", "value" : "a1b2c3d4-e5f6-7890-abcd-ef1234567890" }], "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "professional" }] }, "subType" : { "coding" : [{ "system" : "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/nz-claim-subtype-cs", "code" : "telehealth" }] }, "use" : "claim", "patient" : { "type" : "Patient", "identifier" : { "system" : "https://standards.digital.health.nz/ns/nhi-id", "value" : "ZZZ0008" } }, "created" : "2025-01-15T10:30:00-00:00", "insurer" : { "type" : "Organization", "identifier" : { "system" : "https://standards.digital.health.nz/ns/hpi-organisation-id", "value" : "G0K357-H" } }, "requestor" : { "type" : "Organization", "identifier" : { "use" : "official", "system" : "https://standards.digital.health.nz/ns/hpi-organisation-id", "value" : "GZZ999-J" } }, "request" : { "reference" : "Claim/NzTelehealthClaimExample" }, "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" : "COGP0068" }] } }, { "url" : "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number", "valueIdentifier" : { "system" : "https://standards.digital.health.nz/ns/claim-response-item-identifier", "value" : "cd7b6e0d-c554-4786-a52d-3efd1c187c1a" } }, { "extension" : [{ "url" : "decision", "valueCodeableConcept" : { "coding" : [{ "system" : "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-cs", "code" : "approved", "display" : "Approved" }] } }, { "url" : "reason", "valueCodeableConcept" : { "coding" : [{ "system" : "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs", "code" : "DET064.001", "display" : "Passed" }], "text" : "Record of encounter was found in our system." } }], "url" : "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome" }], "itemSequence" : 1, "adjudication" : [{ "category" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/adjudication", "code" : "benefit" }] }, "reason" : { "coding" : [{ "system" : "https://standards.digital.health.nz/ns/adjudication-reason-code", "code" : "policy" }] }, "amount" : { "value" : 100, "currency" : "NZD" }, "value" : 1 }] }], "total" : [{ "category" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/adjudication", "code" : "benefit" }] }, "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" : [{ "code" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/adjudication-error", "code" : "a001", "display" : "Invalid claim" }], "text" : "Claim validation failed: Missing required service date" } }] }