Health New Zealand Te Whatu Ora Shared Care FHIR API
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Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.5) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: New Zealand Pharmacy Claim Response Example - XML Representation

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<ClaimResponse xmlns="http://hl7.org/fhir">
  <meta>
    <source
            value="https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A"/>
    <profile
             value="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/NzPharmacyClaimResponse"/>
    <tag>
      <system
              value="https://hub.services.digital.health.nz/ns/correlation-id"/>
      <code value="123e4567-e89b-12d3-a456-426614174011"/>
    </tag>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ClaimResponse NzPharmacyClaimResponseExample</b></p><a name="NzPharmacyClaimResponseExample"> </a><a name="hcNzPharmacyClaimResponseExample"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Information Source: <a href="https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A">https://standards.digital.health.nz/ns/hpi-facility-id/FZZ111-A</a></p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-NzPharmacyClaimResponse.html">New Zealand Pharmacy Claim Response</a></p><p style="margin-bottom: 0px">Tag: 123e4567-e89b-12d3-a456-426614174011 (Details: correlation-id code 123e4567-e89b-12d3-a456-426614174011)</p></div><p><b>identifier</b>: <code>https://standards.digital.health.nz/ns/claim-response-identifier</code>/a1b2c3d4-e5f6-7890-abcd-ef1234567890 (use: official, )</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/nz-claim-type pharmacy}">pharmacy</span></p><p><b>subType</b>: <span title="Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/nz-claim-subtypes ICP}">ICP</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: Identifier: <a href="http://fhir.org.nz/ig/base/NamingSystem-nhi.html" title="NHI number">NHI</a>/ZZZ0008</p><p><b>created</b>: 2025-01-01 00:00:00+0000</p><p><b>insurer</b>: Identifier: <a href="http://fhir.org.nz/ig/base/NamingSystem-hpiOrganization.html" title="HPI organizations">HPIOrganization</a>/G0K357-H</p><p><b>requestor</b>: Identifier: <a href="http://fhir.org.nz/ig/base/NamingSystem-hpiOrganization.html" title="HPI organizations">HPIOrganization</a>/GZZ999-9</p><p><b>request</b>: <a href="Claim-NzPharmacyClaimExample2.html">Claim: extension = AG12345,Community Residential Care,AG54321; identifier = https://provider-org-name.co.nz/ns/claim-identifier#C123456 (use: official, ); status = active; type = pharmacy; subType = ICPSA; use = claim; billablePeriod = 2025-01-01 --&gt; 2025-01-01; created = 2025-01-01 00:00:00+1300; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p><blockquote><p><b>item</b></p><p><b>Shared Care Product Or Service</b>: <span title="Codes:{https://standards.digital.health.nz/ns/purchase-unit PU1234}">PU1234</span></p><blockquote><p><b>Shared Care Review Outcome</b></p><ul><li>decision: <span title="Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-cs approved}">Approved</span></li></ul></blockquote><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{https://standards.digital.health.nz/ns/pharmacy-adjudication-category amountpaid}">Amount Paid</span></p><p><b>reason</b>: <span title="Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/adjudication-reason-codes policy}">policy</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>100</td><td>New Zealand dollar</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>Pharmacy Claim Item Detail Product Or Service</b>: <span title="Codes:{https://standards.digital.health.nz/ns/pharmacode 123456}">123456</span></p><blockquote><p><b>Pharmacy Claim Item Detail Review Outcome</b></p><ul><li>decision: <span title="Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-cs approved}">Approved</span></li></ul></blockquote><p><b>Shared Care Claim Trace Number</b>: <code>https://example.com/system</code>/UUID-123456</p><p><b>detailSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{https://standards.digital.health.nz/ns/pharmacy-adjudication-category drugcost}">Drug Cost</span></p><p><b>reason</b>: <span title="Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/adjudication-reason-codes policy}">policy</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>50</td><td>New Zealand dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{https://standards.digital.health.nz/ns/pharmacy-adjudication-category pharmaceuticalsubsidy}">Pharmaceutical Subsidy</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>30</td><td>New Zealand dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{https://standards.digital.health.nz/ns/pharmacy-adjudication-category amountpaid}">Amount Paid</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>100</td><td>New Zealand dollar</td></tr></table></blockquote></blockquote></blockquote><blockquote><p><b>payment</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/ex-paymenttype complete}">Complete</span></p><p><b>date</b>: 2025-01-01</p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>100</td><td>New Zealand dollar</td></tr></table></blockquote><h3>Errors</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ItemSequence</b></td><td><b>DetailSequence</b></td><td><b>Code</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>1</td><td><span title="Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs DET055.002}">NHI number cannot be found in our records</span></td></tr></table></div>
  </text>
  <identifier>
    <use value="official"/>
    <system
            value="https://standards.digital.health.nz/ns/claim-response-identifier"/>
    <value value="a1b2c3d4-e5f6-7890-abcd-ef1234567890"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system
              value="https://fhir-ig.digital.health.nz/shared-care/CodeSystem/nz-claim-type"/>
      <code value="pharmacy"/>
    </coding>
  </type>
  <subType>
    <coding>
      <system
              value="https://fhir-ig.digital.health.nz/shared-care/CodeSystem/nz-claim-subtypes"/>
      <code value="ICP"/>
    </coding>
  </subType>
  <use value="claim"/>
  <patient>
    <type value="Patient"/>
    <identifier>
      <system value="https://standards.digital.health.nz/ns/nhi-id"/>
      <value value="ZZZ0008"/>
    </identifier>
  </patient>
  <created value="2025-01-01T00:00:00-00:00"/>
  <insurer>
    <type value="Organization"/>
    <identifier>
      <system
              value="https://standards.digital.health.nz/ns/hpi-organisation-id"/>
      <value value="G0K357-H"/>
    </identifier>
  </insurer>
  <requestor>
    <type value="Organization"/>
    <identifier>
      <system
              value="https://standards.digital.health.nz/ns/hpi-organisation-id"/>
      <value value="GZZ999-9"/>
    </identifier>
  </requestor>
  <request>🔗 
    <reference value="Claim/NzPharmacyClaimExample2"/>
  </request>
  <outcome value="complete"/>
  <item>
    <extension
               url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service">
      <valueCodeableConcept>
        <coding>
          <system
                  value="https://standards.digital.health.nz/ns/purchase-unit"/>
          <code value="PU1234"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome">
      <extension url="decision">
        <valueCodeableConcept>
          <coding>
            <system
                    value="https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-cs"/>
            <code value="approved"/>
          </coding>
        </valueCodeableConcept>
      </extension>
    </extension>
    <itemSequence value="1"/>
    <adjudication>
      <category>
        <coding>
          <system
                  value="https://standards.digital.health.nz/ns/pharmacy-adjudication-category"/>
          <code value="amountpaid"/>
        </coding>
      </category>
      <reason>
        <coding>
          <system
                  value="https://fhir-ig.digital.health.nz/shared-care/CodeSystem/adjudication-reason-codes"/>
          <code value="policy"/>
        </coding>
      </reason>
      <amount>
        <value value="100"/>
        <currency value="NZD"/>
      </amount>
    </adjudication>
    <detail>
      <extension
                 url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-product-or-service">
        <valueCodeableConcept>
          <coding>
            <system
                    value="https://standards.digital.health.nz/ns/pharmacode"/>
            <code value="123456"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension
                 url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/pharmacy-item-detail-review-outcome">
        <extension url="decision">
          <valueCodeableConcept>
            <coding>
              <system
                      value="https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-cs"/>
              <code value="approved"/>
            </coding>
          </valueCodeableConcept>
        </extension>
      </extension>
      <extension
                 url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number">
        <valueIdentifier>
          <system value="https://example.com/system"/>
          <value value="UUID-123456"/>
        </valueIdentifier>
      </extension>
      <detailSequence value="1"/>
      <adjudication>
        <category>
          <coding>
            <system
                    value="https://standards.digital.health.nz/ns/pharmacy-adjudication-category"/>
            <code value="drugcost"/>
          </coding>
        </category>
        <reason>
          <coding>
            <system
                    value="https://fhir-ig.digital.health.nz/shared-care/CodeSystem/adjudication-reason-codes"/>
            <code value="policy"/>
          </coding>
        </reason>
        <amount>
          <value value="50"/>
          <currency value="NZD"/>
        </amount>
      </adjudication>
      <adjudication>
        <category>
          <coding>
            <system
                    value="https://standards.digital.health.nz/ns/pharmacy-adjudication-category"/>
            <code value="pharmaceuticalsubsidy"/>
          </coding>
        </category>
        <amount>
          <value value="30"/>
          <currency value="NZD"/>
        </amount>
      </adjudication>
      <adjudication>
        <category>
          <coding>
            <system
                    value="https://standards.digital.health.nz/ns/pharmacy-adjudication-category"/>
            <code value="amountpaid"/>
          </coding>
        </category>
        <amount>
          <value value="100"/>
          <currency value="NZD"/>
        </amount>
      </adjudication>
    </detail>
  </item>
  <payment>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/ex-paymenttype"/>
        <code value="complete"/>
      </coding>
    </type>
    <date value="2025-01-01"/>
    <amount>
      <value value="100"/>
      <currency value="NZD"/>
    </amount>
  </payment>
  <error>
    <itemSequence value="1"/>
    <detailSequence value="1"/>
    <code>
      <coding>
        <system
                value="https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs"/>
        <code value="DET055.002"/>
      </coding>
      <text value="NHI number cannot be found in our records"/>
    </code>
  </error>
</ClaimResponse>