FHIR.ClaimResponse
Fields
Meta
Meta.DataModelString
ReliableRequiredFHIR.ClaimResponse
Meta.EventTypeString
ReliableRequired$payment
Meta.EventDateTimeDateTime
ReliableDisplays the UTC date and time that an outgoing request is delivered or an incoming request is received.
ISO 8601 Format
Meta.TestBoolean
ReliableIndicates whether the request is a test or not.
Meta.SourceString
ReliableContains the information for the system initiating the message, including the source ID and name.
Included in messages from Redox
Meta.Source.IDString
ReliableIdentifies the system initiating the message. If you have multiple OAuth API keys per environment type, this value is required. If you have only one OAuth API key per environment type, or you're using legacy API keys, this value is optional.
UUID
Meta.Source.NameString
ReliableDisplays the name of the system initiating the message.
Meta.Destinations[]Array of Objects
ReliableContains the information for the endpoint(s) receiving the request. A request must contain at least one destination, but asynchronous requests can have more than one destination. Synchronous requests like queries can only support one destination.
Required when sending data to Redox.
Meta.Destinations[].IDString
ReliableIdentifies the endpoint that the request is directed to.
UUID
Meta.Destinations[].NameString
ReliableDisplays the name of the endpoint that the request is directed to.
Meta.Logs[]Array of Objects
ReliableContains the log identifier(s) for the request.
Meta.Logs[].IDString
ReliableIdentifies the request log(s) that correspond to this request. You can use this value to locate the relevant log in the Redox dashboard for support and reference.
UUID
Meta.Logs[].AttemptIDString
ReliableIdentifies the request log attempt value, which is useful when retries are possible.
UUID
Meta.FacilityCodeString
PossibleCode for the facility related to the message.
Only use this field if a health system indicates you should. The code is specific to the health system's EHR and might not be unique across health systems. In general, the facility fields within the data models (e.g. OrderingFacility) are more reliable and informative.
Meta.SessionIDString
PossibleSession ID to be passed through for 3rd party sessions.
This is used for SMART App Launch and other OAuth/OpenID Connect flows where an access token is provided in addition to the SSO claims. The SessionID can be used on subsequent Redox API requests to fetch data.
Meta.RespondAsyncBoolean
PossibleA flag for indicating that the query response should follow the Asynchronous Buld Data Request pattern
{
"resourceType": "Bundle",
"id": "ProfessionalPaymentBundle",
"type": "collection",
"identifier": {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:59f129cf-2eca-4965-88f2-452558af1934"
},
"timestamp": "2022-07-02T19:09:02.452Z",
"entry": [
{
"resource": {
"resourceType": "ClaimResponse",
"id": "PaymentProfessional",
"meta": {
"lastUpdated": "2022-12-12T09:14:11+00:00"
},
"status": "active",
"use": "claim",
"language": "en-US",
"identifier": [
{
"value": "urn:uuid:e69ba9b3-407a-4da6-bde2-d1b48792fadf",
"system": "https://www.insurance.com/fhir"
}
],
"type": {
"coding": [
{
"code": "professional",
"system": "http://terminology.hl7.org/CodeSystem/claim-type"
}
],
"text": "Professional"
},
"created": "2022-07-02T00:00:00+00:00",
"insurer": {
"reference": "Organization/RedoxInsurerOrganizationExample"
},
"patient": {
"reference": "Patient/RedoxPABeneficiaryExample"
},
"requestor": {
"reference": "Practitioner/RedoxPractitionerExampleJoan"
},
"outcome": "partial",
"total": [
{
"category": {
"coding": [
{
"code": "paidtoprovider",
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication"
}
],
"text": "Payment Amount"
},
"amount": {
"value": 520,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"code": "submitted",
"system": "http://terminology.hl7.org/CodeSystem/adjudication"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 2550,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"code": "paidbypatient",
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication"
}
],
"text": "Patient Pay Amount"
},
"amount": {
"value": 30,
"currency": "USD"
}
}
],
"item": [
{
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"code": "submitted",
"system": "http://terminology.hl7.org/CodeSystem/adjudication"
}
]
},
"amount": {
"value": 1000,
"currency": "USD"
}
}
]
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/RedoxPACoverageExample"
}
}
]
}
},
{
"resource": {
"resourceType": "Patient",
"id": "RedoxPABeneficiaryExample",
"identifier": [
{
"system": "urn:redox:MRN",
"value": "M23462346"
}
],
"name": [
{
"given": [
"Timothy",
"Paul"
],
"family": "Bixby"
}
],
"gender": "male",
"birthDate": "2008-01-06"
}
},
{
"resource": {
"resourceType": "Coverage",
"id": "RedoxPACoverageExample",
"class": [
{
"type": {
"coding": [
{
"code": "group",
"system": "http://terminology.hl7.org/CodeSystem/coverage-class"
}
]
},
"value": "GRP2245"
}
],
"status": "active",
"beneficiary": {
"reference": "Patient/RedoxPABeneficiaryExample"
},
"payor": [
{
"reference": "Organization/RedoxPAInsurerOrganizationExample"
}
],
"subscriber": {
"reference": "Patient/RedoxPABeneficiaryExample"
},
"subscriberId": "T75644"
}
},
{
"resource": {
"resourceType": "Organization",
"id": "RedoxPAInsurerOrganizationExample",
"active": true,
"name": "Aetna",
"address": [
{
"line": [
"PO Box 14080"
],
"city": "Lexington",
"district": "Fayette",
"state": "KY",
"postalCode": "40512-4079",
"country": "USA"
}
]
}
},
{
"resource": {
"resourceType": "Practitioner",
"id": "RedoxPractitionerExampleJoan",
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "4336749876"
}
],
"name": [
{
"given": [
"Joan"
],
"family": "Fishman"
}
],
"address": [
{
"line": [
"4762 Hickory St."
],
"city": "Monroe",
"district": "Green",
"state": "WI",
"postalCode": "53566",
"country": "USA"
}
],
"telecom": [
{
"value": "+16085558899"
}
]
}
}
],
"Meta": {
"Logs": [
{
"ID": "d9f5d293-7110-461e-a875-3beb089e79f3",
"AttemptID": "925d1617-2fe0-468c-a14c-f8c04b572c54"
}
],
"Test": true,
"EventDateTime": "2024-07-29T16:55:22.999Z",
"Source": {
"ID": "7ce6f387-c33c-417d-8682-81e83628cbd9",
"Name": "Redox Dev Tools"
},
"Destinations": [
{
"ID": "af394f14-b34a-464f-8d24-895f370af4c9",
"Name": "Redox EMR"
}
],
"DataModel": "FHIR.ClaimResponse",
"EventType": "$payment"
}
}Fields
Meta
Meta.DataModelString
ReliableRequiredFHIR.ClaimResponse
Meta.EventTypeString
ReliableRequired$status-response
Meta.EventDateTimeDateTime
ReliableDisplays the UTC date and time that an outgoing request is delivered or an incoming request is received.
ISO 8601 Format
Meta.TestBoolean
ReliableIndicates whether the request is a test or not.
Meta.SourceString
ReliableContains the information for the system initiating the message, including the source ID and name.
Included in messages from Redox
Meta.Source.IDString
ReliableIdentifies the system initiating the message. If you have multiple OAuth API keys per environment type, this value is required. If you have only one OAuth API key per environment type, or you're using legacy API keys, this value is optional.
UUID
Meta.Source.NameString
ReliableDisplays the name of the system initiating the message.
Meta.Destinations[]Array of Objects
ReliableContains the information for the endpoint(s) receiving the request. A request must contain at least one destination, but asynchronous requests can have more than one destination. Synchronous requests like queries can only support one destination.
Required when sending data to Redox.
Meta.Destinations[].IDString
ReliableIdentifies the endpoint that the request is directed to.
UUID
Meta.Destinations[].NameString
ReliableDisplays the name of the endpoint that the request is directed to.
Meta.Logs[]Array of Objects
ReliableContains the log identifier(s) for the request.
Meta.Logs[].IDString
ReliableIdentifies the request log(s) that correspond to this request. You can use this value to locate the relevant log in the Redox dashboard for support and reference.
UUID
Meta.Logs[].AttemptIDString
ReliableIdentifies the request log attempt value, which is useful when retries are possible.
UUID
Meta.FacilityCodeString
PossibleCode for the facility related to the message.
Only use this field if a health system indicates you should. The code is specific to the health system's EHR and might not be unique across health systems. In general, the facility fields within the data models (e.g. OrderingFacility) are more reliable and informative.
Meta.SessionIDString
PossibleSession ID to be passed through for 3rd party sessions.
This is used for SMART App Launch and other OAuth/OpenID Connect flows where an access token is provided in addition to the SSO claims. The SessionID can be used on subsequent Redox API requests to fetch data.
Meta.RespondAsyncBoolean
PossibleA flag for indicating that the query response should follow the Asynchronous Buld Data Request pattern
{
"resourceType": "Bundle",
"id": "InstitutionalClaimStatusCheckResponseBundle",
"type": "collection",
"identifier": {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:59f129cf-2eca-4965-88f2-452558af1934"
},
"timestamp": "2021-10-21T19:09:02.452Z",
"entry": [
{
"resource": {
"resourceType": "ClaimResponse",
"id": "InstitutionalClaimStatusCheckResponse",
"status": "active",
"use": "claim",
"identifier": [
{
"system": "http://myclaim.id",
"value": "123476789"
}
],
"type": {
"coding": [
{
"code": "institutional",
"system": "http://terminology.hl7.org/CodeSystem/claim-type"
}
]
},
"patient": {
"reference": "Patient/RedoxPABeneficiaryExample"
},
"created": "2022-01-18T16:27:49.101Z",
"insurer": {
"reference": "Organization/RedoxInsurerOrganizationExample"
},
"outcome": "partial",
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/RedoxPACoverageExample"
}
}
],
"item": [
{
"itemSequence": 1,
"id": "12387414",
"adjudication": [
{
"category": {
"coding": [
{
"code": "A2",
"system": "https://x12.org/codes/claim-status-category-codes",
"display": "Acknowledgement/Acceptance into adjudication system"
}
]
},
"reason": {
"coding": [
{
"code": "20",
"system": "https://x12.org/codes/claim-status-codes",
"display": "Accepted for processing"
}
]
}
}
]
},
{
"itemSequence": 2,
"id": "5352523553",
"adjudication": [
{
"category": {
"coding": [
{
"code": "A3",
"system": "https://x12.org/codes/claim-status-category-codes",
"display": "Acknowledgement/Returned as unprocessable claim"
}
]
},
"reason": {
"coding": [
{
"code": "297",
"system": "https://x12.org/codes/claim-status-codes",
"display": "Date(s) of service"
}
]
}
}
]
}
]
}
},
{
"resource": {
"resourceType": "Patient",
"id": "RedoxPABeneficiaryExample",
"identifier": [
{
"system": "urn:redox:MRN",
"value": "M23462346"
}
],
"name": [
{
"given": [
"Timothy",
"Paul"
],
"family": "Bixby"
}
],
"gender": "male",
"birthDate": "2008-01-06"
}
},
{
"resource": {
"resourceType": "Coverage",
"id": "RedoxPACoverageExample",
"class": [
{
"type": {
"coding": [
{
"code": "group",
"system": "http://terminology.hl7.org/CodeSystem/coverage-class"
}
]
},
"value": "GRP2245"
}
],
"status": "active",
"beneficiary": {
"reference": "Patient/RedoxPABeneficiaryExample"
},
"payor": [
{
"reference": "Organization/RedoxPAInsurerOrganizationExample"
}
],
"subscriber": {
"reference": "Patient/RedoxPABeneficiaryExample"
},
"subscriberId": "T75644"
}
},
{
"resource": {
"resourceType": "Organization",
"id": "RedoxPARequestorOrganizationExample",
"active": true,
"name": "Good Health Clinics",
"address": [
{
"line": [
"123 Main St."
],
"city": "Madison",
"district": "Dane",
"state": "WI",
"postalCode": "53703",
"country": "USA"
}
]
}
},
{
"resource": {
"resourceType": "Organization",
"id": "RedoxPAInsurerOrganizationExample",
"active": true,
"name": "Aetna",
"address": [
{
"line": [
"PO Box 14080"
],
"city": "Lexington",
"district": "Fayette",
"state": "KY",
"postalCode": "40512-4079",
"country": "USA"
}
]
}
},
{
"resource": {
"resourceType": "Practitioner",
"id": "RedoxPractitionerExamplePat",
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "4356789876"
}
],
"name": [
{
"given": [
"Pat"
],
"family": "Granite"
}
],
"address": [
{
"line": [
"123 Main St."
],
"city": "Madison",
"district": "Dane",
"state": "WI",
"postalCode": "53703",
"country": "USA"
}
],
"telecom": [
{
"value": "+16085551234"
}
]
}
},
{
"resource": {
"resourceType": "Practitioner",
"id": "RedoxPractitionerExampleJoan",
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "4336749876"
}
],
"name": [
{
"given": [
"Joan"
],
"family": "Fishman"
}
],
"address": [
{
"line": [
"4762 Hickory St."
],
"city": "Monroe",
"district": "Green",
"state": "WI",
"postalCode": "53566",
"country": "USA"
}
],
"telecom": [
{
"value": "+16085558899"
}
]
}
}
],
"Meta": {
"Logs": [
{
"ID": "d9f5d293-7110-461e-a875-3beb089e79f3",
"AttemptID": "925d1617-2fe0-468c-a14c-f8c04b572c54"
}
],
"Test": true,
"EventDateTime": "2024-07-29T16:55:22.999Z",
"Source": {
"ID": "7ce6f387-c33c-417d-8682-81e83628cbd9",
"Name": "Redox Dev Tools"
},
"Destinations": [
{
"ID": "af394f14-b34a-464f-8d24-895f370af4c9",
"Name": "Redox EMR"
}
],
"DataModel": "FHIR.ClaimResponse",
"EventType": "$status-response"
}
}Fields
Meta
Meta.DataModelString
ReliableRequiredFHIR.ClaimResponse
Meta.EventTypeString
ReliableRequired$respond
Meta.EventDateTimeDateTime
ReliableDisplays the UTC date and time that an outgoing request is delivered or an incoming request is received.
ISO 8601 Format
Meta.TestBoolean
ReliableIndicates whether the request is a test or not.
Meta.SourceString
ReliableContains the information for the system initiating the message, including the source ID and name.
Included in messages from Redox
Meta.Source.IDString
ReliableIdentifies the system initiating the message. If you have multiple OAuth API keys per environment type, this value is required. If you have only one OAuth API key per environment type, or you're using legacy API keys, this value is optional.
UUID
Meta.Source.NameString
ReliableDisplays the name of the system initiating the message.
Meta.Destinations[]Array of Objects
ReliableContains the information for the endpoint(s) receiving the request. A request must contain at least one destination, but asynchronous requests can have more than one destination. Synchronous requests like queries can only support one destination.
Required when sending data to Redox.
Meta.Destinations[].IDString
ReliableIdentifies the endpoint that the request is directed to.
UUID
Meta.Destinations[].NameString
ReliableDisplays the name of the endpoint that the request is directed to.
Meta.Logs[]Array of Objects
ReliableContains the log identifier(s) for the request.
Meta.Logs[].IDString
ReliableIdentifies the request log(s) that correspond to this request. You can use this value to locate the relevant log in the Redox dashboard for support and reference.
UUID
Meta.Logs[].AttemptIDString
ReliableIdentifies the request log attempt value, which is useful when retries are possible.
UUID
Meta.FacilityCodeString
PossibleCode for the facility related to the message.
Only use this field if a health system indicates you should. The code is specific to the health system's EHR and might not be unique across health systems. In general, the facility fields within the data models (e.g. OrderingFacility) are more reliable and informative.
Meta.SessionIDString
PossibleSession ID to be passed through for 3rd party sessions.
This is used for SMART App Launch and other OAuth/OpenID Connect flows where an access token is provided in addition to the SSO claims. The SessionID can be used on subsequent Redox API requests to fetch data.
Meta.RespondAsyncBoolean
PossibleA flag for indicating that the query response should follow the Asynchronous Buld Data Request pattern
{
"resourceType": "Bundle",
"id": "RedoxClaimResponseBundleComprehensiveExample",
"type": "collection",
"identifier": {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:59f129cf-2eca-4965-88f2-452558af1934"
},
"timestamp": "2021-10-21T19:09:02.452Z",
"entry": [
{
"resource": {
"resourceType": "ClaimResponse",
"id": "RedoxPAClaimResponseExample",
"status": "active",
"use": "preauthorization",
"item": [
{
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"extension": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode",
"valueCodeableConcept": {
"coding": [
{
"code": "A1",
"system": "https://codesystem.x12.org/005010/306",
"display": "Certified in total"
}
]
}
},
{
"url": "number",
"valueString": "AUTH1001"
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
}
]
}
],
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber",
"valueString": "REF456"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthIssueDate",
"valueDate": "2021-08-23"
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemPreAuthPeriod",
"valuePeriod": {
"start": "2021-08-23",
"end": "2021-09-23"
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber",
"valueIdentifier": {
"value": "23462346"
}
},
{
"extension": [
{
"url": "productOrServiceCode",
"valueCodeableConcept": {
"coding": [
{
"code": "93451",
"system": "http://www.ama-assn.org/go/cpt"
}
],
"text": "Right heart catheterization"
}
},
{
"url": "quantity",
"valueQuantity": {
"value": 1
}
},
{
"url": "unitPrice",
"valueMoney": {
"value": 4966,
"currency": "USD"
}
}
],
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
}
],
"itemSequence": 1
}
],
"type": {
"coding": [
{
"code": "professional",
"system": "http://terminology.hl7.org/CodeSystem/claim-type"
}
]
},
"patient": {
"reference": "Patient/RedoxPABeneficiaryExample"
},
"created": "2021-08-23T16:35:54.648Z",
"insurer": {
"reference": "Organization/RedoxPAInsurerOrganizationExample"
},
"requestor": {
"reference": "Organization/RedoxPARequestorOrganizationExample"
},
"request": {
"reference": "Claim/RedoxPAServiceClaimExample",
"identifier": {
"type": {
"coding": [
{
"code": "ClaimID"
}
]
},
"value": "urn:uuid:97b8d6d0-ac3d-411a-b32a-e1d237aceb6a"
}
},
"outcome": "complete",
"processNote": [
{
"text": "Covered under extended benefits"
}
]
}
},
{
"resource": {
"resourceType": "Patient",
"id": "RedoxPABeneficiaryExample",
"identifier": [
{
"system": "urn:redox:MRN",
"value": "M23462346"
}
],
"name": [
{
"given": [
"Timothy",
"Paul"
],
"family": "Bixby"
}
],
"gender": "male",
"birthDate": "2008-01-06"
}
},
{
"resource": {
"resourceType": "Coverage",
"id": "RedoxPACoverageWithRelatedSubscriberExample",
"class": [
{
"type": {
"coding": [
{
"code": "group",
"system": "http://terminology.hl7.org/CodeSystem/coverage-class"
}
]
},
"value": "GRP2245"
}
],
"status": "active",
"beneficiary": {
"reference": "Patient/RedoxPABeneficiaryExample"
},
"payor": [
{
"reference": "Organization/RedoxPAInsurerOrganizationExample"
}
],
"subscriber": {
"reference": "RelatedPerson/RedoxPASubscriberExample"
},
"subscriberId": "M2346623"
}
},
{
"resource": {
"resourceType": "Organization",
"id": "RedoxPARequestorOrganizationExample",
"active": true,
"name": "Good Health Clinics",
"address": [
{
"line": [
"123 Main St."
],
"city": "Madison",
"district": "Dane",
"state": "WI",
"postalCode": "53703",
"country": "USA"
}
]
}
},
{
"resource": {
"resourceType": "Organization",
"id": "RedoxPAInsurerOrganizationExample",
"active": true,
"name": "Aetna",
"address": [
{
"line": [
"PO Box 14080"
],
"city": "Lexington",
"district": "Fayette",
"state": "KY",
"postalCode": "40512-4079",
"country": "USA"
}
]
}
},
{
"resource": {
"resourceType": "PractitionerRole",
"id": "RedoxPAPractitionerRoleExamplePat",
"practitioner": {
"reference": "Practitioner/RedoxPAPractitionerExamplePat"
},
"organization": {
"reference": "Organization/RedoxPARequestorOrganizationExample"
},
"location": [
{
"display": "1st Street Family Clinic"
}
],
"specialty": [
{
"coding": [
{
"code": "394579002",
"system": "http://snomed.info/sct",
"display": "Cardiology"
}
]
}
]
}
},
{
"resource": {
"resourceType": "Practitioner",
"id": "RedoxPAPractitionerExamplePat",
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "4356789876"
}
],
"name": [
{
"given": [
"Pat"
],
"family": "Granite"
}
],
"address": [
{
"line": [
"123 Main St."
],
"city": "Madison",
"district": "Dane",
"state": "WI",
"postalCode": "53703",
"country": "USA"
}
],
"telecom": [
{
"value": "+16085551234"
}
]
}
},
{
"resource": {
"resourceType": "RelatedPerson",
"id": "RedoxPASubscriberExample",
"patient": {
"reference": "Patient/RedoxPABeneficiaryExample"
},
"name": [
{
"given": [
"Barbara"
],
"family": "Bixby"
}
],
"relationship": [
{
"text": "Mother"
}
]
}
},
{
"resource": {
"resourceType": "Claim",
"id": "RedoxPAServiceClaimExample",
"status": "active",
"use": "preauthorization",
"insurance": [
{
"focal": true,
"sequence": 1,
"coverage": {
"reference": "Coverage/RedoxPACoverageExample"
}
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService",
"valueReference": {
"reference": "ServiceRequest/RedoxPAServiceRequestExample"
}
},
{
"url": "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber",
"valueIdentifier": {
"value": "23462346"
}
}
],
"sequence": 1,
"productOrService": {
"coding": [
{
"code": "93456",
"system": "http://www.ama-assn.org/go/cpt"
}
],
"text": "Coronary angiography with right heart catheterization"
}
}
],
"supportingInfo": [
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType",
"code": "additionalInformation",
"display": "Send additional paperwork or supporting information is sent for the request."
}
]
},
"sequence": 1,
"valueReference": {
"reference": "DocumentReference/RedoxPADocumentReferenceExample"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASSupportingInfoType",
"code": "freeFormMessage",
"display": "Written Confirmation."
}
]
},
"sequence": 2,
"valueString": "1"
}
],
"identifier": [
{
"type": {
"coding": [
{
"code": "ClaimID"
}
]
},
"value": "urn:uuid:97b8d6d0-ac3d-411a-b32a-e1d237aceb6a"
}
],
"type": {
"coding": [
{
"code": "professional",
"system": "http://terminology.hl7.org/CodeSystem/claim-type"
}
]
},
"patient": {
"reference": "Patient/RedoxPABeneficiaryExample"
},
"created": "2021-09-02T18:44:13.307Z",
"enterer": {
"reference": "PractitionerRole/RedoxPAPractitionerRoleExamplePat"
},
"insurer": {
"reference": "Organization/RedoxPAInsurerOrganizationExample"
},
"provider": {
"reference": "Organization/RedoxPARequestorOrganizationExample"
},
"priority": {
"coding": [
{
"code": "normal",
"system": "http://terminology.hl7.org/CodeSystem/processpriority"
}
]
},
"diagnosis": [
{
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"code": "I42.9",
"system": "http://hl7.org/fhir/sid/icd-10-cm",
"display": "Cardiomyopathy, unspecified"
}
]
}
}
]
}
}
],
"Meta": {
"Logs": [
{
"ID": "d9f5d293-7110-461e-a875-3beb089e79f3",
"AttemptID": "925d1617-2fe0-468c-a14c-f8c04b572c54"
}
],
"Test": true,
"EventDateTime": "2024-07-29T16:55:22.999Z",
"Source": {
"ID": "7ce6f387-c33c-417d-8682-81e83628cbd9",
"Name": "Redox Dev Tools"
},
"Destinations": [
{
"ID": "af394f14-b34a-464f-8d24-895f370af4c9",
"Name": "Redox EMR"
}
],
"DataModel": "FHIR.ClaimResponse",
"EventType": "$respond"
}
}