Generated Narrative: Bundle 96b80922-b538-4ab3-0176-a80b51242161

Bundle 96b80922-b538-4ab3-0176-a80b51242161 of type message

Entry 1 - fullUrl = urn:uuid:000739e8-c8d0-44f8-b0e0-f89310ea1998

Resource MessageHeader:

Generated Narrative: MessageHeader 000739e8-c8d0-44f8-b0e0-f89310ea1998

Profile: Nphies MessageHeader

event: KSA Message Events payment-reconciliation: Payment Reconciliation

Destinations

-	Endpoint	Receiver
*	http://saudidentalclinic.com.sa	Identifier: http://nphies.sa/license/provider-license/PR-FHIR

sender: Identifier: http://nphies.sa/license/payer-license/INS-FHIR

Sources

-	Endpoint
*	http://sni.com.sa

focus: Bundle: type = message; timestamp = 2023-12-02 19:36:29+0000

Entry 2 - fullUrl = http://sni.com.sa/PaymentReconciliation/90581

Resource PaymentReconciliation:

Generated Narrative: PaymentReconciliation 90581

Profile: Nphies Payment Reconciliation

identifier: http://sni.com.sa/identifiers/paymentreconciliation/90581

status: Active

period: 2023-12-01 --> 2023-12-06

created: 2023-12-06

paymentIssuer: Bundle: type = message; timestamp = 2023-12-19 08:20:29+0000

requestor: Bundle: type = message; timestamp = 2023-12-02 19:36:29+0000

outcome: Processing Complete

disposition: Payment made for the month of December, 2023

paymentDate: 2023-12-06

PaymentAmounts

-	Value	Currency
*	239.55	Saudi riyal

paymentIdentifier: EFT/URN-987590432322

detail

Component - Payment: SAR241.50 (SAR)

Component - Early Fee: SAR0.00 (SAR)

Component - Payment: SAR-1.95 (SAR)

type: Payment

request: Identifier: http://saudidentalclinic.com.sa/identifiers/claim/req_29309905401

submitter: Bundle: type = message; timestamp = 2023-12-02 19:36:29+0000

response: Identifier: http://sni.com.sa/identifiers/claimresponse/res_10411448401

date: 2023-12-06

payee: Bundle: type = message; timestamp = 2023-12-02 19:36:29+0000

Amounts

-	Value	Currency
*	239.55	Saudi riyal

Entry 3 - fullUrl = http://sni.com.sa/Organization/215

Resource Organization:

Generated Narrative: Organization 215

Profile: Nphies Provider Organization

Provider Type: Clinic

identifier: http://nphies.sa/license/provider-license/DC-FHIR

active: true

type: Healthcare Provider

name: Saudi Dental Clinic

address: Hajar Valley, Building 104, Riyadh Saudi Arabia(work)

Entry 4 - fullUrl = http://sni.com.sa/Organization/bff3aa1fbd3648619ac082357bf135db

Resource Organization:

Generated Narrative: Organization bff3aa1fbd3648619ac082357bf135db

Profile: Nphies Insurer Organization

identifier: National Insurance Organization Identifier/INS-FHIR (use: official, )

active: true

type: Insurance Company

name: Saudi National Insurance

address: Olaya Street, Building 70, Riyadh Saudi Arabia(work)