Healthcare Financial Services IG Edition 1
0.3.0 - ci-build
Healthcare Financial Services IG Edition 1 - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
: Message: Polling Response #1 - JSON Representation
{
"resourceType" : "Bundle",
"id" : "c2c63768-a65b-4784-ab91-6c09012c3ab1",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle"
]
},
"type" : "message",
"timestamp" : "2023-12-04T13:39:58.099+00:00",
"entry" : [
{
"fullUrl" : "urn:uuid:bc0e9c0f-3033-44ae-b492-0e7b328d1ab1",
"resource" : {
"resourceType" : "MessageHeader",
"id" : "bc0e9c0f-3033-44ae-b492-0e7b328d1ab1",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_bc0e9c0f-3033-44ae-b492-0e7b328d1ab1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader bc0e9c0f-3033-44ae-b492-0e7b328d1ab1</b></p><a name=\"bc0e9c0f-3033-44ae-b492-0e7b328d1ab1\"> </a><a name=\"hcbc0e9c0f-3033-44ae-b492-0e7b328d1ab1\"> </a><a name=\"bc0e9c0f-3033-44ae-b492-0e7b328d1ab1-en-US\"> </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\">Profile: <a href=\"StructureDefinition-message-header.html\">Nphies MessageHeader</a></p></div><p><b>event</b>: <a href=\"CodeSystem-ksa-message-events.html#ksa-message-events-poll-response\">KSA Message Events poll-response</a>: Poll Response</p><h3>Destinations</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Endpoint</b></td><td><b>Receiver</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://saudigeneralhospital.com.sa\">http://saudigeneralhospital.com.sa</a></td><td>Identifier: <code>http://nphies.sa/license/provider-license</code>/PR-FHIR</td></tr></table><p><b>sender</b>: Identifier: <code>http://nphies.sa/license/nphies</code>/NPHIES</p><h3>Sources</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Endpoint</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://nphies.sa\">http://nphies.sa</a></td></tr></table><h3>Responses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Identifier</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>a7e4caf2-0441-40e5-97d2-5ae180273069</td><td>OK</td></tr></table><p><b>focus</b>: <a href=\"Bundle-c2c63768-a65b-4784-ab91-6c09012c3ab1.html#http-//nphies.sa/Task/560811\">Bundle: type = message; timestamp = 2023-12-04 13:39:58+0000</a></p></div>"
},
"eventCoding" : {
"system" : "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
"code" : "poll-response"
},
"destination" : [
{
"endpoint" : "http://saudigeneralhospital.com.sa",
"receiver" : {
"type" : "Organization",
"identifier" : {
"system" : "http://nphies.sa/license/provider-license",
"value" : "PR-FHIR"
}
}
}
],
"sender" : {
"type" : "Organization",
"identifier" : {
"system" : "http://nphies.sa/license/nphies",
"value" : "NPHIES"
}
},
"source" : {
"endpoint" : "http://nphies.sa"
},
"response" : {
"identifier" : "a7e4caf2-0441-40e5-97d2-5ae180273069",
"code" : "ok"
},
"focus" : [
{
"reference" : "http://nphies.sa/Task/560811"
}
]
}
},
{
"fullUrl" : "http://nphies.sa/Task/560811",
"resource" : {
"resourceType" : "Task",
"id" : "560811",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/poll-response"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Task_560811\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Task 560811</b></p><a name=\"560811\"> </a><a name=\"hc560811\"> </a><a name=\"560811-en-US\"> </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\">Profile: <a href=\"StructureDefinition-poll-response.html\">Nphies Poll Response</a></p></div><p><b>identifier</b>: <code>http://nphies.sa/identifiers/poll-response</code>/rsp_560081</p><p><b>status</b>: Completed</p><p><b>intent</b>: order</p><p><b>priority</b>: Routine</p><p><b>code</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/task-code poll}\">Poll the focal resource</span></p><p><b>authoredOn</b>: 2023-12-04 06:59:00+0300</p><p><b>lastModified</b>: 2023-12-04 06:59:00+0300</p><p><b>requester</b>: <a href=\"Organization-b1b3432921324f97af3be9fd0b1a14ae.html\">Organization Saudi General Hospital</a></p><p><b>owner</b>: <a href=\"Organization-NPHIES.html\">Organization National Program for Health Information Exchange Services</a></p><h3>Outputs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/task-output-type response}\">Response</span></td><td><a href=\"Bundle-c2c63768-a65b-4784-ab91-6c09012c3ab1.html#http-//nphies.sa/Bundle/c2c63768-a65b-4784-ab91-6c09012c3cbc\">Bundle: type = message; timestamp = 2023-12-04 13:39:58+0000</a></td></tr></table></div>"
},
"identifier" : [
{
"system" : "http://nphies.sa/identifiers/poll-response",
"value" : "rsp_560081"
}
],
"status" : "completed",
"intent" : "order",
"priority" : "routine",
"code" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/task-code",
"code" : "poll"
}
]
},
"authoredOn" : "2023-12-04T06:59:00+03:00",
"lastModified" : "2023-12-04T06:59:00+03:00",
"requester" : {
🔗 "reference" : "Organization/b1b3432921324f97af3be9fd0b1a14ae"
},
"owner" : {
🔗 "reference" : "Organization/NPHIES"
},
"output" : [
{
"type" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/task-output-type",
"code" : "response"
}
]
},
"valueReference" : {
"reference" : "http://nphies.sa/Bundle/c2c63768-a65b-4784-ab91-6c09012c3cbc"
}
}
]
}
},
{
"fullUrl" : "http://nphies.sa/Organization/NPHIES",
"resource" : {
"resourceType" : "Organization",
"id" : "NPHIES",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/organization"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_NPHIES\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization NPHIES</b></p><a name=\"NPHIES\"> </a><a name=\"hcNPHIES\"> </a><a name=\"NPHIES-en-US\"> </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\">Profile: <a href=\"StructureDefinition-organization.html\">Nphies Organization</a></p></div><p><b>identifier</b>: <code>http://nphies.sa/license/nphies</code>/NPHIES\u00a0(use:\u00a0official,\u00a0)</p><p><b>active</b>: true</p><p><b>name</b>: National Program for Health Information Exchange Services</p></div>"
},
"identifier" : [
{
"use" : "official",
"system" : "http://nphies.sa/license/nphies",
"value" : "NPHIES"
}
],
"active" : true,
"name" : "National Program for Health Information Exchange Services"
}
},
{
"fullUrl" : "http://nphies.sa/Organization/b1b3432921324f97af3be9fd0b1a14ae",
"resource" : {
"resourceType" : "Organization",
"id" : "b1b3432921324f97af3be9fd0b1a14ae",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_b1b3432921324f97af3be9fd0b1a14ae\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization b1b3432921324f97af3be9fd0b1a14ae</b></p><a name=\"b1b3432921324f97af3be9fd0b1a14ae\"> </a><a name=\"hcb1b3432921324f97af3be9fd0b1a14ae\"> </a><a name=\"b1b3432921324f97af3be9fd0b1a14ae-en-US\"> </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\">Profile: <a href=\"StructureDefinition-provider-organization.html\">Nphies Provider Organization</a></p></div><p><b>Provider Type</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/provider-type 1}\">Hospital</span></p><p><b>identifier</b>: <code>http://nphies.sa/license/provider-license</code>/PR-FHIR</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{http://nphies.sa/terminology/CodeSystem/organization-type prov}\">Healthcare Provider</span></p><p><b>name</b>: Saudi General Hospital</p><p><b>address</b>: Salamah Street, Building 25, Suite 2, Riyadh Saudi Arabia(work)</p></div>"
},
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/provider-type",
"code" : "1",
"display" : "Hospital"
}
]
}
}
],
"identifier" : [
{
"system" : "http://nphies.sa/license/provider-license",
"value" : "PR-FHIR"
}
],
"active" : true,
"type" : [
{
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/organization-type",
"code" : "prov"
}
]
}
],
"name" : "Saudi General Hospital",
"address" : [
{
"use" : "work",
"text" : "Salamah Street, Building 25, Suite 2, Riyadh Saudi Arabia",
"line" : [
"Salamah Street, Building 25, Suite 2",
"Al Malga District"
],
"city" : "Riyadh",
"country" : "Saudi Arabia"
}
]
}
},
{
"fullUrl" : "http://nphies.sa/Bundle/c2c63768-a65b-4784-ab91-6c09012c3cbc",
"resource" : {
"resourceType" : "Bundle",
"id" : "c2c63768-a65b-4784-ab91-6c09012c3cbc",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle"
]
},
"type" : "message",
"timestamp" : "2023-12-04T13:39:58.099+00:00",
"entry" : [
{
"fullUrl" : "urn:uuid:bc0e9c0f-3033-44ae-b492-0e7b328d1c54",
"resource" : {
"resourceType" : "MessageHeader",
"id" : "bc0e9c0f-3033-44ae-b492-0e7b328d1c54",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header"
]
},
"eventCoding" : {
"system" : "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
"code" : "priorauth-response"
},
"destination" : [
{
"endpoint" : "http://saudigeneralhospital.com.sa",
"receiver" : {
"type" : "Organization",
"identifier" : {
"system" : "http://nphies.sa/license/provider-license",
"value" : "PR-FHIR"
}
}
}
],
"sender" : {
"type" : "Organization",
"identifier" : {
"system" : "http://nphies.sa/license/payer-license",
"value" : "INS-FHIR"
}
},
"source" : {
"endpoint" : "http://sni.com.sa"
},
"response" : {
"identifier" : "a7e4caf2-0441-40e5-97d2-5ae1802730af",
"code" : "ok"
},
"focus" : [
{
"reference" : "http://sni.com.sa/ClaimResponse/483079"
}
]
}
},
{
"fullUrl" : "http://sni.com.sa/ClaimResponse/483079",
"resource" : {
"resourceType" : "ClaimResponse",
"id" : "483079",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response"
]
},
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
"code" : "approved"
}
]
}
},
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/reissue-reason",
"code" : "adjudication"
}
]
}
}
],
"identifier" : [
{
"system" : "http://sni.com.sa/identifiers/claimresponse",
"value" : "res_004512"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "institutional"
}
]
},
"subType" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/claim-subtype",
"code" : "ip"
}
]
},
"use" : "preauthorization",
"patient" : {
🔗 "reference" : "Patient/173826788"
},
"created" : "2023-12-05",
"insurer" : {
🔗 "reference" : "Organization/bff3aa1fbd3648619ac082357bf135db"
},
"requestor" : {
🔗 "reference" : "Organization/b1b3432921324f97af3be9fd0b1a14ae"
},
"request" : {
"type" : "Claim",
"identifier" : {
"system" : "http://saudigeneralhospital.com.sa/identifiers/authorization",
"value" : "req_1124856069"
}
},
"outcome" : "complete",
"preAuthRef" : "Auth_455433",
"preAuthPeriod" : {
"start" : "2023-12-04",
"end" : "2023-12-20"
},
"item" : [
{
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
"code" : "approved"
}
]
}
}
],
"itemSequence" : 1,
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible"
}
]
},
"amount" : {
"value" : 300,
"currency" : "SAR"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "copay"
}
]
},
"amount" : {
"value" : 0,
"currency" : "SAR"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "benefit"
}
]
},
"amount" : {
"value" : 300,
"currency" : "SAR"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
"code" : "approved-quantity"
}
]
},
"value" : 1
}
]
}
],
"total" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible"
}
]
},
"amount" : {
"value" : 300,
"currency" : "SAR"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "benefit"
}
]
},
"amount" : {
"value" : 300,
"currency" : "SAR"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "copay"
}
]
},
"amount" : {
"value" : 0,
"currency" : "SAR"
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
🔗 "reference" : "Coverage/1334"
}
}
]
}
},
{
"fullUrl" : "http://sni.com.sa/Coverage/1334",
"resource" : {
"resourceType" : "Coverage",
"id" : "1334",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage"
]
},
"identifier" : [
{
"system" : "http://sni.com.sa/identifiers/memberid",
"value" : "0000000002"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code" : "EHCPOL",
"display" : "extended healthcare"
}
]
},
"policyHolder" : {
🔗 "reference" : "Organization/13"
},
"subscriber" : {
🔗 "reference" : "Patient/123454186"
},
"beneficiary" : {
🔗 "reference" : "Patient/173826788"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "child",
"display" : "Child"
}
]
},
"payor" : [
{
🔗 "reference" : "Organization/bff3aa1fbd3648619ac082357bf135db"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan"
}
]
},
"value" : "CB135",
"name" : "Insurance Plan A"
}
],
"network" : "Golden C"
}
},
{
"fullUrl" : "http://sni.com.sa/Organization/13",
"resource" : {
"resourceType" : "Organization",
"id" : "13",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization"
]
},
"identifier" : [
{
"system" : "http://nphies.sa/identifiers/organization",
"value" : "5009"
}
],
"active" : true,
"name" : "Policy Holder Organization"
}
},
{
"fullUrl" : "http://sni.com.sa/Organization/b1b3432921324f97af3be9fd0b1a14ae",
"resource" : {
"resourceType" : "Organization",
"id" : "b1b3432921324f97af3be9fd0b1a14ae",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization"
]
},
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/provider-type",
"code" : "1",
"display" : "Hospital"
}
]
}
}
],
"identifier" : [
{
"system" : "http://nphies.sa/license/provider-license",
"value" : "PR-FHIR"
}
],
"active" : true,
"type" : [
{
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/organization-type",
"code" : "prov"
}
]
}
],
"name" : "Saudi General Hospital",
"address" : [
{
"use" : "work",
"text" : "Salamah Street, Building 25, Suite 2, Riyadh Saudi Arabia",
"line" : [
"Salamah Street, Building 25, Suite 2",
"Al Malga District"
],
"city" : "Riyadh",
"country" : "Saudi Arabia"
}
]
}
},
{
"fullUrl" : "http://sni.com.sa/Patient/173826788",
"resource" : {
"resourceType" : "Patient",
"id" : "173826788",
"meta" : {
"profile" : [
🔗 "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient"
]
},
"extension" : [
{
"url" : "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://nphies.sa/terminology/CodeSystem/occupation",
"code" : "student"
}
]
}
}
],
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PRC",
"display" : "Permanent Resident Card Number"
}
]
},
"system" : "http://nphies.sa/identifier/iqama",
"value" : "2000000002"
}
],
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