Message: Authorization Advanced Response #1 - Healthcare Financial Services IG Edition 1 v0.3.0

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

Example Bundle: Message: Authorization Advanced Response #1

Generated Narrative: Bundle dccc9ae9-e640-4fe1-b3fd-5af3c1c12210

Profile: Nphies Bundle

Bundle dccc9ae9-e640-4fe1-b3fd-5af3c1c12210 of type message

Entry 1 - fullUrl = urn:uuid:c7150958-640a-456b-8252-265675d12300

Resource MessageHeader:

Generated Narrative: MessageHeader c7150958-640a-456b-8252-265675d12300

Profile: Nphies MessageHeader
event: KSA Message Events advanced-authorization: Advanced Authorization
Destinations
- Receiver
* Identifier: http://nphies.sa/license/provider-license/PR-FHIR
sender: Identifier: http://nphies.sa/license/payer-license/INS-FHIR
source
focus: Bundle: type = message; timestamp = 2023-12-04 13:39:58+0000

Entry 2 - fullUrl = http://sni.com.sa/AdvancedPriorauth/483079

Resource ClaimResponse:

Generated Narrative: ClaimResponse 142298

Profile: Nphies Advanced Authorization
Adjudication Outcome: Approved
Advanced Auth Reason Extension: Referral
Newborn: false
Service Provider Extension: Bundle: type = message; timestamp = 2023-12-04 13:39:58+0000
Referring Provider Extension: Dr. Test Doctor outside npies (wave3)
Supporting Info Extension
http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-sequence: 1
http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-category: Information
http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-valueString: Advanced authorization for providing mentioned services to the patient
Diagnosis Extension
http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-sequence: 2
http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-diagnosisCodeableConcept: V49.4
http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-type: Secondary Diagnosis
identifier: http://sni.com.sa/identifiers/advanced-priorauth/AdvAuth-300982300
status: Active
type: Oral
subType: OutPatient
use: Preauthorization
patient: Bundle: type = message; timestamp = 2023-12-19 08:20:29+0000
created: 2022-07-18
insurer: Bundle: type = message; timestamp = 2023-12-19 08:20:29+0000
outcome: complete
preAuthRef: AdAuth-150123-1530
preAuthPeriod: 2022-09-15 18:10:44+0000 --> 2022-10-15 18:10:44+0000
addItem
Maternity: false
Adjudication Outcome: Approved
Sequence Extension: 1
Information Sequence Extension: 1
Package Code: false
productOrService: The extraoral repair of a crown, bridge or splint.
quantity: 1
bodySite: No display for ClaimResponse.addItem.bodySite (subSite: Ventral)
noteNumber: 1
adjudication
category: Eligible Amount
Amounts
- Value Currency
* 100 SAR
adjudication
category: CoPay
Amounts
- Value Currency
* 0 SAR
adjudication
category: Approved Quantity
Amounts
- Value Currency
* 1 SAR
adjudication
category: Tax
Amounts
- Value Currency
* 15 SAR
adjudication
category: Benefit Amount
Amounts
- Value Currency
* 100 SAR
total
category: Benefit Amount
Amounts
- Value
* 100
ProcessNotes
- Number Type Text
* 1 Display Process Note Text to give more general information or direction
Insurances
- Sequence Focal Coverage
* 1 false Bundle: type = message; timestamp = 2023-12-19 08:20:29+0000

Entry 3 - fullUrl = http://sni.com.sa/Coverage/1333

Resource Coverage:

Generated Narrative: Coverage 1333

Profile: Nphies Coverage
identifier: http://sni.com.sa/identifiers/memberid/0000000001
status: Active
type: extended healthcare
policyHolder: Organization Policy Holder Organization
subscriber: Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)
beneficiary: Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)
dependent: 01
relationship: Self
Classes
- Type Value Name
* Plan CB135 Insurance Plan A
network: Golden C

Entry 4 - fullUrl = http://sni.com.sa/Organization/13

Resource Organization:

Generated Narrative: Organization 13

Profile: Nphies Policy Holder Organization
identifier: http://nphies.sa/identifiers/organization/5009
active: true
name: Policy Holder Organization

Entry 5 - fullUrl = http://sni.com.sa/Organization/b1b3432921324f97af3be9fd0b1a14ae

Resource Organization:

Generated Narrative: Organization b1b3432921324f97af3be9fd0b1a14ae

Profile: Nphies Provider Organization
Provider Type: Hospital
identifier: http://nphies.sa/license/provider-license/PR-FHIR
active: true
type: Healthcare Provider
name: Saudi General Hospital
Contacts
- Address
* Salamah Street, Building 25, Suite 2, Riyadh Saudi Arabia(work)

Entry 6 - fullUrl = http://sni.com.sa/Patient/123454186

Resource Patient:

Generated Narrative: Patient 123454186

Profile: Nphies Patient
Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)
Active: true Deceased: false
Marital Status: Married
Contact Detail
+966512345691
Salamah Street, Building 25, Suite 2, Saudi Arabia(home)
Patient Occupation Business

Entry 7 - 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
Contacts
- Address
* Olaya Street, Building 70, Riyadh Saudi Arabia(work)