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
Example Claim: Claim Vision Request #1
Generated Narrative: Claim 123773
Profile: Nphies Claim Vision
Episode: http://saudivisioncare.com.sa/identifiers/episode/EpisodeID_20220120_43567
identifier: http://saudivisioncare.com.sa/identifiers/claim/req_9123078
status: Active
type: Vision
subType: OutPatient
use: Claim
patient: Sara Abbas Female, DoB: 1989-03-13 ( Permanent Resident Card Number: 2000000003)
created: 2023-12-06 09:20:15+0300
insurer: Organization Saudi National Insurance
provider: Organization Saudi Vision Care
priority: Normal
Payees
| Type |
| Provider |
CareTeams
| Sequence | Provider | Role | Qualification |
| 1 | Practitioner Dr. Ashraf Naeem | Primary provider | Primary Care / Ophthalmology |
Diagnoses
| Sequence | Diagnosis[x] | Type |
| 1 | Examination of eyes and vision | Principal Diagnosis |
Insurances
| Sequence | Focal | Coverage |
| 1 | true | Coverage: identifier = http://sni.com.sa/identifiers/memberid#0000000003; status = active; type = extended healthcare; relationship = Spouse; network = Golden C |
item
Patient Share: SAR20.00 (SAR)
Tax: SAR48.00 (SAR)
Patient Invoice:
http://saudivisioncare.com.sa/identifiers/patientInvoice/Invc-20220120-Proc425030002sequence: 1
careTeamSequence: 1
diagnosisSequence: 1
productOrService: Ophthalmological examination, bilateral
serviced: 2023-12-06
quantity: 1
UnitPrices
Value Currency 400 Saudi riyal factor: 0.8
Nets
Value Currency 368 Saudi riyal
Totals
| Value | Currency |
| 368 | Saudi riyal |