Healthcare Financial Services IG Edition 1
0.4.0 - STU-Ballot with Updates
Healthcare Financial Services IG Edition 1
0.4.0 - STU-Ballot with Updates
Healthcare Financial Services IG Edition 1 - Local Development build (v0.4.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Adjudication Outcome: Approved
Advanced Auth Reason: Referral
Newborn: false
Service Provider Extension: Organization Saudi General Hospital
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: 1
- http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-diagnosisCodeableConcept: K01.1
- http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-type: Principal Diagnosis
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: Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)
created: 2022-07-18
insurer: Organization Saudi National Insurance
outcome: Processing 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: UPPER LEFT; PERMANENT TEETH # 5
subSite: Ventral
noteNumber: 1
adjudication
category: Eligible Amount
Amounts
Value Currency 100 Saudi riyal adjudication
category: CoPay
Amounts
Value Currency 0 Saudi riyal adjudication
category: Approved Quantity
Amounts
Value Currency 1 Saudi riyal adjudication
category: Tax
Amounts
Value Currency 15 Saudi riyal adjudication
category: Benefit Amount
Amounts
Value Currency 100 Saudi riyal
total
category: Benefit Amount
Amounts
Value Currency 100 Saudi riyal
| Number | Type | Text |
| 1 | Display | Process Note Text to give more general information or direction |