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 ClaimResponse: Advanced Authorization example #1
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: 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 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 |