Healthcare Financial Services IG Edition 1
0.3.0 - ci-build Saudi Arabia flag

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: Claim Oral Response #1

Generated Narrative: ClaimResponse 293094

Adjudication Outcome: Approved

identifier: http://sni.com.sa/identifiers/claimresponse/res_10411448401

status: Active

type: Oral

subType: OutPatient

use: Claim

patient: Sara Abbas Female, DoB: 1989-03-13 ( Permanent Resident Card Number: 2000000003)

created: 2023-12-05

insurer: Organization Saudi National Insurance

requestor: Organization Saudi Dental Clinic

request: Identifier: http://saudidentalclinic.com.sa/identifiers/claim/req_29309905401

outcome: Processing Complete

item

Adjudication Outcome: Approved

Patient Invoice: http://saudidentalclinic.com.sa/identifiers/patientInvoice/Invc-20220120/IP-1110987

itemSequence: 1

adjudication

category: Eligible Amount

Amounts

-ValueCurrency
*230Saudi riyal

adjudication

category: CoPay

Amounts

-ValueCurrency
*20Saudi riyal

adjudication

category: Benefit Amount

Amounts

-ValueCurrency
*210Saudi riyal

adjudication

category: Approved Quantity

value: 1

adjudication

category: Tax

Amounts

-ValueCurrency
*31.5Saudi riyal

total

category: Eligible Amount

Amounts

-ValueCurrency
*230Saudi riyal

total

category: Benefit Amount

Amounts

-ValueCurrency
*210Saudi riyal

total

category: CoPay

Amounts

-ValueCurrency
*20Saudi riyal

total

category: Tax

Amounts

-ValueCurrency
*31.5Saudi riyal

Insurances

-SequenceFocalCoverage
*1trueCoverage: identifier = http://sni.com.sa/identifiers/memberid#0000000003; status = active; type = extended healthcare; relationship = Spouse; network = Golden C