Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot
Healthcare Financial Services IG Edition 1
0.3.0 - STU-Ballot
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
Adjudication Outcome: Approved
Transfer Authorization Number: GHD517
Transfer Authorization Period: 2021-10-10 --> 2021-10-12
Transfer Authorization Provider: Organization Test Provider 2
identifier: http://sni.com.sa/identifiers/claimresponse/resp_618044
status: Active
type: Oral
subType: OutPatient
use: Preauthorization
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/authorization/req_293093
outcome: Processing Complete
preAuthRef: PLJ9147
preAuthPeriod: 2021-10-10 --> 2021-10-12
payeeType: Provider
item
Adjudication Outcome: Approved
itemSequence: 1
noteNumber: 1
adjudication
category: Approved Quantity
value: 1
adjudication
category: Benefit Amount
Amounts
Value Currency 0 Saudi riyal
| Number | Type | Text |
| 1 | Print (Form) | Referral to Test Provider 2, authorization #GHD517, for Root Canal |
| Sequence | Focal | Coverage |
| 1 | true | Coverage: identifier = http://sni.com.sa/identifiers/memberid#0000000003; status = active; type = extended healthcare; relationship = Spouse; network = Golden C |