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curl -X POST \ | |
'https://r4-dot-hum-hcs-rapid-fhir-sbx.appspot.com/fhir/Claim/$submit' \ | |
--data @sample-request.json |
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{ | |
"resourceType": "Claim", | |
"id": "760151", | |
"text": { | |
"status": "generated", | |
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Pharmacy Claim</div>" | |
}, | |
"identifier": [ | |
{ | |
"system": "http://happypharma.com/claim", | |
"value": "7612345" | |
} | |
], | |
"status": "active", | |
"type": { | |
"coding": [ | |
{ | |
"system": "http://terminology.hl7.org/CodeSystem/claim-type", | |
"code": "pharmacy" | |
} | |
] | |
}, | |
"use": "claim", | |
"patient": { | |
"reference": "Patient/1235" | |
}, | |
"created": "2014-08-16", | |
"insurer": { | |
"reference": "Organization/2" | |
}, | |
"provider": { | |
"reference": "Organization/1456" | |
}, | |
"priority": { | |
"coding": [ | |
{ | |
"code": "stat" | |
} | |
] | |
}, | |
"prescription": { | |
"reference": "http://pharmacy.org/MedicationRequest/AB1234G" | |
}, | |
"originalPrescription": { | |
"reference": "http://pharmacy.org/MedicationRequest/AB1202B" | |
}, | |
"payee": { | |
"type": { | |
"coding": [ | |
{ | |
"code": "provider" | |
} | |
] | |
} | |
}, | |
"careTeam": [ | |
{ | |
"sequence": 1, | |
"provider": { | |
"reference": "Practitioner/example" | |
} | |
} | |
], | |
"supportingInfo": [ | |
{ | |
"sequence": 1, | |
"category": { | |
"coding": [ | |
{ | |
"code": "pharmacyrefill" | |
} | |
] | |
}, | |
"code": { | |
"coding": [ | |
{ | |
"system": "http://example.org/fhir/CodeSystem/pharmacy-refill", | |
"code": "new" | |
} | |
] | |
} | |
}, | |
{ | |
"sequence": 2, | |
"category": { | |
"coding": [ | |
{ | |
"code": "pharmacyinformation" | |
} | |
] | |
}, | |
"code": { | |
"coding": [ | |
{ | |
"system": "http://example.org/fhir/CodeSystem/pharmacy-information", | |
"code": "refillsremaining" | |
} | |
] | |
}, | |
"valueQuantity": { | |
"value": 2 | |
} | |
}, | |
{ | |
"sequence": 3, | |
"category": { | |
"coding": [ | |
{ | |
"code": "pharmacyinformation" | |
} | |
] | |
}, | |
"code": { | |
"coding": [ | |
{ | |
"system": "http://example.org/fhir/CodeSystem/pharmacy-information", | |
"code": "dayssupply" | |
} | |
] | |
}, | |
"valueQuantity": { | |
"value": 90 | |
} | |
} | |
], | |
"diagnosis": [ | |
{ | |
"sequence": 1, | |
"diagnosisCodeableConcept": { | |
"coding": [ | |
{ | |
"code": "654456" | |
} | |
] | |
} | |
} | |
], | |
"insurance": [ | |
{ | |
"sequence": 1, | |
"focal": true, | |
"coverage": { | |
"reference": "Coverage/9876B1" | |
} | |
} | |
], | |
"item": [ | |
{ | |
"sequence": 1, | |
"careTeamSequence": [ | |
1 | |
], | |
"informationSequence": [ | |
1, | |
2, | |
3 | |
], | |
"productOrService": { | |
"coding": [ | |
{ | |
"system": "http://www.nlm.nih.gov/research/umls/rxnorm", | |
"code": "51079-456-20", | |
"display": "Alprazolam 0.25mg (Xanax)" | |
} | |
] | |
}, | |
"servicedDate": "2014-08-16", | |
"quantity": { | |
"value": 90, | |
"unit": "TAB", | |
"system": "http://unitsofmeasure.org", | |
"code": "TAB" | |
}, | |
"net": { | |
"value": 90, | |
"currency": "USD" | |
}, | |
"detail": [ | |
{ | |
"sequence": 1, | |
"productOrService": { | |
"coding": [ | |
{ | |
"system": "http://hl7.org/fhir/ex-pharmaservice", | |
"code": "drugcost" | |
} | |
] | |
}, | |
"net": { | |
"value": 45, | |
"currency": "USD" | |
} | |
}, | |
{ | |
"sequence": 2, | |
"productOrService": { | |
"coding": [ | |
{ | |
"system": "http://hl7.org/fhir/ex-pharmaservice", | |
"code": "markup" | |
} | |
] | |
}, | |
"net": { | |
"value": 9, | |
"currency": "USD" | |
} | |
}, | |
{ | |
"sequence": 3, | |
"productOrService": { | |
"coding": [ | |
{ | |
"system": "http://hl7.org/fhir/ex-pharmaservice", | |
"code": "dispensefee" | |
} | |
] | |
}, | |
"net": { | |
"value": 36, | |
"currency": "USD" | |
} | |
} | |
] | |
} | |
], | |
"total": { | |
"value": 90, | |
"currency": "USD" | |
} | |
} |
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{ | |
"resourceType": "ClaimResponse", | |
"id": "f26e6aa0-aa81-4c56-a137-1c1f7a377462", | |
"text": { | |
"status": "generated", | |
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the ClaimResponse to Claim Oral Average with additional items</div>" | |
}, | |
"identifier": [ | |
{ | |
"system": "http://happypharma.com/claim", | |
"value": "7612345" | |
} | |
], | |
"status": "active", | |
"type": { | |
"coding": [ | |
{ | |
"system": "http://terminology.hl7.org/CodeSystem/claim-type", | |
"code": "pharmacy" | |
} | |
] | |
}, | |
"use": "claim", | |
"patient": { | |
"reference": "Patient/1235" | |
}, | |
"created": "2019-9-12", | |
"insurer": { | |
"identifier": { | |
"system": "http://www.jurisdiction.org/insurers", | |
"value": "555123" | |
} | |
}, | |
"requestor": { | |
"reference": "Organization/1" | |
}, | |
"request": { | |
"identifier": { | |
"system": "http://happypharma.com/claim", | |
"value": "7612345" | |
} | |
}, | |
"outcome": "complete", | |
"disposition": "RTBI pre-determination.", | |
"payeeType": { | |
"coding": [ | |
{ | |
"system": "http://terminology.hl7.org/CodeSystem/payeetype", | |
"code": "other" | |
} | |
] | |
}, | |
"item": [ | |
{ | |
"itemSequence": 1, | |
"adjudication": [ | |
{ | |
"category": { | |
"coding": [ | |
{ | |
"code": "benefit" | |
} | |
] | |
}, | |
"amount": { | |
"value": 45, | |
"currency": "USD" | |
} | |
}, | |
{ | |
"category": { | |
"coding": [ | |
{ | |
"code": "copay" | |
} | |
] | |
}, | |
"amount": { | |
"value": 25, | |
"currency": "USD" | |
} | |
} | |
] | |
} | |
], | |
"addItem": [ | |
{ | |
"itemSequence": [ | |
1 | |
], | |
"productOrService": { | |
"coding": [ | |
{ | |
"system": "http://www.nlm.nih.gov/research/umls/rxnorm", | |
"code": "51079-456-20", | |
"display": "Alprazolam 0.25mg (Xanax)" | |
} | |
] | |
}, | |
"net": { | |
"value": 45, | |
"currency": "USD" | |
}, | |
"noteNumber": [ | |
201 | |
], | |
"adjudication": [ | |
{ | |
"category": { | |
"coding": [ | |
{ | |
"code": "benefit" | |
} | |
] | |
}, | |
"amount": { | |
"value": 45, | |
"currency": "USD" | |
} | |
}, | |
{ | |
"category": { | |
"coding": [ | |
{ | |
"code": "copay" | |
} | |
] | |
}, | |
"amount": { | |
"value": 25, | |
"currency": "USD" | |
} | |
} | |
] | |
} | |
], | |
"total": [ | |
{ | |
"category": { | |
"coding": [ | |
{ | |
"code": "submitted" | |
} | |
] | |
}, | |
"amount": { | |
"value": 45, | |
"currency": "USD" | |
} | |
}, | |
{ | |
"category": { | |
"coding": [ | |
{ | |
"code": "benefit" | |
} | |
] | |
}, | |
"amount": { | |
"value": 45, | |
"currency": "USD" | |
} | |
} | |
], | |
"payment": { | |
"type": { | |
"coding": [ | |
{ | |
"system": "http://terminology.hl7.org/CodeSystem/ex-paymenttype", | |
"code": "complete" | |
} | |
] | |
}, | |
"date": "2019-9-12", | |
"amount": { | |
"value": 45, | |
"currency": "USD" | |
}, | |
"identifier": { | |
"system": "http://www.Humana.com/fhir/paymentidentifier", | |
"value": "201408-2-15507" | |
} | |
}, | |
"processNote": [ | |
{ | |
"number": 101, | |
"type": "print", | |
"text": "Connectathon 22.", | |
"language": { | |
"coding": [ | |
{ | |
"system": "urn:ietf:bcp:47", | |
"code": "en-CA" | |
} | |
] | |
} | |
} | |
] | |
} |
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