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@jmandel jmandel/example.sh
Last active Sep 12, 2019

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curl -X POST \
'https://r4-dot-hum-hcs-rapid-fhir-sbx.appspot.com/fhir/Claim/$submit' \
--data @sample-request.json
{
"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"
}
}
{
"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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