Skip to content

Instantly share code, notes, and snippets.

@jmandel

jmandel/careevolution.json

Last active September 15, 2019 13:32
Show Gist options
  • Star 0 You must be signed in to star a gist
  • Fork 0 You must be signed in to fork a gist
  • Save jmandel/7c9f58bc46cd2beb6ecbc4e6772719a0 to your computer and use it in GitHub Desktop.
Save jmandel/7c9f58bc46cd2beb6ecbc4e6772719a0 to your computer and use it in GitHub Desktop.
Download ZIP
CARIN Blue Button Examples from FHIR 2019-09 Connectathon
Raw
careevolution.json
{
"resourceType": "Bundle",
"type": "searchset",
"total": 3,
"link": [
{
"relation": "self",
"url": "https://fhir.careevolution.com/Master.Adapter1.WebClient/api/fhir-r4/ExplanationOfBenefit?patient=d4b1d050-584f-4797-a9c7-ab72e4cd4452&_count=20"
},
{
"relation": "first",
"url": "https://fhir.careevolution.com/Master.Adapter1.WebClient/api/fhir-r4/ExplanationOfBenefit?_query=d0ecbb1b-0fc3-4f10-aecf-47f7e4b096ca&_count=20&_start=1"
}
],
"entry": [
{
"fullUrl": "https://fhir.careevolution.com/Master.Adapter1.WebClient/api/fhir-r4/ExplanationOfBenefit/6f978df0-3121-e611-8128-0a69c1b3225b",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "6f978df0-3121-e611-8128-0a69c1b3225b",
"meta": {
"lastUpdated": "2016-05-23T22:01:59.137+00:00"
},
"identifier": [
{
"use": "usual",
"value": "123456780C3"
}
],
"_status": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
"valueCode": "unsupported"
},
{
"url": "http://careevolution.com/fhirextensions#term",
"valueCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ClaimStatus",
"code": "PAID",
"display": "PAID",
"userSelected": true
}
],
"text": "PAID"
}
}
]
},
"type": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ClaimType",
"code": "Institutional",
"display": "Institutional",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/FhirCodes/ClaimType",
"code": "institutional",
"display": "Institutional",
"userSelected": false
},
{
"system": "http://hl7.org/fhir/ex-claimtype",
"code": "institutional"
}
],
"text": "Institutional"
},
"patient": {
"reference": "Patient/d4b1d050-584f-4797-a9c7-ab72e4cd4452"
},
"billablePeriod": {
"start": "2012-08-31T00:00:00-04:00",
"end": "2012-09-10T00:00:00-04:00"
},
"item": [
{
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/MedicationType",
"code": "CALCIUM CARB 1250MG/5ML",
"userSelected": true
}
]
},
"servicedDate": "2012-09-16"
},
{
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/MedicationType",
"code": "ALBUTEROL 90MCG INHALER",
"userSelected": true
}
]
},
"servicedDate": "2012-09-16"
},
{
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/MedicationType",
"code": "PREVACID 30MG CAPSULE DR.",
"userSelected": true
}
]
},
"servicedDate": "2012-09-16"
},
{
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/MedicationType",
"code": "NORVASC 5MG TABLET",
"userSelected": true
}
]
},
"servicedDate": "2012-09-16"
}
],
"payment": {
"amount": {
"value": 3000.54
}
}
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "https://fhir.careevolution.com/Master.Adapter1.WebClient/api/fhir-r4/ExplanationOfBenefit/41978df0-3121-e611-8128-0a69c1b3225b",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "41978df0-3121-e611-8128-0a69c1b3225b",
"meta": {
"lastUpdated": "2016-05-23T22:01:55.57+00:00"
},
"identifier": [
{
"use": "usual",
"value": "123456780C2"
}
],
"_status": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
"valueCode": "unsupported"
},
{
"url": "http://careevolution.com/fhirextensions#term",
"valueCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ClaimStatus",
"code": "PAID",
"display": "PAID",
"userSelected": true
}
],
"text": "PAID"
}
}
]
},
"type": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ClaimType",
"code": "Institutional",
"display": "Institutional",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/FhirCodes/ClaimType",
"code": "institutional",
"display": "Institutional",
"userSelected": false
},
{
"system": "http://hl7.org/fhir/ex-claimtype",
"code": "institutional"
}
],
"text": "Institutional"
},
"patient": {
"reference": "Patient/d4b1d050-584f-4797-a9c7-ab72e4cd4452"
},
"billablePeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"careTeam": [
{
"provider": {
"reference": "Practitioner/df968df0-3121-e611-8128-0a69c1b3225b"
},
"role": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/CaregiverRelationshipType",
"code": "ClaimProvider",
"display": "Claim Provider",
"userSelected": true
}
],
"text": "Claim Provider"
}
},
{
"provider": {
"reference": "Practitioner/de968df0-3121-e611-8128-0a69c1b3225b"
},
"role": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/CaregiverRelationshipType",
"code": "PayToProvider",
"display": "Pay To Provider",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/CaregiverRelationshipType",
"code": "PayToProvider",
"display": "Pay To Provider",
"userSelected": false
}
],
"text": "Pay To Provider"
}
}
],
"diagnosis": [
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "518.84",
"display": "ACUTE&CHRONIC RESPIRATORY FAILURE",
"userSelected": true
}
],
"text": "ACUTE&CHRONIC RESPIRATORY FAILURE"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "Primary",
"display": "Primary Diagnosis",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Primary",
"display": "Primary",
"userSelected": false
}
],
"text": "Primary Diagnosis"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 2,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "491.21",
"display": "OBST CHRONIC BRONCHITIS W_EXACERBAT",
"userSelected": true
}
],
"text": "OBST CHRONIC BRONCHITIS W_EXACERBAT"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "Admit",
"display": "Admit",
"userSelected": true
}
],
"text": "Admit"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 3,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "416.2",
"display": "CHRONIC PULMONARY EMBOLISM",
"userSelected": true
}
],
"text": "CHRONIC PULMONARY EMBOLISM"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 4,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "599.0",
"display": "UTI SITE NOT SPECIFIED",
"userSelected": true
}
],
"text": "UTI SITE NOT SPECIFIED"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 5,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "584.9",
"display": "ACUTE KIDNEY FAILURE UNSPECIFIED",
"userSelected": true
}
],
"text": "ACUTE KIDNEY FAILURE UNSPECIFIED"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 6,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "491.22",
"display": "OBST CHRN BRONCHITIS W/AC BRONCHIT",
"userSelected": true
}
],
"text": "OBST CHRN BRONCHITIS W/AC BRONCHIT"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 7,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "V85.43",
"display": "BODY MASS INDEX 50.0-59.9 ADULT",
"userSelected": true
}
],
"text": "BODY MASS INDEX 50.0-59.9 ADULT"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 8,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "428.32",
"display": "CHRONIC DIASTOLIC HEART FAILURE",
"userSelected": true
}
],
"text": "CHRONIC DIASTOLIC HEART FAILURE"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 9,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "278.01",
"display": "MORBID OBESITY",
"userSelected": true
}
],
"text": "MORBID OBESITY"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 10,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "305.1",
"display": "NONDEPENDENT TOBACCO USE DISORDER",
"userSelected": true
}
],
"text": "NONDEPENDENT TOBACCO USE DISORDER"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 11,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "714.0",
"display": "RHEUMATOID ARTHRITIS",
"userSelected": true
}
],
"text": "RHEUMATOID ARTHRITIS"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 12,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "458.9",
"display": "UNSPECIFIED HYPOTENSION",
"userSelected": true
}
],
"text": "UNSPECIFIED HYPOTENSION"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 13,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "276.7",
"display": "HYPERPOTASSEMIA",
"userSelected": true
}
],
"text": "HYPERPOTASSEMIA"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 14,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "428.0",
"display": "CHF UNSPECIFIED",
"userSelected": true
}
],
"text": "CHF UNSPECIFIED"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 15,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "250.02",
"display": "DB W_O COMP TYPE II_UNS UNCNTRL",
"userSelected": true
}
],
"text": "DB W_O COMP TYPE II_UNS UNCNTRL"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 16,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "784.0",
"display": "HEADACHE",
"userSelected": true
}
],
"text": "HEADACHE"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 17,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "041.4",
"display": "E COLI INFECTION CCE and UNS SITE",
"userSelected": true
}
],
"text": "E COLI INFECTION CCE and UNS SITE"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 18,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "530.81",
"display": "ESOPHAGEAL REFLUX",
"userSelected": true
}
],
"text": "ESOPHAGEAL REFLUX"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 19,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "799.02",
"display": "HYPOXEMIA",
"userSelected": true
}
],
"text": "HYPOXEMIA"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
}
],
"procedure": [
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-procedureType",
"valueCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ProcedureType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
}
],
"text": "SECONDARY"
}
}
],
"sequence": 0,
"date": "2013-09-01T00:00:00-04:00",
"procedureCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ProcedureCode",
"code": "00.17",
"display": "INFUSION OF VASOPRESSOR AGENT",
"userSelected": true
}
],
"text": "INFUSION OF VASOPRESSOR AGENT"
}
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-procedureType",
"valueCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ProcedureType",
"code": "Primary",
"display": "Primary Diagnosis",
"userSelected": true
}
],
"text": "Primary Diagnosis"
}
}
],
"sequence": 0,
"date": "2013-09-01T00:00:00-04:00",
"procedureCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ProcedureCode",
"code": "38.97",
"display": "CVC PLACEMENT WITH GUIDANCE",
"userSelected": true
}
],
"text": "CVC PLACEMENT WITH GUIDANCE"
}
}
],
"item": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "111",
"display": "Room and Board - Private - Medical_Surgical_GYN",
"userSelected": true
}
],
"text": "Room and Board - Private - Medical_Surgical_GYN"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "111",
"display": "Room and Board - Private - Medical_Surgical_GYN",
"userSelected": true
}
],
"text": "Room and Board - Private - Medical_Surgical_GYN"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 8
}
},
{
"sequence": 2,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "200",
"display": "Intensive Care - General",
"userSelected": true
}
],
"text": "Intensive Care - General"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "200",
"display": "Intensive Care - General",
"userSelected": true
}
],
"text": "Intensive Care - General"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-01T00:00:00-04:00"
},
"quantity": {
"value": 2
}
},
{
"sequence": 3,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "230",
"display": "Incremental Nursing Care Rate - General",
"userSelected": true
}
],
"text": "Incremental Nursing Care Rate - General"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "230",
"display": "Incremental Nursing Care Rate - General",
"userSelected": true
}
],
"text": "Incremental Nursing Care Rate - General"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-01T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 4,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "250",
"display": "Pharmacy - General",
"userSelected": true
}
],
"text": "Pharmacy - General"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "250",
"display": "Pharmacy - General",
"userSelected": true
}
],
"text": "Pharmacy - General"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 1
}
},
{
"sequence": 5,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "258",
"display": "Pharmacy - IV Solutions",
"userSelected": true
}
],
"text": "Pharmacy - IV Solutions"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "258",
"display": "Pharmacy - IV Solutions",
"userSelected": true
}
],
"text": "Pharmacy - IV Solutions"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 6,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "260",
"display": "IV Therapy -General",
"userSelected": true
}
],
"text": "IV Therapy -General"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "260",
"display": "IV Therapy -General",
"userSelected": true
}
],
"text": "IV Therapy -General"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 7,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "271",
"display": "Medical_Surgical Supplies and Devices - Nonsterile Supply",
"userSelected": true
}
],
"text": "Medical_Surgical Supplies and Devices - Nonsterile Supply"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "271",
"display": "Medical_Surgical Supplies and Devices - Nonsterile Supply",
"userSelected": true
}
],
"text": "Medical_Surgical Supplies and Devices - Nonsterile Supply"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 8,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "300",
"display": "Laboratory - General",
"userSelected": true
}
],
"text": "Laboratory - General"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "300",
"display": "Laboratory - General",
"userSelected": true
}
],
"text": "Laboratory - General"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 9,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "301",
"display": "Laboratory - Chemistry",
"userSelected": true
}
],
"text": "Laboratory - Chemistry"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "301",
"display": "Laboratory - Chemistry",
"userSelected": true
}
],
"text": "Laboratory - Chemistry"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 10,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "302",
"display": "Laboratory - Immunology",
"userSelected": true
}
],
"text": "Laboratory - Immunology"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "302",
"display": "Laboratory - Immunology",
"userSelected": true
}
],
"text": "Laboratory - Immunology"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 11,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "305",
"display": "Laboratory - Hematology",
"userSelected": true
}
],
"text": "Laboratory - Hematology"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "305",
"display": "Laboratory - Hematology",
"userSelected": true
}
],
"text": "Laboratory - Hematology"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 12,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "306",
"display": "Laboratory - Bacteriology and Microbiology",
"userSelected": true
}
],
"text": "Laboratory - Bacteriology and Microbiology"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "306",
"display": "Laboratory - Bacteriology and Microbiology",
"userSelected": true
}
],
"text": "Laboratory - Bacteriology and Microbiology"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 13,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "307",
"display": "Laboratory - Urology",
"userSelected": true
}
],
"text": "Laboratory - Urology"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "307",
"display": "Laboratory - Urology",
"userSelected": true
}
],
"text": "Laboratory - Urology"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 14,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "324",
"display": "Radiology - Diagnostic - Chest X-Ray",
"userSelected": true
}
],
"text": "Radiology - Diagnostic - Chest X-Ray"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "324",
"display": "Radiology - Diagnostic - Chest X-Ray",
"userSelected": true
}
],
"text": "Radiology - Diagnostic - Chest X-Ray"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 15,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "352",
"display": "CT Scan - Body Scan",
"userSelected": true
}
],
"text": "CT Scan - Body Scan"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "352",
"display": "CT Scan - Body Scan",
"userSelected": true
}
],
"text": "CT Scan - Body Scan"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 1
}
},
{
"sequence": 16,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "410",
"display": "Respiratory Services - General",
"userSelected": true
}
],
"text": "Respiratory Services - General"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "410",
"display": "Respiratory Services - General",
"userSelected": true
}
],
"text": "Respiratory Services - General"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 59
}
},
{
"sequence": 17,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "420",
"display": "Physical Therapy - General",
"userSelected": true
}
],
"text": "Physical Therapy - General"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "420",
"display": "Physical Therapy - General",
"userSelected": true
}
],
"text": "Physical Therapy - General"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 18,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "424",
"display": "Physical Therapy - Evaluation or Reevaluation",
"userSelected": true
}
],
"text": "Physical Therapy - Evaluation or Reevaluation"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "424",
"display": "Physical Therapy - Evaluation or Reevaluation",
"userSelected": true
}
],
"text": "Physical Therapy - Evaluation or Reevaluation"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 19,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "430",
"display": "Occupational Therapy - General",
"userSelected": true
}
],
"text": "Occupational Therapy - General"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "430",
"display": "Occupational Therapy - General",
"userSelected": true
}
],
"text": "Occupational Therapy - General"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 20,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "434",
"display": "Occupational Therapy - Evaluation or Reevaluation",
"userSelected": true
}
],
"text": "Occupational Therapy - Evaluation or Reevaluation"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "434",
"display": "Occupational Therapy - Evaluation or Reevaluation",
"userSelected": true
}
],
"text": "Occupational Therapy - Evaluation or Reevaluation"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 21,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "450",
"display": "Emergency Room - General",
"userSelected": true
}
],
"text": "Emergency Room - General"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "450",
"display": "Emergency Room - General",
"userSelected": true
}
],
"text": "Emergency Room - General"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
},
{
"sequence": 22,
"category": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/RevenueCode",
"code": "730",
"display": "EKG_ECG (Electrocardiogram) - General",
"userSelected": true
}
],
"text": "EKG_ECG (Electrocardiogram) - General"
},
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "730",
"display": "EKG_ECG (Electrocardiogram) - General",
"userSelected": true
}
],
"text": "EKG_ECG (Electrocardiogram) - General"
},
"servicedPeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"quantity": {
"value": 0
}
}
],
"payment": {
"amount": {
"value": 15585.54
}
}
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "https://fhir.careevolution.com/Master.Adapter1.WebClient/api/fhir-r4/ExplanationOfBenefit/34978df0-3121-e611-8128-0a69c1b3225b",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "34978df0-3121-e611-8128-0a69c1b3225b",
"meta": {
"lastUpdated": "2016-05-23T22:01:55.317+00:00"
},
"identifier": [
{
"use": "usual",
"value": "123456780C1"
}
],
"_status": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
"valueCode": "unsupported"
},
{
"url": "http://careevolution.com/fhirextensions#term",
"valueCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ClaimStatus",
"code": "PAID",
"display": "PAID",
"userSelected": true
}
],
"text": "PAID"
}
}
]
},
"type": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ClaimType",
"code": "Professional",
"display": "Professional",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/FhirCodes/ClaimType",
"code": "professional",
"display": "Professional",
"userSelected": false
},
{
"system": "http://hl7.org/fhir/ex-claimtype",
"code": "professional"
}
],
"text": "Professional"
},
"patient": {
"reference": "Patient/d4b1d050-584f-4797-a9c7-ab72e4cd4452"
},
"billablePeriod": {
"start": "2015-06-20T00:00:00-04:00",
"end": "2015-06-20T00:00:00-04:00"
},
"diagnosis": [
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2015-06-20T00:00:00-04:00"
}
],
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "250.00",
"display": "DB W_O COMP TYPE II_UNS NOT UNCNTRL",
"userSelected": true
}
],
"text": "DB W_O COMP TYPE II_UNS NOT UNCNTRL"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "1",
"display": "1",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Primary",
"display": "Primary",
"userSelected": false
}
],
"text": "1"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2015-06-20T00:00:00-04:00"
}
],
"sequence": 2,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "401.1",
"display": "ESSENTIAL HYPERTENSION, BENIGN",
"userSelected": true
}
],
"text": "ESSENTIAL HYPERTENSION, BENIGN"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "2",
"display": "2",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "2"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2015-06-20T00:00:00-04:00"
}
],
"sequence": 3,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "272.4",
"display": "OTHER and UNSPECIFIED HYPERLIPIDEMIA",
"userSelected": true
}
],
"text": "OTHER and UNSPECIFIED HYPERLIPIDEMIA"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "3",
"display": "3",
"userSelected": true
}
],
"text": "3"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2015-06-20T00:00:00-04:00"
}
],
"sequence": 4,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "593.9",
"display": "UNSPECIFIED DISORDER KIDNEY and URETER",
"userSelected": true
}
],
"text": "UNSPECIFIED DISORDER KIDNEY and URETER"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "4",
"display": "4",
"userSelected": true
}
],
"text": "4"
}
]
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "83036",
"display": "HGB GLYCOSYLATED",
"userSelected": true
}
],
"text": "HGB GLYCOSYLATED"
},
"servicedPeriod": {
"start": "2015-06-20T00:00:00-04:00",
"end": "2015-06-20T00:00:00-04:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceLocation",
"code": "81",
"display": "Independent Laboratory",
"userSelected": true
}
],
"text": "Independent Laboratory"
},
"quantity": {
"value": 1
}
},
{
"sequence": 2,
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "80061",
"display": "LIPID PANEL",
"userSelected": true
}
],
"text": "LIPID PANEL"
},
"servicedPeriod": {
"start": "2015-06-20T00:00:00-04:00",
"end": "2015-06-20T00:00:00-04:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceLocation",
"code": "81",
"display": "Independent Laboratory",
"userSelected": true
}
],
"text": "Independent Laboratory"
},
"quantity": {
"value": 1
}
},
{
"sequence": 3,
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "36415",
"display": "COLLJ VEN BLD VNPNXR",
"userSelected": true
}
],
"text": "COLLJ VEN BLD VNPNXR"
},
"servicedPeriod": {
"start": "2015-06-20T00:00:00-04:00",
"end": "2015-06-20T00:00:00-04:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceLocation",
"code": "81",
"display": "Independent Laboratory",
"userSelected": true
}
],
"text": "Independent Laboratory"
},
"quantity": {
"value": 1
}
},
{
"sequence": 4,
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "81001",
"display": "URNLS DIP STICK/TABLET RGNT AUTO MIC",
"userSelected": true
}
],
"text": "URNLS DIP STICK/TABLET RGNT AUTO MIC"
},
"servicedPeriod": {
"start": "2015-06-20T00:00:00-04:00",
"end": "2015-06-20T00:00:00-04:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceLocation",
"code": "81",
"display": "Independent Laboratory",
"userSelected": true
}
],
"text": "Independent Laboratory"
},
"quantity": {
"value": 1
}
},
{
"sequence": 5,
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "82570",
"display": "CREATININE OTH SRC",
"userSelected": true
}
],
"text": "CREATININE OTH SRC"
},
"servicedPeriod": {
"start": "2015-06-20T00:00:00-04:00",
"end": "2015-06-20T00:00:00-04:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceLocation",
"code": "81",
"display": "Independent Laboratory",
"userSelected": true
}
],
"text": "Independent Laboratory"
},
"quantity": {
"value": 1
}
},
{
"sequence": 6,
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "82043",
"display": "ALBUMIN URINE MICROALBUMIN QUAN",
"userSelected": true
}
],
"text": "ALBUMIN URINE MICROALBUMIN QUAN"
},
"servicedPeriod": {
"start": "2015-06-20T00:00:00-04:00",
"end": "2015-06-20T00:00:00-04:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceLocation",
"code": "81",
"display": "Independent Laboratory",
"userSelected": true
}
],
"text": "Independent Laboratory"
},
"quantity": {
"value": 1
}
},
{
"sequence": 7,
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "82248",
"display": "BILIRUBIN DIR",
"userSelected": true
}
],
"text": "BILIRUBIN DIR"
},
"servicedPeriod": {
"start": "2015-06-20T00:00:00-04:00",
"end": "2015-06-20T00:00:00-04:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceLocation",
"code": "81",
"display": "Independent Laboratory",
"userSelected": true
}
],
"text": "Independent Laboratory"
},
"quantity": {
"value": 1
}
},
{
"sequence": 8,
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceCode",
"code": "80053",
"display": "COMPRE METAB PANEL",
"userSelected": true
}
],
"text": "COMPRE METAB PANEL"
},
"servicedPeriod": {
"start": "2015-06-20T00:00:00-04:00",
"end": "2015-06-20T00:00:00-04:00"
},
"locationCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ServiceLocation",
"code": "81",
"display": "Independent Laboratory",
"userSelected": true
}
],
"text": "Independent Laboratory"
},
"quantity": {
"value": 1
}
}
],
"payment": {
"amount": {
"value": 73.69
}
}
},
"search": {
"mode": "match"
}
}
]
}
Raw
edifecs.json
{
"resourceType": "Bundle",
"id": "d527fd3e-150c-44d7-843b-1d934d3ac1e7",
"meta": {
"lastUpdated": "2019-09-15T13:19:22.965+00:00"
},
"type": "searchset",
"total": 2,
"link": [
{
"relation": "self",
"url": "https://localhost:10443/hapi-fhir-jpaserver/R4/ExplanationOfBenefit"
}
],
"entry": [
{
"fullUrl": "https://localhost:10443/hapi-fhir-jpaserver/R4/ExplanationOfBenefit/2452",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "2452",
"meta": {
"versionId": "1",
"lastUpdated": "2019-09-14T17:52:57.483+00:00"
},
"extension": [
{
"url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-fi-num-extension",
"valueIdentifier": {
"system": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-fi-num",
"value": "592015694"
}
},
{
"url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-carr-clm-alowd-amt-extension",
"valueMoney": {
"value": 107.3,
"currency": "USD"
}
},
{
"url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-clm-cash-ddctbl-apld-amt-extension",
"valueMoney": {
"value": 0,
"currency": "USD"
}
},
{
"url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prpayamt-extension",
"valueMoney": {
"value": 85.49,
"currency": "USD"
}
}
],
"identifier": [
{
"system": "837P.CLM01",
"value": "255789059"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/ex-claimtype",
"code": "professional"
}
],
"text": "Blue Button Carrier Claim"
},
"use": "claim",
"patient": {
"reference": "Patient/2410"
},
"billablePeriod": {
"start": "2019-08-09",
"end": "2019-08-09"
},
"created": "2019-09-10T19:09:00",
"insurer": {
"identifier": {
"value": "592015694"
}
},
"provider": {
"identifier": {
"value": "1122334455"
}
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1122334455"
}
},
"role": {
"coding": [
{
"system": "http://hl7.org/fhir/claimcareteamrole",
"code": "other",
"display": "Other"
}
]
}
}
],
"insurance": [
{
"focal": true,
"coverage": {
"type": "12"
}
}
],
"item": [
{
"sequence": 610829936,
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "99214"
}
]
},
"servicedPeriod": {
"start": "2019-08-09",
"end": "2019-08-09"
},
"quantity": {
"value": 1
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://www.x12.org/codes/claim-adjustment-group-codes/",
"code": "contractual"
}
]
},
"reason": {
"coding": [
{
"system": "http://www.x12.org/codes/claim-adjustment-reason-codes/",
"code": "45"
}
]
},
"amount": {
"value": 219.82,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://www.x12.org/codes/claim-adjustment-group-codes/",
"code": "other"
}
]
},
"reason": {
"coding": [
{
"system": "http://www.x12.org/codes/claim-adjustment-reason-codes/",
"code": "23"
}
]
},
"amount": {
"value": 85.49,
"currency": "USD"
}
}
]
}
],
"payment": {
"amount": {
"value": 21.81,
"currency": "USD"
}
}
},
"search": {
"mode": "match"
},
"response": {
"status": "201 Created",
"etag": "W/\"1\""
}
},
{
"fullUrl": "https://localhost:10443/hapi-fhir-jpaserver/R4/ExplanationOfBenefit/2453",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "2453",
"meta": {
"versionId": "1",
"lastUpdated": "2019-09-14T17:53:20.076+00:00"
},
"identifier": [
{
"system": "837P.CLM01",
"value": "INST.ECMS.PROD.T2"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/ex-claimtype",
"code": "institutional",
"display": "Institutional"
}
],
"text": "Blue Button Outpatient Claim"
},
"use": "claim",
"patient": {
"reference": "Patient/2410"
},
"billablePeriod": {
"extension": [
{
"url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-claim-query-cd-extension",
"valueCoding": {
"system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
"code": "3"
}
}
],
"start": "2018-05-09",
"end": "2018-05-09"
},
"created": "2018-10-06",
"insurer": {
"identifier": {
"value": "090"
}
},
"provider": {
"reference": "Organization/2116"
},
"payee": {
"party": {
"identifier": {
"value": "1982651111"
}
}
},
"facility": {
"extension": [
{
"url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-fac-type-cd-extension",
"valueCoding": {
"system": "https://bluebutton.cms.gov/assets/ig/ValueSet-clm-fac-type-cd"
}
}
],
"identifier": {
"value": "1982651111"
}
},
"outcome": "complete",
"careTeam": [
{
"sequence": 1,
"provider": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1982651111"
}
},
"role": {
"coding": [
{
"system": "http://hl7.org/fhir/claimcareteamrole",
"code": "other",
"display": "Other/Billing"
}
]
}
}
],
"supportingInfo": [
{
"sequence": 1,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/assets/ig/ValueSet-information-categories",
"code": "clm-freq-cd",
"display": "Claim Frequency Code"
}
]
},
"code": {
"coding": [
{
"system": "https://bluebutton.cms.gov/assets/ig/ValueSet-clm-freq-cd",
"code": "1"
}
]
}
},
{
"sequence": 2,
"category": {
"coding": [
{
"code": "hospitalized"
}
]
},
"timingPeriod": {
"start": "2018-05-09"
}
},
{
"sequence": 3,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/assets/ig/ValueSet-information-categories",
"code": "clm-ip-admsn-type-cd",
"display": "Claim Inpatient Admission Type Code"
}
]
},
"code": {
"coding": [
{
"system": "https://bluebutton.cms.gov/assets/ig/ValueSet-clm-ip-admsn-type-cd",
"code": "3"
}
]
}
},
{
"sequence": 4,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/assets/ig/ValueSet-information-categories",
"code": "clm-src-ip-admsn-cd",
"display": "Claim Source Inpatient Admission Code"
}
]
},
"code": {
"coding": [
{
"system": "https://bluebutton.cms.gov/assets/ig/ValueSet-clm-src-ip-admsn-cd",
"code": "1"
}
]
}
},
{
"sequence": 5,
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/assets/ig/ValueSet-information-categories",
"code": "ptnt-dschrg-stus-cd",
"display": "Patient Discharge Status Code"
}
]
},
"code": {
"coding": [
{
"system": "https://bluebutton.cms.gov/assets/ig/ValueSet-ptnt-dschrg-stus-cd",
"code": "01"
}
]
}
}
],
"diagnosis": [
{
"extension": [
{
"url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
"valueCoding": {
"system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
"code": "1"
}
}
],
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/icd-10",
"code": "R102"
}
]
},
"type": [
{
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-diagnosistype",
"code": "principal"
}
]
}
]
},
{
"sequence": 2,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/icd-10",
"code": "R102"
}
]
},
"type": [
{
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-diagnosistype",
"code": "admitting"
}
]
}
]
},
{
"extension": [
{
"url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
"valueCoding": {
"system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
"code": "1"
}
}
],
"sequence": 3,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/icd-10",
"code": "N946"
}
]
},
"type": [
{
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-diagnosistype",
"code": "clinical"
}
]
}
]
},
{
"extension": [
{
"url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
"valueCoding": {
"system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
"code": "1"
}
}
],
"sequence": 4,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/icd-10",
"code": "N736"
}
]
},
"type": [
{
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-diagnosistype",
"code": "clinical"
}
]
}
]
},
{
"extension": [
{
"url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
"valueCoding": {
"system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
"code": "1"
}
}
],
"sequence": 5,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/icd-10",
"code": "N9410"
}
]
},
"type": [
{
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-diagnosistype",
"code": "clinical"
}
]
}
]
},
{
"sequence": 6,
"diagnosisCodeableConcept": {
"extension": [
{
"url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension",
"valueCoding": {
"system": "https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-poa-ind-sw1",
"code": "1"
}
}
],
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/icd-10",
"code": "J449"
}
]
},
"type": [
{
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-diagnosistype",
"code": "clinical"
}
]
}
]
}
],
"insurance": [
{
"focal": true,
"coverage": {
"type": "BL"
}
}
],
"item": [
{
"sequence": 1,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0250"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "88888"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 1,
"unit": "UN"
}
},
{
"sequence": 2,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0250"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "88888"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 1,
"unit": "UN"
}
},
{
"sequence": 3,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0250"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "88888"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 1,
"unit": "UN"
}
},
{
"sequence": 4,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0272"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "88888"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 9,
"unit": "UN"
}
},
{
"sequence": 5,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0301"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "80053"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 1,
"unit": "UN"
}
},
{
"sequence": 6,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0305"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "85730"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 1,
"unit": "UN"
}
},
{
"sequence": 7,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0305"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "85027"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 1,
"unit": "UN"
}
},
{
"sequence": 8,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0305"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "85610"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 1,
"unit": "UN"
}
},
{
"sequence": 9,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0307"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "81025"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 1,
"unit": "UN"
}
},
{
"sequence": 10,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0360"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "49329"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 1,
"unit": "UN"
}
},
{
"sequence": 11,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0370"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "00840"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 1,
"unit": "UN"
}
},
{
"sequence": 12,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0412"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "94640"
}
]
},
"modifier": [
{
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "59"
}
]
}
],
"servicedDate": "2018-05-09",
"quantity": {
"value": 1,
"unit": "UN"
}
},
{
"sequence": 13,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0636"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "J3010"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 5,
"unit": "UN"
}
},
{
"sequence": 14,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0636"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "J0131"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 75,
"unit": "UN"
}
},
{
"sequence": 15,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0636"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "J0690"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 4,
"unit": "UN"
}
},
{
"sequence": 16,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0636"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "J1100"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 4,
"unit": "UN"
}
},
{
"sequence": 17,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0636"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "J1170"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 1,
"unit": "UN"
}
},
{
"sequence": 18,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0636"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "J1170"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 1,
"unit": "UN"
}
},
{
"sequence": 19,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0636"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "J2250"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 2,
"unit": "UN"
}
},
{
"sequence": 20,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0636"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "J2405"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 4,
"unit": "UN"
}
},
{
"sequence": 21,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0636"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "J2765"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 1,
"unit": "UN"
}
},
{
"sequence": 22,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0710"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "88888"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 3,
"unit": "UN"
}
}
],
"total": [
{
"category": {
"coding": [
{
"code": "submitted"
}
]
},
"amount": {
"value": 27611.3,
"currency": "USD"
}
}
]
},
"search": {
"mode": "match"
},
"response": {
"status": "201 Created",
"etag": "W/\"1\""
}
}
]
}
Sign up for free to join this conversation on GitHub. Already have an account? Sign in to comment