{ "resourceType" : "Bundle", "id" : "ClaimBundle-preauthorization-example-01", "meta" : { "profile" : ["https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimBundle"], "security" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-Confidentiality", "code" : "V", "display" : "very restricted" }] }, "identifier" : { "value" : "bc3c6c57-2053-4d0e-ac40-139ccccff645" }, "type" : "collection", "timestamp" : "2025-03-08T11:32:26.605+05:30", "entry" : [{ "fullUrl" : "urn:uuid:4e857d1b-6189-41b5-96c3-20e1a90ce8de", "resource" : { "resourceType" : "Claim", "id" : "4e857d1b-6189-41b5-96c3-20e1a90ce8de", "meta" : { "profile" : ["https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Claim 4e857d1b-6189-41b5-96c3-20e1a90ce8de

identifier: 7612345

status: Active

type: Inpatient care management (procedure)

use: Preauthorization

patient: Patient

billablePeriod: 2025-03-07 11:01:00+0500 --> 2025-04-07 11:01:00+0500

created: 2025-03-08 11:01:00+0500

insurer: Organization

provider: Organization

priority: Normal

CareTeams

-SequenceProviderRoleQualification
*1PractitionerHealthcare professional (occupation)Clinical specialty (qualifier value)

Diagnoses

-SequenceDiagnosis[x]Type
*1Cardiac arrest, unspecifiedFinal diagnosis (discharge) (contextual qualifier) (qualifier value)

procedure

sequence: 1

procedure: Angiography

procedure

sequence: 2

procedure: Angioplasty of blood vessel

Insurances

-SequenceFocalCoverage
*1trueCoverage

item

sequence: 1

careTeamSequence: 1

productOrService: Angiography

UnitPrices

-ValueCurrency
*10000Indian rupee

Nets

-ValueCurrency
*10000Indian rupee

item

sequence: 2

careTeamSequence: 1

productOrService: Angioplasty of blood vessel

UnitPrices

-ValueCurrency
*40000Indian rupee

Nets

-ValueCurrency
*40000Indian rupee

item

sequence: 3

careTeamSequence: 1

productOrService: Intensive care unit

UnitPrices

-ValueCurrency
*2000Indian rupee

Nets

-ValueCurrency
*20000Indian rupee

Totals

-ValueCurrency
*70000Indian rupee
" }, "identifier" : [{ "value" : "7612345" }], "status" : "active", "type" : { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "737481003", "display" : "Inpatient care management (procedure)" }] }, "use" : "preauthorization", "patient" : { "reference" : "urn:uuid:ca5de1b1-0bb6-4cbf-b3b4-2c006f7a72f3", "display" : "Patient" }, "billablePeriod" : { "start" : "2025-03-07T11:01:00+05:00", "end" : "2025-04-07T11:01:00+05:00" }, "created" : "2025-03-08T11:01:00+05:00", "insurer" : { "reference" : "urn:uuid:5999df2e-77b5-4398-80ca-f6a4f4904f97", "display" : "Organization" }, "provider" : { "reference" : "urn:uuid:ae6fc073-c976-415b-8333-0ace1ebd6ac4", "display" : "Organization" }, "priority" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal" }] }, "careTeam" : [{ "sequence" : 1, "provider" : { "reference" : "urn:uuid:6166b645-5ff9-4a2e-aa90-b0b8fb0ebb55", "display" : "Practitioner" }, "role" : { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "223366009", "display" : "Healthcare professional (occupation)" }] }, "qualification" : { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "394658006", "display" : "Clinical specialty (qualifier value)" }] } }], "diagnosis" : [{ "sequence" : 1, "diagnosisCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/sid/icd-10", "code" : "I46.9", "display" : "Cardiac arrest, unspecified" }] }, "type" : [{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "89100005", "display" : "Final diagnosis (discharge) (contextual qualifier) (qualifier value)" }] }] }], "procedure" : [{ "sequence" : 1, "procedureCodeableConcept" : { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "77343006", "display" : "Angiography" }] } }, { "sequence" : 2, "procedureCodeableConcept" : { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "418285008", "display" : "Angioplasty of blood vessel" }] } }], "insurance" : [{ "sequence" : 1, "focal" : true, "coverage" : { "reference" : "urn:uuid:eacc00ce-0948-4e9d-99f2-95ce8fa53fbf", "display" : "Coverage" } }], "item" : [{ "sequence" : 1, "careTeamSequence" : [1], "productOrService" : { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "77343006", "display" : "Angiography" }] }, "unitPrice" : { "value" : 10000, "currency" : "INR" }, "net" : { "value" : 10000, "currency" : "INR" } }, { "sequence" : 2, "careTeamSequence" : [1], "productOrService" : { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "418285008", "display" : "Angioplasty of blood vessel" }] }, "unitPrice" : { "value" : 40000, "currency" : "INR" }, "net" : { "value" : 40000, "currency" : "INR" } }, { "sequence" : 3, "careTeamSequence" : [1], "productOrService" : { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "309904001", "display" : "Intensive care unit" }] }, "unitPrice" : { "value" : 2000, "currency" : "INR" }, "net" : { "value" : 20000, "currency" : "INR" } }], "total" : { "value" : 70000, "currency" : "INR" } } }, { "fullUrl" : "urn:uuid:ca5de1b1-0bb6-4cbf-b3b4-2c006f7a72f3", "resource" : { "resourceType" : "Patient", "id" : "ca5de1b1-0bb6-4cbf-b3b4-2c006f7a72f3", "meta" : { "profile" : ["https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Patient ca5de1b1-0bb6-4cbf-b3b4-2c006f7a72f3

Adarsh Agrawal Male, DoB: 1981-01-12 ( Adhaar number: 7225-4829-5255)

Contact Detail+919818512600
" }, "identifier" : [{ "type" : { "coding" : [{ "system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code", "code" : "ADN", "display" : "Adhaar number" }] }, "system" : "https://uidai.gov.in/", "value" : "7225-4829-5255" }], "name" : [{ "text" : "Adarsh Agrawal" }], "telecom" : [{ "system" : "phone", "value" : "+919818512600", "use" : "home" }], "gender" : "male", "birthDate" : "1981-01-12" } }, { "fullUrl" : "urn:uuid:5999df2e-77b5-4398-80ca-f6a4f4904f97", "resource" : { "resourceType" : "Organization", "id" : "5999df2e-77b5-4398-80ca-f6a4f4904f97", "meta" : { "profile" : ["https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Organization 5999df2e-77b5-4398-80ca-f6a4f4904f97

identifier: Registry of Hospitals in Network of Insurance (ROHINI) ID/4567878

type: Insurance Company

name: XYZ Insurance Co. Ltd.

telecom: +91 243 2634 1234, contact@xyz.org

" }, "identifier" : [{ "type" : { "coding" : [{ "system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code", "code" : "ROHINI", "display" : "Registry of Hospitals in Network of Insurance (ROHINI) ID" }] }, "system" : "https://rohini.iib.gov.in/", "value" : "4567878" }], "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/organization-type", "code" : "ins", "display" : "Insurance Company" }] }], "name" : "XYZ Insurance Co. Ltd.", "telecom" : [{ "system" : "phone", "value" : "+91 243 2634 1234", "use" : "work" }, { "system" : "email", "value" : "contact@xyz.org", "use" : "work" }] } }, { "fullUrl" : "urn:uuid:ae6fc073-c976-415b-8333-0ace1ebd6ac4", "resource" : { "resourceType" : "Organization", "id" : "ae6fc073-c976-415b-8333-0ace1ebd6ac4", "meta" : { "profile" : ["https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Organization ae6fc073-c976-415b-8333-0ace1ebd6ac4

identifier: Provider number/45675454

type: Healthcare Provider

name: XYZ Hospital Co. Ltd.

telecom: +91 243 2634 1278, contact@xyz.org

" }, "identifier" : [{ "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "code" : "PRN", "display" : "Provider number" }] }, "system" : "https://facility.ndhm.gov.in", "value" : "45675454" }], "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/organization-type", "code" : "prov", "display" : "Healthcare Provider" }] }], "name" : "XYZ Hospital Co. Ltd.", "telecom" : [{ "system" : "phone", "value" : "+91 243 2634 1278", "use" : "work" }, { "system" : "email", "value" : "contact@xyz.org", "use" : "work" }] } }, { "fullUrl" : "urn:uuid:6166b645-5ff9-4a2e-aa90-b0b8fb0ebb55", "resource" : { "resourceType" : "Practitioner", "id" : "6166b645-5ff9-4a2e-aa90-b0b8fb0ebb55", "meta" : { "profile" : ["https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Practitioner 6166b645-5ff9-4a2e-aa90-b0b8fb0ebb55

identifier: Medical License number/21-1521-3828-3227

name: Dr. Aayush Agrawal

" }, "identifier" : [{ "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v2-0203", "code" : "MD", "display" : "Medical License number" }] }, "system" : "https://doctor.ndhm.gov.in", "value" : "21-1521-3828-3227" }], "name" : [{ "text" : "Dr. Aayush Agrawal" }] } }, { "fullUrl" : "urn:uuid:eacc00ce-0948-4e9d-99f2-95ce8fa53fbf", "resource" : { "resourceType" : "Coverage", "id" : "eacc00ce-0948-4e9d-99f2-95ce8fa53fbf", "meta" : { "profile" : ["https://nrces.in/ndhm/fhir/r4/StructureDefinition/Coverage"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Coverage eacc00ce-0948-4e9d-99f2-95ce8fa53fbf

identifier: https://xyzinsurance.in/policynumber//235037120

status: Active

type: health insurance plan policy

subscriber: Patient

subscriberId: ABC123456BI007

beneficiary: Patient

relationship: Self

period: ?? --> 2026-03-17

payor: Organization

" }, "identifier" : [{ "system" : "https://xyzinsurance.in/policynumber/", "value" : "235037120" }], "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code" : "HIP", "display" : "health insurance plan policy" }] }, "subscriber" : { "reference" : "urn:uuid:ca5de1b1-0bb6-4cbf-b3b4-2c006f7a72f3", "display" : "Patient" }, "subscriberId" : "ABC123456BI007", "beneficiary" : { "reference" : "urn:uuid:ca5de1b1-0bb6-4cbf-b3b4-2c006f7a72f3", "display" : "Patient" }, "relationship" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code" : "self" }] }, "period" : { "end" : "2026-03-17" }, "payor" : [{ "reference" : "urn:uuid:5999df2e-77b5-4398-80ca-f6a4f4904f97", "display" : "Organization" }] } }] }