LinuxForHealth FHIR Implementation Guide
8.0.0 - draft
LinuxForHealth FHIR Implementation Guide
8.0.0 - draft
LinuxForHealth FHIR Implementation Guide - Local Development build (v8.0.0). See the Directory of published versions
Resource Claim "CDMClaimProfessionalInstance"
Information Source: http://acme-health.com/WellnessMedicalCenter!
Profile: CDM Claim
Snapshot Age In Years: 20
Aggregate Claim Indicator: N
Claim Snapshot Provider Name: Dr Smith
Claim Snapshot Provider Zip Code: 79912
Employee Business Unit: EmpBusUnit (local-employee-business-unit#EmpBusUnit)
Employer: EmployerCode (local-employer-code#EmployerCode)
Financial System: FinanceSys (local-financial-system#FinanceSys)
Claim Category: F1 (claim-status-category-codes#F1)
Claim Status: F1 (claim-status-codes#F1)
Last Claim Indicator: Y
Participating Plan: LocalParticipatingPlan (local-participating-plan#LocalParticipatingPlan)
Referral Indicator: N
Submission Type: SubmitType (local-submission-type#SubmitType)
Payer PCP Responsibility Indicator: Y
identifier: Source System Row Identifier: 000000000000000000019721078(use: OFFICIAL), Source System Row Identifier: 000000000000000000099999999(use: SECONDARY)
status: active
type: Medical claim; Institutional/Professional unknown (Payer Claim Type Codes#medical; local-claim-type#Medical)
subType: Emergency (Claim Subtype Codes#emergency)
use: claim
patient: Patient/CDMPatientInstance " MCLASTNAME"
created: 2017-07-15 05:31:00-0500
provider: Organization/Provider1 "Dr Smith"
priority: Normal (Process Priority Codes#normal)
referral: ServiceRequest/CDMServiceRequestInstance
careTeam
sequence: 1
provider: Practitioner/DrKelly " KELLY"
role: Ordering provider (Claim Care Team Role Codes#ordering)
careTeam
sequence: 2
provider: Organization/Provider1 "Dr Smith"
role: Servicing provider (Claim Care Team Role Codes#servicing)
qualification: 01 (local-specialty#01)
| - | Sequence | Category | Code | Value[x] |
| * | 1 | Information (Claim Information Category Codes#info) | Network provider indicator (Claim Supporting Info Type Codes#network-provider-indicator) | Y |
diagnosis
sequence: 1
diagnosis: Migraine, Unspecified, not Intractable, without Status Migrainosus (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#G43.909)
type: Principal Diagnosis (Example Diagnosis Type Codes#principal)
diagnosis
sequence: 2
diagnosis: Encntr for general adult medical exam w/o abnormal findings (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#Z00.00)
type: Discharge Diagnosis (Example Diagnosis Type Codes#discharge)
| - | Extension | Sequence | Focal | Identifier | Coverage | PreAuthRef |
| * | , , | 1 | true | id: PPOB | Coverage/PrimaryPayerExample | Y |
| - | Date | Type |
| * | 2017-06-25 | No (Payer Indicator Codes#N) |
| - | Extension | Sequence | CareTeamSequence | ProductOrService | Modifier | Serviced[x] | Location[x] | Quantity | BodySite | SubSite |
| * | , , , | 1 | 2 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit (2.16.840.1.113883.6.285#G0438; local-service-type#LocalServiceType) | Dressing for one wound (Procedure Modifier Codes#A1) | 2017-06-25 --> 2017-06-25 | Office (CMS Place of Service Codes (POS)#11; local-place-of-service#LocalPlcOfService) | 1 | Upper Right Third Molar (Wisdom Tooth) (American Dental Association Tooth Numbering Code System#1; American Dental Association Tooth Quadrant Code System#UR) | LocalToothSurface1 (local-tooth-surface#LocalToothSurface1), LocalToothSurface2 (local-tooth-surface#LocalToothSurface2) |