<?xml version="1.0" encoding="UTF-8"?>

<ClaimResponse xmlns="http://hl7.org/fhir">
  <meta>
    <source value="https://standards.digital.health.nz/ns/hpi-facility-id/F12345-A"/>
    <profile value="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/SharedCareClaimResponse"/>
    <tag>
      <system value="https://hub.services.digital.health.nz/ns/correlation-id"/>
      <code value="xxxxxxxx-xxxx-xxxx-xxxx-xxxxxxxxxxxx"/>
    </tag>
  </meta>
  <text>
    <status value="extensions"/><div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ClaimResponse NzTelehealthClaimResponseExample</b></p><a name="NzTelehealthClaimResponseExample"> </a><a name="hcNzTelehealthClaimResponseExample"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Information Source: <a href="https://standards.digital.health.nz/ns/hpi-facility-id/F12345-A">https://standards.digital.health.nz/ns/hpi-facility-id/F12345-A</a></p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-SharedCareClaimResponse.html">NZ SharedCare Claim Response</a></p><p style="margin-bottom: 0px">Tag: xxxxxxxx-xxxx-xxxx-xxxx-xxxxxxxxxxxx (Details: correlation-id code xxxxxxxx-xxxx-xxxx-xxxx-xxxxxxxxxxxx)</p></div><p><b>identifier</b>: <code>https://standards.digital.health.nz/ns/claim-response-identifier</code>/a1b2c3d4-e5f6-7890-abcd-ef1234567890 (use: official, )</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}">Professional</span></p><p><b>subType</b>: <span title="Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/nz-claim-subtype-cs telehealth}">Telehealth</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: Identifier: <a href="http://fhir.org.nz/ig/base/NamingSystem-nhi.html" title="NHI number">NHI</a>/ZZZ0008</p><p><b>created</b>: 2025-01-15 10:30:00+0000</p><p><b>insurer</b>: Identifier: <a href="http://fhir.org.nz/ig/base/NamingSystem-hpiOrganization.html" title="HPI organizations">HPIOrganization</a>/G0K357-H</p><p><b>requestor</b>: Identifier: <a href="http://fhir.org.nz/ig/base/NamingSystem-hpiOrganization.html" title="HPI organizations">HPIOrganization</a>/GZZ999-J (use: official, )</p><p><b>request</b>: <a href="Claim-NzTelehealthClaimExample.html">Claim: extension = AGRS-202sdfg4-00121,https://example.org/fhir/trace-number#7890; identifier = https://provider-org-name.co.nz/ns/claim-identifier#C123456 (use: official, ); status = active; type = Professional; subType = Telehealth; use = claim; billablePeriod = 2025-01-01 00:00:00+1300 --&gt; 2025-01-02 00:00:00+1300; created = 2025-01-01 00:00:00+1300; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p><blockquote><p><b>item</b></p><p><b>Shared Care Product Or Service</b>: <span title="Codes:{https://standards.digital.health.nz/ns/purchase-unit COGP0068}">COGP0068</span></p><p><b>Shared Care Claim Trace Number</b>: <code>https://standards.digital.health.nz/ns/claim-response-item-identifier</code>/cd7b6e0d-c554-4786-a52d-3efd1c187c1a</p><blockquote><p><b>Shared Care Review Outcome</b></p><ul><li>decision: <span title="Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-cs approved}">Approved</span></li><li>reason: <span title="Codes:{https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs DET064.001}">Record of encounter was found in our system.</span></li></ul></blockquote><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}">Benefit Amount</span></p><p><b>reason</b>: <span title="Codes:{https://standards.digital.health.nz/ns/adjudication-reason-code policy}">policy</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>100</td><td>New Zealand dollar</td></tr></table><p><b>value</b>: 1</p></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}">Benefit Amount</span></p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>100</td><td>New Zealand dollar</td></tr></table></blockquote><blockquote><p><b>payment</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/ex-paymenttype complete}">Complete</span></p><p><b>date</b>: 2025-01-01</p><h3>Amounts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>100</td><td>New Zealand dollar</td></tr></table></blockquote><h3>Errors</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/adjudication-error a001}">Claim validation failed: Missing required service date</span></td></tr></table></div>
  </text>
  <identifier>
    <use value="official"/>
    <system value="https://standards.digital.health.nz/ns/claim-response-identifier"/>
    <value value="a1b2c3d4-e5f6-7890-abcd-ef1234567890"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="professional"/>
    </coding>
  </type>
  <subType>
    <coding>
      <system value="https://fhir-ig.digital.health.nz/shared-care/CodeSystem/nz-claim-subtype-cs"/>
      <code value="telehealth"/>
    </coding>
  </subType>
  <use value="claim"/>
  <patient>
    <type value="Patient"/>
    <identifier>
      <system value="https://standards.digital.health.nz/ns/nhi-id"/>
      <value value="ZZZ0008"/>
    </identifier>
  </patient>
  <created value="2025-01-15T10:30:00-00:00"/>
  <insurer>
    <type value="Organization"/>
    <identifier>
      <system value="https://standards.digital.health.nz/ns/hpi-organisation-id"/>
      <value value="G0K357-H"/>
    </identifier>
  </insurer>
  <requestor>
    <type value="Organization"/>
    <identifier>
      <use value="official"/>
      <system value="https://standards.digital.health.nz/ns/hpi-organisation-id"/>
      <value value="GZZ999-J"/>
    </identifier>
  </requestor>
  <request>
    <reference value="Claim/NzTelehealthClaimExample"/>
  </request>
  <outcome value="complete"/>
  <item>
    <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service">
      <valueCodeableConcept>
        <coding>
          <system value="https://standards.digital.health.nz/ns/purchase-unit"/>
          <code value="COGP0068"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number">
      <valueIdentifier>
        <system value="https://standards.digital.health.nz/ns/claim-response-item-identifier"/>
        <value value="cd7b6e0d-c554-4786-a52d-3efd1c187c1a"/>
      </valueIdentifier>
    </extension>
    <extension url="https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome">
      <extension url="decision">
        <valueCodeableConcept>
          <coding>
            <system value="https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-cs"/>
            <code value="approved"/>
            <display value="Approved"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="reason">
        <valueCodeableConcept>
          <coding>
            <system value="https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs"/>
            <code value="DET064.001"/>
            <display value="Passed"/>
          </coding>
          <text value="Record of encounter was found in our system."/>
        </valueCodeableConcept>
      </extension>
    </extension>
    <itemSequence value="1"/>
    <adjudication>
      <category>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
          <code value="benefit"/>
        </coding>
      </category>
      <reason>
        <coding>
          <system value="https://standards.digital.health.nz/ns/adjudication-reason-code"/>
          <code value="policy"/>
        </coding>
      </reason>
      <amount>
        <value value="100"/>
        <currency value="NZD"/>
      </amount>
      <value value="1"/>
    </adjudication>
  </item>
  <total>
    <category>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
        <code value="benefit"/>
      </coding>
    </category>
    <amount>
      <value value="100"/>
      <currency value="NZD"/>
    </amount>
  </total>
  <payment>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/ex-paymenttype"/>
        <code value="complete"/>
      </coding>
    </type>
    <date value="2025-01-01"/>
    <amount>
      <value value="100"/>
      <currency value="NZD"/>
    </amount>
  </payment>
  <error>
    <code>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/adjudication-error"/>
        <code value="a001"/>
        <display value="Invalid claim"/>
      </coding>
      <text value="Claim validation failed: Missing required service date"/>
    </code>
  </error>
</ClaimResponse>