{
  "resourceType" : "ClaimResponse",
  "meta" : {
    "source" : "https://standards.digital.health.nz/ns/hpi-facility-id/F12345-A",
    "profile" : ["https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/SharedCareClaimResponse"],
    "tag" : [{
      "system" : "https://hub.services.digital.health.nz/ns/correlation-id",
      "code" : "xxxxxxxx-xxxx-xxxx-xxxx-xxxxxxxxxxxx"
    }]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<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\u00a0(use:\u00a0official,\u00a0)</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\u00a0(use:\u00a0official,\u00a0)</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\u00a0(use:\u00a0official,\u00a0); 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>"
  },
  "identifier" : [{
    "use" : "official",
    "system" : "https://standards.digital.health.nz/ns/claim-response-identifier",
    "value" : "a1b2c3d4-e5f6-7890-abcd-ef1234567890"
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "professional"
    }]
  },
  "subType" : {
    "coding" : [{
      "system" : "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/nz-claim-subtype-cs",
      "code" : "telehealth"
    }]
  },
  "use" : "claim",
  "patient" : {
    "type" : "Patient",
    "identifier" : {
      "system" : "https://standards.digital.health.nz/ns/nhi-id",
      "value" : "ZZZ0008"
    }
  },
  "created" : "2025-01-15T10:30:00-00:00",
  "insurer" : {
    "type" : "Organization",
    "identifier" : {
      "system" : "https://standards.digital.health.nz/ns/hpi-organisation-id",
      "value" : "G0K357-H"
    }
  },
  "requestor" : {
    "type" : "Organization",
    "identifier" : {
      "use" : "official",
      "system" : "https://standards.digital.health.nz/ns/hpi-organisation-id",
      "value" : "GZZ999-J"
    }
  },
  "request" : {
    "reference" : "Claim/NzTelehealthClaimExample"
  },
  "outcome" : "complete",
  "item" : [{
    "extension" : [{
      "url" : "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-product-or-service",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "https://standards.digital.health.nz/ns/purchase-unit",
          "code" : "COGP0068"
        }]
      }
    },
    {
      "url" : "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-trace-number",
      "valueIdentifier" : {
        "system" : "https://standards.digital.health.nz/ns/claim-response-item-identifier",
        "value" : "cd7b6e0d-c554-4786-a52d-3efd1c187c1a"
      }
    },
    {
      "extension" : [{
        "url" : "decision",
        "valueCodeableConcept" : {
          "coding" : [{
            "system" : "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-cs",
            "code" : "approved",
            "display" : "Approved"
          }]
        }
      },
      {
        "url" : "reason",
        "valueCodeableConcept" : {
          "coding" : [{
            "system" : "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs",
            "code" : "DET064.001",
            "display" : "Passed"
          }],
          "text" : "Record of encounter was found in our system."
        }
      }],
      "url" : "https://fhir-ig.digital.health.nz/shared-care/StructureDefinition/shared-care-review-outcome"
    }],
    "itemSequence" : 1,
    "adjudication" : [{
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "benefit"
        }]
      },
      "reason" : {
        "coding" : [{
          "system" : "https://standards.digital.health.nz/ns/adjudication-reason-code",
          "code" : "policy"
        }]
      },
      "amount" : {
        "value" : 100,
        "currency" : "NZD"
      },
      "value" : 1
    }]
  }],
  "total" : [{
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
        "code" : "benefit"
      }]
    },
    "amount" : {
      "value" : 100,
      "currency" : "NZD"
    }
  }],
  "payment" : {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/ex-paymenttype",
        "code" : "complete"
      }]
    },
    "date" : "2025-01-01",
    "amount" : {
      "value" : 100,
      "currency" : "NZD"
    }
  },
  "error" : [{
    "code" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/adjudication-error",
        "code" : "a001",
        "display" : "Invalid claim"
      }],
      "text" : "Claim validation failed: Missing required service date"
    }
  }]
}