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Response 3850

The document is a FHIR Bundle containing a message with multiple entries including a MessageHeader, Task, and ClaimResponse. It details a poll-response event and includes information about a patient's prior authorization request and its outcome. The document provides structured data related to healthcare transactions and responses within the NPHIES framework.

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0% found this document useful (0 votes)
18 views7 pages

Response 3850

The document is a FHIR Bundle containing a message with multiple entries including a MessageHeader, Task, and ClaimResponse. It details a poll-response event and includes information about a patient's prior authorization request and its outcome. The document provides structured data related to healthcare transactions and responses within the NPHIES framework.

Uploaded by

xnzbgbn2c8
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as TXT, PDF, TXT or read online on Scribd
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{ "resourceType": "Bundle", "id": "8a3e42fe-0b34-4753-97b1-e665ff8b0075",

"meta": { "profile": [
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"type": "message", "timestamp": "2025-01-14T18:07:47.007+03:00", "entry": [
{ "fullUrl": "http://nphies.sa/MessageHeader/a3844bdc-51cb-46b9-ba04-
8d11e2c0d220", "resource": { "resourceType": "MessageHeader",
"id": "a3844bdc-51cb-46b9-ba04-8d11e2c0d220", "meta":
{ "profile": [
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], "tag": [ { "system":
"http://nphies.sa/terminology/CodeSystem/meta-tags", "code":
"queued-messages" } ] }, "eventCoding": {
"system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
"code": "poll-response" }, "destination": [ {
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"receiver": { "type": "Organization", "identifier": {
"system": "http://nphies.sa/license/provider-license", "value":
"10000000055424" } } } ],
"sender": { "type": "Organization", "identifier": {
"system": "http://nphies.sa/license/nphies", "value": "NPHIES"
} }, "source": { "endpoint": "http://nphies.sa/"
}, "response": { "identifier": "4c0fc62c-40cc-4fd7-b28b-
5e9cbd639aff", "code": "ok" } } },
{ "fullUrl": "http://nphies.sa/Task/de5a0dff-8450-4f68-a924-3fcd48b47e11",
"resource": { "resourceType": "Task", "id": "de5a0dff-8450-4f68-
a924-3fcd48b47e11", "meta": { "profile":
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], "tag": [ { "code": "NPHIES generated",
"display": "NPHIES generated" } ] },
"identifier": [ { "system": "http://nphies-fhir-ahh-
suwaidi.com.sa/Task", "value": "435" } ],
"status": "completed", "intent": "order", "priority": "routine",
"code": { "coding": [ { "system":
"http://nphies.sa/terminology/CodeSystem/task-code", "code": "poll"
} ] }, "authoredOn": "2025-01-14",
"lastModified": "2025-01-14", "requester": { "reference":
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"system": "http://nphies.sa/license/nphies", "value": "NPHIES"
} }, "input": [ { "type": {
"coding": [ { "system":
"http://nphies.sa/terminology/CodeSystem/task-input-type",
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] }, "valuePeriod": { "start": "2025-01-
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} }, { "type": { "coding": [
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type", "code": "count", "display": "Count"
} ] }, "valuePositiveInt": 1 },
{ "type": { "coding": [ {
"system": "http://nphies.sa/terminology/CodeSystem/task-input-type",
"code": "include-message-type", "display": "Include Message
Type" } ] }, "valueCode":
"priorauth-response" }, { "type": {
"coding": [ { "system":
"http://nphies.sa/terminology/CodeSystem/task-input-type",
"code": "include-message-type", "display": "Include Message
Type" } ] }, "valueCode":
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"http://nphies.sa/terminology/CodeSystem/task-input-type",
"code": "include-message-type", "display": "Include Message
Type" } ] }, "valueCode":
"claim-response" }, { "type":
{ "coding": [ { "system":
"http://nphies.sa/terminology/CodeSystem/task-input-type",
"code": "include-message-type", "display": "Include Message
Type" } ] }, "valueCode":
"payment-reconciliation" } ], "output": [ {
"type": { "coding":
[ { "system":
"http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response" } ] },
"valueReference": { "reference": "http://nphies.sa/Bundle/23e7ab41-
5a13-46c2-9135-
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"resource": { "resourceType": "MessageHeader", "id":
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] }, "eventCoding": { "system":
"http://nphies.sa/terminology/CodeSystem/ksa-message-events",
"code": "priorauth-response" }, "destination": [
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"receiver": { "type": "Organization",
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], "sender": { "type": "Organization",
"identifier": { "system": "http://nphies.sa/license/payer-
license", "value": "7000911508" }
}, "source": { "endpoint":
"https://tawuniya.com.sa" }, "response": {
"identifier": "74f51ca3-4b18-42d1-8d1d-ab5b0ec06174", "code": "ok"
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"https://tawuniya.com.sa/ClaimResponse/230c916f-382c-434c-88f6-2bb9195948d3"
} ] } },
{ "fullUrl": "https://tawuniya.com.sa/ClaimResponse/230c916f-382c-
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"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-
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"code": "not-required" } ]
} } ], "identifier": [
{ "system": "https://tawuniya.com.sa/claimResponse",
"value": "230c916f-382c-434c-88f6-
2bb9195948d3" } ], "status":
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[ { "system":
"http://terminology.hl7.org/CodeSystem/claim-type", "code":
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"subType": { "coding": [ {
"system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
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] }, "use": "preauthorization",
"patient": { "reference": "https://tawuniya.com.sa/Patient/615814"
}, "created": "2025-01-14T18:00:22+03:00", "insurer":
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}, "requestor": { "reference":
"https://tawuniya.com.sa/Organization/118" },
"request": { "identifier": { "system":
"http://nphies-fhir-HammadiSU.com.sa/Preauthorization", "value":
"AR456616" } }, "outcome":
"complete", "disposition": "Please note that the amount of the
requested services do not require prior approval from Tawuniya, as per this
Policy's terms and conditions. Kindly, provide the necessary medical services to
our clie", "preAuthRef": "75823353", "preAuthPeriod":
{ "start": "2025-01-14", "end": "2025-02-13"
}, "item": [ { "extension": [
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"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-
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} } ], "itemSequence":
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}, "amount": { "value": 190,
"currency": "SAR" } },
{ "category": { "coding": [
{ "system":
"http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted" } ]
}, "amount": { "value": 190,
"currency": "SAR" } },
{ "category": { "coding": [
{ "system":
"http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
"code": "approved-quantity" } ]
}, "value": 1 } ]
}, { "extension": [ {
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-
adjudication-outcome", "valueCodeableConcept": {
"coding": [ { "system":
"http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
"code": "not-required" } ]
} } ], "itemSequence":
2, "adjudication": [ {
"category": { "coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit" } ]
}, "amount": { "value": 265,
"currency": "SAR" } },
{ "category": { "coding": [
{ "system":
"http://terminology.hl7.org/CodeSystem/adjudication",
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}, "amount": { "value": 265,
"currency": "SAR" } },
{ "category": { "coding": [
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"code": "approved-quantity" } ]
}, "value": 1 } ]
} ], "total": [ {
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}, "amount": { "value": 455,
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}, "amount": { "value": 455,
"currency": "SAR" } } ],
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"focal": false, "coverage": { "reference":
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} } ] } }, {
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] }, "extension": [ {
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"system": "http://nphies.sa/terminology/CodeSystem/occupation",
"code": "agriculture", "display": "Agriculture"
} ] } },
{ "url":
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"valueCodeableConcept": { "coding": [ {
"system": "https://hl7.org/fhir/valueset-iso3166-1-3.html",
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} ] } } ],
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] }, "system":
"http://nphies.sa/identifier/nationalid", "value": "1106101700"
} ], "active": true, "name": [
{ "use": "official", "text": "Mrs Khadijah
Ali Abdullah Ojaymah", "family": "Ojaymah",
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"Abdullah" ], "prefix": [
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"gender": "female", "_gender": { "extension": [
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administrative-gender", "valueCodeableConcept": {
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"http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code": "female", "display": "Female"
} ] } }
]
}, "birthDate": "1999-12-02", "maritalStatus":
{ "coding": [ { "system":
"http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M" } ] } }
}, { "fullUrl": "https://tawuniya.com.sa/Organization/118",
"resource": { "resourceType": "Organization", "id":
"118", "meta": { "profile":
[
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1.0.0" ] }, "extension": [
{ "url":
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
"valueCodeableConcept": { "coding": [ {
"system": "http://nphies.sa/terminology/CodeSystem/provider-type",
"code": "1", "display":
"Hospital" } ] }
} ], "identifier": [ {
"system": "http://nphies.sa/license/provider-license", "value":
"10000000055424" } ], "active":
true, "type": [ { "coding": [
{ "system":
"http://nphies.sa/terminology/CodeSystem/organization-type",
"code": "prov" } ] }
], "name": "Al Hammadi Hospital, Al Suwaidi Branch" }
}, { "fullUrl": "https://tawuniya.com.sa/Organization/6",
"resource": { "resourceType": "Organization", "id":
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[
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1.0.0" ] }, "identifier": [
{ "system": "http://nphies.sa/license/payer-license",
"value": "7000911508" } ], "active":
true, "type": [ { "coding": [
{ "system":
"http://nphies.sa/terminology/CodeSystem/organization-type",
"code": "ins" } ] }
], "name": "The Cooperative Company for Cooperative Insurance"
} }, { "fullUrl":
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{ "profile": [
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] }, "identifier": [ {
"system": "https://tawuniya.com.sa/memberid", "value":
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[ { "system":
"http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL" } ] },
"policyHolder": { "reference":
"https://tawuniya.com.sa/Organization/22961514-2586-4d10-af7c-1d4fcb8c0148"
}, "beneficiary": { "reference":
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"relationship": { "coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self", "display": "self" }
] }, "payor": [ {
"reference": "https://tawuniya.com.sa/Organization/6" }
], "class": [ { "type": {
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"http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "group", "display": "Group"
} ] }, "value": "MIDDLE
EAST INTERNET CO LIMITED // TAWUNIYA", "name": "MIDDLE EAST
INTERNET CO LIMITED // TAWUNIYA" }, {
"type": { "coding": [ {
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan", "display": "Plan" }
] }, "value": "36286543",
"name": "36286543" },
{ "type": { "coding": [
{ "system":
"http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "class", "display": "Class"
} ] }, "value": "A",
"name": "A" } ] } },
{ "fullUrl": "https://tawuniya.com.sa/Organization/22961514-2586-4d10-
af7c-1d4fcb8c0148", "resource": { "resourceType":
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"meta": { "profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|
1.0.0" ] }, "identifier": [
{ "system": "http://nphies.sa/identifier/Organization",
"value": "72259" } ], "active":
true, "name": "MIDDLE EAST INTERNET CO LIMITED // TAWUNIYA"
} } ] } }, { "fullUrl": "http://nphies-
fhir-ahh-suwaidi.com.sa/Organization/2", "resource":
{ "resourceType": "Organization", "id": "2", "meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|
1.0.0" ] }, "extension":
[ { "url":
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
"valueCodeableConcept": { "coding": [ {
"system": "http://nphies.sa/terminology/CodeSystem/provider-type",
"code": "1", "display": "Hospital" }
] } } ], "identifier": [ {
"system": "http://nphies.sa/license/provider-license", "value":
"10000000055424" } ], "active": true, "type":
[ { "coding": [ { "system":
"http://nphies.sa/terminology/CodeSystem/organization-type",
"code": "prov", "display": "Healthcare Provider" }
] } ], "name": "Al Hammadi Hospital -
Suwaidi" } }, { "fullUrl": "http://nphies-fhir-ahh-
suwaidi.com.sa/Organization/4", "resource": { "resourceType":
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] }, "identifier": [ { "system":
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], "active": true, "type": [ { "coding":
[ { "system":
"http://nphies.sa/terminology/CodeSystem/organization-type",
"code": "other", "display":
"Other" } ] } ], "name":
"National Platform for Health Information Exchange
Services" } } ] }

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