MHK Interoperability Implementation Guide
0.1.0 - CI Build
MHK Interoperability Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
{
"resourceType" : "ClaimResponse",
"id" : "PAS-ClaimResponse",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><h3>Eylea Injection Prior Authorization Response</h3><p>This response indicates approval for Eylea injection treatment.</p></div>"
},
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "professional",
"display" : "Professional Claim"
}
]
},
"use" : "preauthorization",
"patient" : {
"reference" : "Patient/example"
},
"created" : "2025-06-05",
"insurer" : {
"reference" : "Organization/payer"
},
"outcome" : "complete",
"disposition" : "Approved for Eylea injection",
"item" : [
{
"itemSequence" : 1,
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible",
"display" : "Eligible Amount"
}
]
},
"amount" : {
"value" : 500,
"currency" : "USD"
}
}
]
}
],
"payment" : {
"type" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/payment-type",
"code" : "payment",
"display" : "Payment"
}
]
},
"amount" : {
"value" : 500,
"currency" : "USD"
}
}
}