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
<ClaimResponse xmlns="http://hl7.org/fhir">
<id value="PAS-ClaimResponse"/>
<text>
<status value="generated"/>
<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>
</text>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="professional"/>
<display value="Professional Claim"/>
</coding>
</type>
<use value="preauthorization"/>
<patient>
<reference value="Patient/example"/>
</patient>
<created value="2025-06-05"/>
<insurer>
<reference value="Organization/payer"/>
</insurer>
<outcome value="complete"/>
<disposition value="Approved for Eylea injection"/>
<item>
<itemSequence value="1"/>
<adjudication>
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/adjudication"/>
<code value="eligible"/>
<display value="Eligible Amount"/>
</coding>
</category>
<amount>
<value value="500"/>
<currency value="USD"/>
</amount>
</adjudication>
</item>
<payment>
<type>
<coding>
<system value="http://hl7.org/fhir/payment-type"/>
<code value="payment"/>
<display value="Payment"/>
</coding>
</type>
<amount>
<value value="500"/>
<currency value="USD"/>
</amount>
</payment>
</ClaimResponse>