MHK Interoperability Implementation Guide
0.1.0 - CI Build

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: PAS ClaimResponse for Eylea - XML Representation

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<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>