This page is part of the HL7 Belgium FHIR Implementation Guide - MyCareNet profiles (v2.0.0: Trial Use) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
<Bundle xmlns="http://hl7.org/fhir">
<id value="ex06"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementdemandreply"/>
</meta>
<type value="message"/>
<timestamp value="2015-07-14T11:15:37+02:00"/>
<entry>
<fullUrl value="urn:uuid:ce2e2084-3f5c-4f52-8551-8088bb6d3491"/>
<resource>
<MessageHeader>
<id value="667b18ce-3d37-4581-9baa-6fada338038c"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-messageheader"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: MessageHeader</b><a name="667b18ce-3d37-4581-9baa-6fada338038c"> </a></p><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">Resource MessageHeader "667b18ce-3d37-4581-9baa-6fada338038c" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-be-messageheader.html">MyCareNet MessageHeader BE profile</a></p></div><p><b>event</b>: claimresponse-decide (Details: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/message-events code claimresponse-decide = 'claimresponse-decide', stated as 'null')</p><h3>Destinations</h3><table class="grid"><tr><td>-</td><td><b>Endpoint</b></td><td><b>Receiver</b></td></tr><tr><td>*</td><td><code>urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3</code></td><td><a href="#PractitionerRole_PractitionerRole1">See above (PractitionerRole/PractitionerRole1)</a></td></tr></table><p><b>sender</b>: <a href="#Organization_OrganizationIO1">See above (Organization/OrganizationIO1)</a></p><h3>Sources</h3><table class="grid"><tr><td>-</td><td><b>Endpoint</b></td></tr><tr><td>*</td><td><code>urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358</code></td></tr></table><h3>Responses</h3><table class="grid"><tr><td>-</td><td><b>Identifier</b></td><td><b>Code</b></td></tr><tr><td>*</td><td>267b18ce-3d37-4581-9baa-6fada338038b</td><td>ok</td></tr></table><p><b>focus</b>: <a href="#ClaimResponse_ClaimResponse1">See above (ClaimResponse/ClaimResponse1)</a></p></div>
</text>
<eventCoding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/message-events"/>
<code value="claimresponse-decide"/>
</eventCoding>
<destination>
<endpoint value="urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3"/>
<receiver>
<reference value="PractitionerRole/PractitionerRole1"/>
</receiver>
</destination>
<sender>
<reference value="Organization/OrganizationIO1"/>
</sender>
<source>
<endpoint value="urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358"/>
</source>
<response>
<identifier value="267b18ce-3d37-4581-9baa-6fada338038b"/>
<code value="ok"/>
</response>
<focus>
<reference value="ClaimResponse/ClaimResponse1"/>
</focus>
</MessageHeader>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:1dc5d974-5447-4afe-a4ab-57081ca518c3"/>
<resource>
<PractitionerRole>
<id value="PractitionerRole1"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: PractitionerRole</b><a name="PractitionerRole1"> </a></p><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">Resource PractitionerRole "PractitionerRole1" </p><p style="margin-bottom: 0px">Profile: <a href="https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/StructureDefinition-be-practitionerrole.html">Practitioner role core BE profile</a></p></div><p><b>practitioner</b>: <a href="#Practitioner_Practitioner1">See above (Practitioner/Practitioner1)</a></p><p><b>code</b>: physiotherapist <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/CodeSystem-cd-hcparty.html">HCParty</a>#persphysiotherapist)</span></p></div>
</text>
<practitioner>
<reference value="Practitioner/Practitioner1"/>
</practitioner>
<code>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty"/>
<code value="persphysiotherapist"/>
</coding>
</code>
</PractitionerRole>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931"/>
<resource>
<Practitioner>
<id value="Practitioner1"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitioner"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Practitioner</b><a name="Practitioner1"> </a></p><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">Resource Practitioner "Practitioner1" </p><p style="margin-bottom: 0px">Profile: <a href="https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/StructureDefinition-be-practitioner.html">Practitioner core BE profile</a></p></div><p><b>identifier</b>: id: 54263481527</p><p><b>name</b>: John Smith </p></div>
</text>
<identifier>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"/>
<value value="54263481527"/>
</identifier>
<name>
<family value="Smith"/>
<given value="John"/>
</name>
</Practitioner>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:cfabb40d-a53f-4c56-bc19-725ea669b358"/>
<resource>
<Organization>
<id value="OrganizationIO1"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-organization"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Organization</b><a name="OrganizationIO1"> </a></p><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">Resource Organization "OrganizationIO1" </p><p style="margin-bottom: 0px">Profile: <a href="https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/StructureDefinition-be-organization.html">Organisation core BE profile</a></p></div><p><b>identifier</b>: id: 300</p><p><b>name</b>: Union Nationale des Mutualités Socialistes - Nationaal Verbond van de Socialistische Mutualiteiten</p></div>
</text>
<identifier>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancenumber"/>
<value value="300"/>
</identifier>
<name
value="Union Nationale des Mutualités Socialistes - Nationaal Verbond van de Socialistische Mutualiteiten"/>
</Organization>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686"/>
<resource>
<Patient>
<id value="Patient1"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Patient</b><a name="Patient1"> </a></p><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">Resource Patient "Patient1" </p><p style="margin-bottom: 0px">Profile: <a href="https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/StructureDefinition-be-patient.html">Patient core BE profile</a></p></div><p><b>identifier</b>: id: n° inscription mutualiste</p><p><b>name</b>: Jean Dupont </p><p><b>gender</b>: male</p></div>
</text>
<identifier>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancymembership"/>
<value value="n° inscription mutualiste"/>
<assigner>
<identifier>
<system
value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancenumber"/>
<value value="n° mutualité"/>
</identifier>
</assigner>
</identifier>
<name>
<family value="Dupont"/>
<given value="Jean"/>
</name>
<gender value="male"/>
</Patient>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:0a0d60df-0340-45a6-a493-a5d67f74d693"/>
<resource>
<ClaimResponse>
<id value="ClaimResponse1"/>
<meta>
<profile
value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaimresponse"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: ClaimResponse</b><a name="ClaimResponse1"> </a></p><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">Resource ClaimResponse "ClaimResponse1" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-be-eagreementclaimresponse.html">MyCareNet eAgreement Claim Response BE profile</a></p></div><p><b>status</b>: active</p><p><b>type</b>: Professional <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html">Claim Type Codes</a>#professional)</span></p><p><b>subType</b>: physiotherapy-fb <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-agreement-types.html">CodeSystem agreement types</a>#physiotherapy-fb)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href="#Patient_Patient1">See above (Patient/Patient1)</a></p><p><b>created</b>: 2015-07-14 11:15:30+0200</p><p><b>insurer</b>: <a href="#Organization_OrganizationIO1">See above (Organization/OrganizationIO1)</a></p><p><b>requestor</b>: <a href="#PractitionerRole_PractitionerRole1">See above (PractitionerRole/PractitionerRole1)</a></p><p><b>outcome</b>: complete</p><p><b>preAuthRef</b>: identifiant business de la décision (accord/refus/en traitement)</p><blockquote><p><b>addItem</b></p><p><b>itemSequence</b>: 1</p><p><b>productOrService</b>: fb-51 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-nihdi-physiotherapy-pathologysituationcode.html">CodeSystem NIHDIPhysiotherapyPathology</a>#fb-51)</span></p><h3>Adjudications</h3><table class="grid"><tr><td>-</td><td><b>Category</b></td><td><b>Reason</b></td></tr><tr><td>*</td><td>refusal <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-decision-values.html">CodeSystem decision values</a>#refusal)</span></td><td>ajout de commentaires sur le refus <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-refusal-values.html">CodeSystem refusal values</a>#REF_AGREE_ALL_001)</span></td></tr></table></blockquote></div>
</text>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="professional"/>
</coding>
</type>
<subType>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types"/>
<code value="physiotherapy-fb"/>
</coding>
</subType>
<use value="preauthorization"/>
<patient>
<reference value="Patient/Patient1"/>
</patient>
<created value="2015-07-14T11:15:30+02:00"/>
<insurer>
<reference value="Organization/OrganizationIO1"/>
</insurer>
<requestor>
<reference value="PractitionerRole/PractitionerRole1"/>
</requestor>
<outcome value="complete"/>
<preAuthRef
value="identifiant business de la décision (accord/refus/en traitement)"/>
<addItem>
<itemSequence value="1"/>
<productOrService>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/nihdi-physiotherapy-pathologysituationcode"/>
<code value="fb-51"/>
</coding>
</productOrService>
<adjudication>
<category>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/decision-values"/>
<code value="refusal"/>
</coding>
</category>
<reason>
<coding>
<system
value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/refusal-values"/>
<code value="REF_AGREE_ALL_001"/>
</coding>
<text value="ajout de commentaires sur le refus"/>
</reason>
</adjudication>
</addItem>
</ClaimResponse>
</resource>
</entry>
</Bundle>
IG © 2022+ eHealth Platform. Package hl7.fhir.be.mycarenet#2.0.0 based on FHIR 4.0.1. Generated 2023-04-27
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