Publication Build: This will be filled in by the publication tooling
| Page standards status: Informative |
Generated Narrative: ClaimResponse PASClaimInquiryResponseExample
identifier: http://example.org/PATIENT_EVENT_TRACE_NUMBER/111099
status: Active
type: Professional
use: Preauthorization
patient: JOE SMITH Male, DoB Unknown ( Member Number)
created: 2019-07-20 11:01:00+0500
insurer: Organization MARYLAND CAPITAL INSURANCE COMPANY
outcome: Processing Complete
item
ItemRequestedServiceDate: 2005-05-02 --> 2005-06-02
itemSequence: 1
Adjudications
Extension Category Submitted Amount
| Sequence | Focal | Coverage |
| 1 | true | Coverage: status = active; subscriberId = 1122334455; relationship = Self |