Publication Build: This will be filled in by the publication tooling
| Page standards status: Informative |
Generated Narrative: ClaimResponse
Resource ClaimResponse "PASClaimInquiryResponseExample"
Profile: PAS Claim Inquiry Response
identifier: id: 111099
status: active
type: Professional (Claim Type Codes#professional)
use: preauthorization
patient: Patient/SubscriberExample " SMITH"
created: 2019-07-20 11:01:00+0500
insurer: Organization/InsurerExample "MARYLAND CAPITAL INSURANCE COMPANY"
outcome: complete
item
ItemRequestedServiceDate: 2005-05-02 --> 2005-06-02
itemSequence: 1
Adjudications
Extension Category Submitted Amount (Adjudication Value Codes#submitted)
| Sequence | Focal | Coverage |
| 1 | true | Coverage/InsuranceExample |