{

"resourceType": "Claim",
"id": "960151",
"text": {
  "status": "generated",
  "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Claim</div>"
},
"identifier": [
  {
    "system": "http://happyhospital.com/claim",
    "value": "96123451"
  }
],
"status": "active",
"type": {
  "coding": [
    {
      "system": "http://hl7.org/fhir/ex-claimtype",
      "code": "institutional"
    }
  ]
},
"use": "complete",
"patient": {
  "reference": "Patient/1"
},
"billablePeriod": {
  "start": "2014-08-15",
  "end": "2014-08-16"
},
"created": "2014-08-16",
"enterer": {
  "identifier": {
    "system": "http://jurisdiction.org/facilities/HOSP1234/users",
    "value": "UC1234"
  }
},
"insurer": {
  "reference": "Organization/2"
},
"provider": {
  "identifier": {
    "system": "http://npid.org/providerid",
    "value": "NJ12345"
  }
},
"organization": {
  "reference": "Organization/1"
},
"priority": {
  "coding": [
    {
      "code": "normal"
    }
  ]
},
"payee": {
  "type": {
    "coding": [
      {
        "code": "provider"
      }
    ]
  }
},
"facility": {
  "identifier": {
    "system": "http://jurisdiction.org/facilities",
    "value": "HOSP1234"
  }
},
"careTeam": [
  {
    "sequence": 1,
    "provider": {
      "reference": "Practitioner/example"
    },
    "responsible": true,
    "role": {
      "coding": [
        {
          "system": "http://hl7.org/fhir/claim-careteamrole",
          "code": "primary"
        }
      ]
    },
    "qualification": {
      "coding": [
        {
          "system": "http://hl7.org/fhir/provider-qualification",
          "code": "physician"
        }
      ]
    }
  }
],
"diagnosis": [
  {
    "sequence": 1,
    "diagnosisCodeableConcept": {
      "coding": [
        {
          "code": "654456"
        }
      ]
    },
    "type": [
      {
        "coding": [
          {
            "system": "http://hl7.org/fhir/ex-diagnosistype",
            "code": "admitting"
          }
        ]
      }
    ],
    "packageCode": {
      "coding": [
        {
          "system": "http://hl7.org/fhir/ex-diagnosisrelatedgroup",
          "code": "400",
          "display": "Head trauma - concussion"
        }
      ]
    }
  }
],
"insurance": [
  {
    "sequence": 1,
    "focal": true,
    "coverage": {
      "reference": "Coverage/9876B1"
    },
    "businessArrangement": "BA987123",
    "preAuthRef": [
      "PA2014G56473"
    ]
  }
],
"accident": {
  "date": "2014-07-09",
  "type": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/v3/ActIncidentCode",
        "code": "SPT",
        "display": "Sporting Accident"
      }
    ]
  },
  "locationAddress": {
    "text": "Grouse Mountain Ski Hill"
  }
},
"employmentImpacted": {
  "start": "2014-08-16",
  "end": "2014-08-16"
},
"hospitalization": {
  "start": "2014-08-15",
  "end": "2014-08-16"
},
"item": [
  {
    "sequence": 1,
    "careTeamLinkId": [
      1
    ],
    "service": {
      "coding": [
        {
          "system": "http://hl7.org/fhir/ex-serviceproduct",
          "code": "exam"
        }
      ]
    },
    "servicedDate": "2014-08-16",
    "unitPrice": {
      "value": 125.00,
      "system": "urn:iso:std:iso:4217",
      "code": "USD"
    },
    "net": {
      "value": 125.00,
      "system": "urn:iso:std:iso:4217",
      "code": "USD"
    }
  }
],
"total": {
  "value": 125.00,
  "system": "urn:iso:std:iso:4217",
  "code": "USD"
}

}