{
  "resourceType" : "Bundle",
  "id" : "bundle-chargeback-submitted",
  "meta" : {
    "profile" : ["https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-message-bundle"]
  },
  "identifier" : {
    "system" : "https://exchange.example.org/bundle-ids",
    "value" : "bundle-sub-1001"
  },
  "type" : "message",
  "timestamp" : "2026-04-24T15:00:00Z",
  "entry" : [{
    "fullUrl" : "urn:uuid:11111111-1111-4111-8111-111111111111",
    "resource" : {
      "resourceType" : "MessageHeader",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_null\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader </b></p><p><b>event</b>: events: 340b.chargeback.submitted (340b.chargeback.submitted)</p><h3>Sources</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Endpoint</b></td></tr><tr><td style=\"display: none\">*</td><td>urn:system:tpa-01</td></tr></table><p><b>focus</b>: <a href=\"Bundle-bundle-chargeback-submitted.html#urn-uuid-22222222-2222-4222-8222-222222222222\">Claim: extension = tx-1001,corr-9001,1.2.0,https://exchange.example.org/chargeback#cb-1001; status = active; type = Pharmacy; use = claim; created = 2026-04-24; priority = Normal</a></p></div>"
      },
      "eventCoding" : {
        "system" : "https://exchange.example.org/events",
        "code" : "340b.chargeback.submitted"
      },
      "source" : {
        "endpoint" : "urn:system:tpa-01"
      },
      "focus" : [{
        "reference" : "urn:uuid:22222222-2222-4222-8222-222222222222"
      }]
    }
  },
  {
    "fullUrl" : "urn:uuid:22222222-2222-4222-8222-222222222222",
    "resource" : {
      "resourceType" : "Claim",
      "id" : "claim-340b-1001",
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_claim-340b-1001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim claim-340b-1001</b></p><a name=\"claim-340b-1001\"> </a><a name=\"hcclaim-340b-1001\"> </a><p><b>340B Exchange Transaction ID Extension</b>: tx-1001</p><p><b>340B Correlation ID Extension</b>: corr-9001</p><p><b>340B Rule Set Version Extension</b>: 1.2.0</p><p><b>340B Chargeback Reference Extension</b>: <code>https://exchange.example.org/chargeback</code>/cb-1001</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type pharmacy}\">Pharmacy</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Bundle-bundle-chargeback-adjudicated.html#urn-uuid-33333333-3333-4333-8333-333333333333\">Pat Example  (no stated gender), DoB Unknown</a></p><p><b>created</b>: 2026-04-24</p><p><b>insurer</b>: <a href=\"Bundle-bundle-chargeback-adjudicated.html#urn-uuid-55555555-5555-4555-8555-555555555555\">Organization Example Manufacturer 77</a></p><p><b>provider</b>: <a href=\"Bundle-bundle-chargeback-submitted.html#urn-uuid-44444444-4444-4444-8444-444444444444\">Organization Example Pharmacy 22</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Bundle-bundle-chargeback-submitted.html#urn-uuid-66666666-6666-4666-8666-666666666666\">Coverage: status = active</a></td></tr></table><h3>Items</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>ProductOrService</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://example.org/drug-codes 00000-1111-22}\">00000-1111-22</span></td></tr></table></div>"
      },
      "extension" : [{
        "url" : "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-exchange-transaction-id",
        "valueString" : "tx-1001"
      },
      {
        "url" : "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-correlation-id",
        "valueString" : "corr-9001"
      },
      {
        "url" : "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-rule-set-version",
        "valueString" : "1.2.0"
      },
      {
        "url" : "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-chargeback-reference",
        "valueIdentifier" : {
          "system" : "https://exchange.example.org/chargeback",
          "value" : "cb-1001"
        }
      }],
      "status" : "active",
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
          "code" : "pharmacy"
        }]
      },
      "use" : "claim",
      "patient" : {
        "reference" : "urn:uuid:33333333-3333-4333-8333-333333333333"
      },
      "created" : "2026-04-24",
      "insurer" : {
        "reference" : "urn:uuid:55555555-5555-4555-8555-555555555555"
      },
      "provider" : {
        "reference" : "urn:uuid:44444444-4444-4444-8444-444444444444"
      },
      "priority" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
          "code" : "normal"
        }]
      },
      "insurance" : [{
        "sequence" : 1,
        "focal" : true,
        "coverage" : {
          "reference" : "urn:uuid:66666666-6666-4666-8666-666666666666"
        }
      }],
      "item" : [{
        "sequence" : 1,
        "productOrService" : {
          "coding" : [{
            "system" : "http://example.org/drug-codes",
            "code" : "00000-1111-22"
          }]
        }
      }]
    }
  },
  {
    "fullUrl" : "urn:uuid:33333333-3333-4333-8333-333333333333",
    "resource" : {
      "resourceType" : "Patient",
      "id" : "p-001",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_p-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient p-001</b></p><a name=\"p-001\"> </a><a name=\"hcp-001\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Pat Example  (no stated gender), DoB Unknown</p><hr/></div>"
      },
      "name" : [{
        "family" : "Example",
        "given" : ["Pat"]
      }]
    }
  },
  {
    "fullUrl" : "urn:uuid:44444444-4444-4444-8444-444444444444",
    "resource" : {
      "resourceType" : "Organization",
      "id" : "pharmacy-22",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_pharmacy-22\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization pharmacy-22</b></p><a name=\"pharmacy-22\"> </a><a name=\"hcpharmacy-22\"> </a><p><b>name</b>: Example Pharmacy 22</p></div>"
      },
      "name" : "Example Pharmacy 22"
    }
  },
  {
    "fullUrl" : "urn:uuid:55555555-5555-4555-8555-555555555555",
    "resource" : {
      "resourceType" : "Organization",
      "id" : "manufacturer-77",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_manufacturer-77\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization manufacturer-77</b></p><a name=\"manufacturer-77\"> </a><a name=\"hcmanufacturer-77\"> </a><p><b>name</b>: Example Manufacturer 77</p></div>"
      },
      "name" : "Example Manufacturer 77"
    }
  },
  {
    "fullUrl" : "urn:uuid:66666666-6666-4666-8666-666666666666",
    "resource" : {
      "resourceType" : "Coverage",
      "id" : "cov-001",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_cov-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage cov-001</b></p><a name=\"cov-001\"> </a><a name=\"hccov-001\"> </a><p><b>status</b>: Active</p><p><b>beneficiary</b>: <a href=\"Bundle-bundle-chargeback-adjudicated.html#urn-uuid-33333333-3333-4333-8333-333333333333\">Pat Example  (no stated gender), DoB Unknown</a></p><p><b>payor</b>: <a href=\"Bundle-bundle-chargeback-adjudicated.html#urn-uuid-55555555-5555-4555-8555-555555555555\">Organization Example Manufacturer 77</a></p></div>"
      },
      "status" : "active",
      "beneficiary" : {
        "reference" : "urn:uuid:33333333-3333-4333-8333-333333333333"
      },
      "payor" : [{
        "reference" : "urn:uuid:55555555-5555-4555-8555-555555555555"
      }]
    }
  }]
}