340B FHIR Exchange Implementation Guide - Local Development build (v0.1.0-ballot) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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: claimresponse-example-ruleset - JSON Representation

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{
  "resourceType" : "ClaimResponse",
  "id" : "claimresponse-example-ruleset",
  "meta" : {
    "profile" : [
      🔗 "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-claim-response"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse claimresponse-example-ruleset</b></p><a name=\"claimresponse-example-ruleset\"> </a><a name=\"hcclaimresponse-example-ruleset\"> </a><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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-340b-claim-response.html\">340B Claim Response Profile</a></p></div><p><b>340B Correlation ID Extension</b>: corr-cb-7721</p><p><b>340B Exchange Transaction ID Extension</b>: tx-cb-7721</p><p><b>340B Rule Set Version Extension</b>: 1.2.0</p><p><b>340B Manufacturer ID Extension</b>: <code>https://exchange.example.org/manufacturers</code>/mfr-77</p><p><b>identifier</b>: <code>https://exchange.example.org/claimresponse-ids</code>/cr-7721</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=\"Patient-p-001.html\">Pat Example  (no stated gender), DoB Unknown</a></p><p><b>created</b>: 2026-04-24</p><p><b>insurer</b>: <a href=\"Organization-manufacturer-77.html\">Organization Example Manufacturer 77</a></p><p><b>request</b>: <a href=\"Claim-claim-chargeback-001.html\">Claim: extension = corr-cb-7721,tx-cb-7721,1.2.0,https://exchange.example.org/chargeback#cb-7721; identifier = https://exchange.example.org/claim-ids#claim-7721; status = active; type = Pharmacy; use = claim; created = 2026-04-24; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p></div>"
  },
  "extension" : [
    {
      "url" : "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-correlation-id",
      "valueString" : "corr-cb-7721"
    },
    {
      "url" : "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-exchange-transaction-id",
      "valueString" : "tx-cb-7721"
    },
    {
      "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-manufacturer-id",
      "valueIdentifier" : {
        "system" : "https://exchange.example.org/manufacturers",
        "value" : "mfr-77"
      }
    }
  ],
  "identifier" : [
    {
      "system" : "https://exchange.example.org/claimresponse-ids",
      "value" : "cr-7721"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "pharmacy"
      }
    ]
  },
  "use" : "claim",
  "patient" : {
    🔗 "reference" : "Patient/p-001"
  },
  "created" : "2026-04-24",
  "insurer" : {
    🔗 "reference" : "Organization/manufacturer-77"
  },
  "request" : {
    🔗 "reference" : "Claim/claim-chargeback-001"
  },
  "outcome" : "complete"
}