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 - XML Representation

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<ClaimResponse xmlns="http://hl7.org/fhir">
  <id value="claimresponse-example-ruleset"/>
  <meta>
    <profile
             value="https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-claim-response"/>
  </meta>
  <text>
    <status value="extensions"/>
    <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>
  </text>
  <extension
             url="https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-correlation-id">
    <valueString value="corr-cb-7721"/>
  </extension>
  <extension
             url="https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-exchange-transaction-id">
    <valueString value="tx-cb-7721"/>
  </extension>
  <extension
             url="https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-rule-set-version">
    <valueString value="1.2.0"/>
  </extension>
  <extension
             url="https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-manufacturer-id">
    <valueIdentifier>
      <system value="https://exchange.example.org/manufacturers"/>
      <value value="mfr-77"/>
    </valueIdentifier>
  </extension>
  <identifier>
    <system value="https://exchange.example.org/claimresponse-ids"/>
    <value value="cr-7721"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="pharmacy"/>
    </coding>
  </type>
  <use value="claim"/>
  <patient>🔗 
    <reference value="Patient/p-001"/>
  </patient>
  <created value="2026-04-24"/>
  <insurer>🔗 
    <reference value="Organization/manufacturer-77"/>
  </insurer>
  <request>🔗 
    <reference value="Claim/claim-chargeback-001"/>
  </request>
  <outcome value="complete"/>
</ClaimResponse>