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# | Location | File | Last Modified |
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1 | MCCF_EDI_TAS_TASCore v2.0_Build_10.zip\MCCF_EDI_TAS_API_Core\src\test\fsc-277\Archive | mock-277 JRA.js | Wed Apr 3 02:27:36 2019 UTC |
2 | MCCF_EDI_TAS_TASCore v2.0_Build_10.zip\MCCF_EDI_TAS_API_Core\src\test\fsc-277\Archive | mock-277 JRA.js | Mon Apr 15 18:00:13 2019 UTC |
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1 | module.exp orts.CONFI G = { | |
2 | "tasFHIREn dpoint": " https:// DNS . URL /VA-FHIR-S erver/fhir ", | |
3 | "operati on": "SEAR CH", | |
4 | "fhirRes ourceBundl e": "Bundl e", | |
5 | "fhirRes ourceClaim " : "Claim ", | |
6 | "vistaIn stance": " eBilling_d ev", | |
7 | "reportT ype" : "fs c", | |
8 | "use" : "277STAT", | |
9 | "descrip tion": "27 7 Business Service A PI", | |
10 | "queueNa me" : "jef fs277StatT ransaction s", | |
11 | "errorQu eueName" : "jeffs277 StatTransB ad", | |
12 | "queueAddr ess" : "am qps:// DNS . URL : PORT /fsc-queue s-dev", | |
13 | "extract Timestamp" : "020419- jws277-1" | |
14 | } | |
15 | ||
16 | module.exp orts.MOCK_ 277 = { | |
17 | "resourc eType": "B undle", | |
18 | "type": "batch", | |
19 | "entry": [ | |
20 | { | |
21 | "res ource": { | |
22 | "r esourceTyp e": "Locat ion", | |
23 | "i dentifier" : [ | |
24 | { | |
25 | "value": "652" | |
26 | } | |
27 | ] | |
28 | } | |
29 | }, | |
30 | { | |
31 | "ext ension": [ | |
32 | { | |
33 | "url": "ur n:va:vista :segment", | |
34 | "valueStri ng": "277S TAT-Header " | |
35 | } | |
36 | ], | |
37 | "res ource": { | |
38 | "r esourceTyp e": "Messa geHeader", | |
39 | "e xtension": [ | |
40 | { | |
41 | "url": " urn:va:vis ta:sequenc e", | |
42 | "valueSt ring": "27 7STAT-Head er-1-Retur n Message ID" | |
43 | } | |
44 | ], | |
45 | "r esponse": { | |
46 | "identifie r": "277ST AT" | |
47 | } | |
48 | } | |
49 | }, | |
50 | { | |
51 | "ext ension": [ | |
52 | { | |
53 | "url": "ur n:va:vista :segment", | |
54 | "valueStri ng": "277S TAT-Header " | |
55 | } | |
56 | ], | |
57 | "res ource": { | |
58 | "r esourceTyp e": "Messa geHeader", | |
59 | "e xtension": [ | |
60 | { | |
61 | "url": " urn:va:vis ta:sequenc e", | |
62 | "valueSt ring": "27 7STAT-Head er-3-Statu s Date" | |
63 | } | |
64 | ], | |
65 | "t imestamp": "2018-04- 19T16:19:5 5.567-04:0 0" | |
66 | } | |
67 | }, | |
68 | { | |
69 | "ext ension": [ | |
70 | { | |
71 | "url": "ur n:va:vista :segment", | |
72 | "valueStri ng": "277S TAT-Header " | |
73 | } | |
74 | ], | |
75 | "res ource": { | |
76 | "r esourceTyp e": "Messa geHeader", | |
77 | "e xtension": [ | |
78 | { | |
79 | "url": " urn:va:vis ta:sequenc e", | |
80 | "valueSt ring": "27 7STAT-Head er-4-Statu s Time" | |
81 | } | |
82 | ], | |
83 | "t imestamp": "2018-04- 19T16:19:5 5.567-04:0 0" | |
84 | } | |
85 | }, | |
86 | { | |
87 | "ext ension": [ | |
88 | { | |
89 | "url": "ur n:va:vista :segment", | |
90 | "valueStri ng": "277S TAT-Header " | |
91 | } | |
92 | ], | |
93 | "res ource": { | |
94 | "r esourceTyp e": "Basic ", | |
95 | "e xtension": [ | |
96 | { | |
97 | "url": " urn:va:vis ta:sequenc e", | |
98 | "valueSt ring": "27 7STAT-Head er-5-MRA s tatus" | |
99 | } | |
100 | ], | |
101 | "c ode": { | |
102 | "coding": [ | |
103 | { | |
104 | "displ ay": "N" | |
105 | } | |
106 | ] | |
107 | } | |
108 | } | |
109 | }, | |
110 | { | |
111 | "ext ension": [ | |
112 | { | |
113 | "url": "ur n:va:vista :segment", | |
114 | "valueStri ng": "277S TAT-Header " | |
115 | } | |
116 | ], | |
117 | "res ource": { | |
118 | "r esourceTyp e": "Basic ", | |
119 | "e xtension": [ | |
120 | { | |
121 | "url": " urn:va:vis ta:sequenc e", | |
122 | "valueSt ring": "27 7STAT-Head er-6-Total Number Cl aims Submi tted" | |
123 | } | |
124 | ], | |
125 | "c ode": { | |
126 | "coding": [ | |
127 | { | |
128 | "displ ay": "120" | |
129 | } | |
130 | ] | |
131 | } | |
132 | } | |
133 | }, | |
134 | { | |
135 | "ext ension": [ | |
136 | { | |
137 | "url": "ur n:va:vista :segment", | |
138 | "valueStri ng": "277S TAT-Header " | |
139 | } | |
140 | ], | |
141 | "res ource": { | |
142 | "r esourceTyp e": "Basic ", | |
143 | "e xtension": [ | |
144 | { | |
145 | "url": " urn:va:vis ta:sequenc e", | |
146 | "valueSt ring": "27 7STAT-Head er-7-Total Number Cl aims Rejec ted" | |
147 | } | |
148 | ], | |
149 | "c ode": { | |
150 | "coding": [ | |
151 | { | |
152 | "displ ay": "2" | |
153 | } | |
154 | ] | |
155 | } | |
156 | } | |
157 | }, | |
158 | { | |
159 | "ext ension": [ | |
160 | { | |
161 | "url": "ur n:va:vista :segment", | |
162 | "valueStri ng": "277S TAT-Header " | |
163 | } | |
164 | ], | |
165 | "res ource": { | |
166 | "r esourceTyp e": "Basic ", | |
167 | "e xtension": [ | |
168 | { | |
169 | "url": " urn:va:vis ta:sequenc e", | |
170 | "valueSt ring": "27 7STAT-Head er-8-Total Charges S ubmitted" | |
171 | } | |
172 | ], | |
173 | "c ode": { | |
174 | "coding": [ | |
175 | { | |
176 | "displ ay": "100" | |
177 | } | |
178 | ] | |
179 | } | |
180 | } | |
181 | }, | |
182 | { | |
183 | "ext ension": [ | |
184 | { | |
185 | "url": "ur n:va:vista :segment", | |
186 | "valueStri ng": "277S TAT-Header " | |
187 | } | |
188 | ], | |
189 | "res ource": { | |
190 | "r esourceTyp e": "Basic ", | |
191 | "e xtension": [ | |
192 | { | |
193 | "url": " urn:va:vis ta:sequenc e", | |
194 | "valueSt ring": "27 7STAT-Head er-9-Total Charges R ejected" | |
195 | } | |
196 | ], | |
197 | "c ode": { | |
198 | "coding": [ | |
199 | { | |
200 | "displ ay": "21" | |
201 | } | |
202 | ] | |
203 | } | |
204 | } | |
205 | }, | |
206 | { | |
207 | "ext ension": [ | |
208 | { | |
209 | "url": "ur n:va:vista :segment", | |
210 | "valueStri ng": "277S TAT-Header " | |
211 | } | |
212 | ], | |
213 | "res ource": { | |
214 | "r esourceTyp e": "Organ ization", | |
215 | "i dentifier" : [ | |
216 | { | |
217 | "value": "Sample V alue" | |
218 | } | |
219 | ], | |
220 | "n ame": "Sam ple Value" | |
221 | } | |
222 | }, | |
223 | { | |
224 | "ext ension": [ | |
225 | { | |
226 | "url": "ur n:va:vista :segment", | |
227 | "valueStri ng": "277S TAT-Header " | |
228 | } | |
229 | ], | |
230 | "res ource": { | |
231 | "r esourceTyp e": "Basic ", | |
232 | "c ode": { | |
233 | "coding": [ | |
234 | { | |
235 | "code" : "Sample Value" | |
236 | } | |
237 | ] | |
238 | } | |
239 | } | |
240 | }, | |
241 | { | |
242 | "ext ension": [ | |
243 | { | |
244 | "url": "ur n:va:vista :segment", | |
245 | "valueStri ng": "277S TAT-Header " | |
246 | } | |
247 | ], | |
248 | "res ource": { | |
249 | "r esourceTyp e": "Messa geHeader", | |
250 | "s ource": { | |
251 | "name": "P NC", | |
252 | "software" : "X" | |
253 | } | |
254 | } | |
255 | }, | |
256 | { | |
257 | "ext ension": [ | |
258 | { | |
259 | "url": "ur n:va:vista :segment", | |
260 | "valueStri ng": "277S TAT-Header " | |
261 | } | |
262 | ], | |
263 | "res ource": { | |
264 | "r esourceTyp e": "Messa geHeader", | |
265 | "e xtension": [ | |
266 | { | |
267 | "url": " urn:va:vis ta:sequenc e", | |
268 | "valueSt ring": "27 7STAT-Head er-14-Batc h Referenc e Number" | |
269 | } | |
270 | ], | |
271 | "r esponse": { | |
272 | "identifie r": "Sampl e Value" | |
273 | } | |
274 | } | |
275 | }, | |
276 | { | |
277 | "ext ension": [ | |
278 | { | |
279 | "url": "ur n:va:vista :segment", | |
280 | "valueStri ng": "277S TAT-Messag e-Header" | |
281 | }, | |
282 | { | |
283 | "url": "ur n:va:vista :occurence ", | |
284 | "valueStri ng": "1" | |
285 | } | |
286 | ], | |
287 | "res ource": { | |
288 | "r esourceTyp e": "Claim ", | |
289 | "i dentifier" : [ | |
290 | { | |
291 | "value": "Sample V alue" | |
292 | } | |
293 | ], | |
294 | "i tem": [ | |
295 | { | |
296 | "categor y": { | |
297 | "codin g": [ | |
298 | { | |
299 | "c ode": "cod e" | |
300 | } | |
301 | ] | |
302 | } | |
303 | } | |
304 | ] | |
305 | } | |
306 | }, | |
307 | { | |
308 | "ext ension": [ | |
309 | { | |
310 | "url": "ur n:va:vista :segment", | |
311 | "valueStri ng": "277S TAT-Messag e-Header" | |
312 | }, | |
313 | { | |
314 | "url": "ur n:va:vista :occurence ", | |
315 | "valueStri ng": "2" | |
316 | } | |
317 | ], | |
318 | "res ource": { | |
319 | "r esourceTyp e": "Claim ", | |
320 | "i dentifier" : [ | |
321 | { | |
322 | "value": "Sample V alue2" | |
323 | } | |
324 | ], | |
325 | "i tem": [ | |
326 | { | |
327 | "categor y": { | |
328 | "codin g": [ | |
329 | { | |
330 | "c ode": "cod e2" | |
331 | } | |
332 | ] | |
333 | } | |
334 | } | |
335 | ] | |
336 | } | |
337 | }, | |
338 | { | |
339 | "ext ension": [ | |
340 | { | |
341 | "url": "ur n:va:vista :segment", | |
342 | "valueStri ng": "277S TAT-Messag e-Header" | |
343 | }, | |
344 | { | |
345 | "url": "ur n:va:vista :occurence ", | |
346 | "valueStri ng": "1" | |
347 | } | |
348 | ], | |
349 | "res ource": { | |
350 | "r esourceTyp e": "Basic ", | |
351 | "i dentifier" : [ | |
352 | { | |
353 | "value": "Sample V alue" | |
354 | } | |
355 | ] | |
356 | } | |
357 | }, | |
358 | { | |
359 | "ext ension": [ | |
360 | { | |
361 | "url": "ur n:va:vista :segment", | |
362 | "valueStri ng": "277S TAT-Messag e-Header" | |
363 | }, | |
364 | { | |
365 | "url": "ur n:va:vista :occurence ", | |
366 | "valueStri ng": "2" | |
367 | } | |
368 | ], | |
369 | "res ource": { | |
370 | "r esourceTyp e": "Basic ", | |
371 | "i dentifier" : [ | |
372 | { | |
373 | "value": "Sample V alue2" | |
374 | } | |
375 | ] | |
376 | } | |
377 | }, | |
378 | { | |
379 | "ext ension": [ | |
380 | { | |
381 | "url": "ur n:va:vista :segment", | |
382 | "valueStri ng": "277S TAT-Messag e-Header" | |
383 | }, | |
384 | { | |
385 | "url": "ur n:va:vista :occurence ", | |
386 | "valueStri ng": "1" | |
387 | } | |
388 | ], | |
389 | "res ource": { | |
390 | "r esourceTyp e": "Opera tionOutcom e", | |
391 | "i ssue": [ | |
392 | { | |
393 | "diagnos tics": "Sa mple Value ", | |
394 | "express ion": "Sam ple Value" | |
395 | } | |
396 | ] | |
397 | } | |
398 | }, | |
399 | { | |
400 | "ext ension": [ | |
401 | { | |
402 | "url": "ur n:va:vista :segment", | |
403 | "valueStri ng": "277S TAT-Messag e-Header" | |
404 | }, | |
405 | { | |
406 | "url": "ur n:va:vista :occurence ", | |
407 | "valueStri ng": "2" | |
408 | } | |
409 | ], | |
410 | "res ource": { | |
411 | "r esourceTyp e": "Opera tionOutcom e", | |
412 | "i ssue": [ | |
413 | { | |
414 | "diagnos tics": "Sa mple Value 2", | |
415 | "express ion": "Sam ple Value2 " | |
416 | } | |
417 | ] | |
418 | } | |
419 | }, | |
420 | { | |
421 | "ext ension": [ | |
422 | { | |
423 | "url": "ur n:va:vista :segment", | |
424 | "valueStri ng": "277S TAT-Messag e-Data" | |
425 | }, | |
426 | { | |
427 | "url": "ur n:va:vista :occurence ", | |
428 | "valueStri ng": "1" | |
429 | } | |
430 | ], | |
431 | "res ource": { | |
432 | "r esourceTyp e": "Claim ", | |
433 | "i tem": [ | |
434 | { | |
435 | "categor y": { | |
436 | "codin g": [ | |
437 | { | |
438 | "c ode": "cod e" | |
439 | } | |
440 | ] | |
441 | } | |
442 | } | |
443 | ], | |
444 | "i dentifier" : [ | |
445 | { | |
446 | "value": "Sample V alue" | |
447 | } | |
448 | ] | |
449 | } | |
450 | }, | |
451 | { | |
452 | "ext ension": [ | |
453 | { | |
454 | "url": "ur n:va:vista :segment", | |
455 | "valueStri ng": "277S TAT-Messag e-Data" | |
456 | }, | |
457 | { | |
458 | "url": "ur n:va:vista :occurence ", | |
459 | "valueStri ng": "2" | |
460 | } | |
461 | ], | |
462 | "res ource": { | |
463 | "r esourceTyp e": "Claim ", | |
464 | "i tem": [ | |
465 | { | |
466 | "categor y": { | |
467 | "codin g": [ | |
468 | { | |
469 | "c ode": "cod e2" | |
470 | } | |
471 | ] | |
472 | } | |
473 | } | |
474 | ], | |
475 | "i dentifier" : [ | |
476 | { | |
477 | "value": "Sample V alue2" | |
478 | } | |
479 | ] | |
480 | } | |
481 | }, | |
482 | { | |
483 | "ext ension": [ | |
484 | { | |
485 | "url": "ur n:va:vista :segment", | |
486 | "valueStri ng": "277S TAT-Messag e-Data" | |
487 | }, | |
488 | { | |
489 | "url": "ur n:va:vista :occurence ", | |
490 | "valueStri ng": "1" | |
491 | } | |
492 | ], | |
493 | "res ource": { | |
494 | "e xtension": [ | |
495 | { | |
496 | "url": " urn:va:vis ta:sequenc e", | |
497 | "valueSt ring": "27 7STAT-Mess age-Data-3 -AcceptRej ectCode" | |
498 | } | |
499 | ], | |
500 | "r esourceTyp e": "Claim Response", | |
501 | "d isposition ": "Sample Value" | |
502 | } | |
503 | }, | |
504 | { | |
505 | "ext ension": [ | |
506 | { | |
507 | "url": "ur n:va:vista :segment", | |
508 | "valueStri ng": "277S TAT-Messag e-Data" | |
509 | }, | |
510 | { | |
511 | "url": "ur n:va:vista :occurence ", | |
512 | "valueStri ng": "2" | |
513 | } | |
514 | ], | |
515 | "res ource": { | |
516 | "e xtension": [ | |
517 | { | |
518 | "url": " urn:va:vis ta:sequenc e", | |
519 | "valueSt ring": "27 7STAT-Mess age-Data-3 -AcceptRej ectCode" | |
520 | } | |
521 | ], | |
522 | "r esourceTyp e": "Claim Response", | |
523 | "d isposition ": "Sample Value2" | |
524 | } | |
525 | }, | |
526 | { | |
527 | "ext ension": [ | |
528 | { | |
529 | "url": "ur n:va:vista :segment", | |
530 | "valueStri ng": "277S TAT-Messag e-Data" | |
531 | }, | |
532 | { | |
533 | "url": "ur n:va:vista :occurence ", | |
534 | "valueStri ng": "1" | |
535 | } | |
536 | ], | |
537 | "res ource": { | |
538 | "e xtension": [ | |
539 | { | |
540 | "url": " urn:va:vis ta:sequenc e", | |
541 | "valueSt ring": "27 7STAT-Mess age-Data-4 -WarnError InfoCode" | |
542 | } | |
543 | ], | |
544 | "r esourceTyp e": "Claim Response", | |
545 | "d isposition ": "Sample Value" | |
546 | } | |
547 | }, | |
548 | { | |
549 | "ext ension": [ | |
550 | { | |
551 | "url": "ur n:va:vista :segment", | |
552 | "valueStri ng": "277S TAT-Messag e-Data" | |
553 | }, | |
554 | { | |
555 | "url": "ur n:va:vista :occurence ", | |
556 | "valueStri ng": "2" | |
557 | } | |
558 | ], | |
559 | "res ource": { | |
560 | "e xtension": [ | |
561 | { | |
562 | "url": " urn:va:vis ta:sequenc e", | |
563 | "valueSt ring": "27 7STAT-Mess age-Data-4 -WarnError InfoCode" | |
564 | } | |
565 | ], | |
566 | "r esourceTyp e": "Claim Response", | |
567 | "d isposition ": "Sample Value2" | |
568 | } | |
569 | }, | |
570 | { | |
571 | "ext ension": [ | |
572 | { | |
573 | "url": "ur n:va:vista :segment", | |
574 | "valueStri ng": "277S TAT-Messag e-Data" | |
575 | }, | |
576 | { | |
577 | "url": "ur n:va:vista :occurence ", | |
578 | "valueStri ng": "1" | |
579 | } | |
580 | ], | |
581 | "res ource": { | |
582 | "e xtension": [ | |
583 | { | |
584 | "url": " urn:va:vis ta:sequenc e", | |
585 | "valueSt ring": "27 7STAT-Mess age-Data-5 -StatusCod e" | |
586 | } | |
587 | ], | |
588 | "r esourceTyp e": "Claim Response", | |
589 | "d isposition ": "Sample Value" | |
590 | } | |
591 | }, | |
592 | { | |
593 | "ext ension": [ | |
594 | { | |
595 | "url": "ur n:va:vista :segment", | |
596 | "valueStri ng": "277S TAT-Messag e-Data" | |
597 | }, | |
598 | { | |
599 | "url": "ur n:va:vista :occurence ", | |
600 | "valueStri ng": "2" | |
601 | } | |
602 | ], | |
603 | "res ource": { | |
604 | "e xtension": [ | |
605 | { | |
606 | "url": " urn:va:vis ta:sequenc e", | |
607 | "valueSt ring": "27 7STAT-Mess age-Data-5 -StatusCod e" | |
608 | } | |
609 | ], | |
610 | "r esourceTyp e": "Claim Response", | |
611 | "d isposition ": "Sample Value2" | |
612 | } | |
613 | }, | |
614 | { | |
615 | "ext ension": [ | |
616 | { | |
617 | "url": "ur n:va:vista :segment", | |
618 | "valueStri ng": "277S TAT-Messag e-Data" | |
619 | }, | |
620 | { | |
621 | "url": "ur n:va:vista :occurence ", | |
622 | "valueStri ng": "1" | |
623 | } | |
624 | ], | |
625 | "res ource": { | |
626 | "e xtension": [ | |
627 | { | |
628 | "url": " urn:va:vis ta:sequenc e", | |
629 | "valueSt ring": "27 7STAT-Mess age-Data-6 -StatusMes sage" | |
630 | } | |
631 | ], | |
632 | "r esourceTyp e": "Claim Response", | |
633 | "d isposition ": "Sample Value" | |
634 | } | |
635 | }, | |
636 | { | |
637 | "ext ension": [ | |
638 | { | |
639 | "url": "ur n:va:vista :segment", | |
640 | "valueStri ng": "277S TAT-Messag e-Data" | |
641 | }, | |
642 | { | |
643 | "url": "ur n:va:vista :occurence ", | |
644 | "valueStri ng": "2" | |
645 | } | |
646 | ], | |
647 | "res ource": { | |
648 | "e xtension": [ | |
649 | { | |
650 | "url": " urn:va:vis ta:sequenc e", | |
651 | "valueSt ring": "27 7STAT-Mess age-Data-6 -StatusMes sage" | |
652 | } | |
653 | ], | |
654 | "r esourceTyp e": "Claim Response", | |
655 | "d isposition ": "Sample Value2" | |
656 | } | |
657 | }, | |
658 | { | |
659 | "ext ension": [ | |
660 | { | |
661 | "url": "ur n:va:vista :segment", | |
662 | "valueStri ng": "277S TAT-Claim- Data" | |
663 | }, | |
664 | { | |
665 | "url": "ur n:va:vista :occurence ", | |
666 | "valueStri ng": "1" | |
667 | } | |
668 | ], | |
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670 | "r esourceTyp e": "Claim ", | |
671 | "i dentifier" : [ | |
672 | { | |
673 | "extensi on": [ | |
674 | { | |
675 | "url ": "urn:va :vista:seq uence", | |
676 | "val ueString": "277STAT- Claim-Data -2-Bill Nu mber" | |
677 | } | |
678 | ], | |
679 | "value": "Sample V alue" | |
680 | }, | |
681 | { | |
682 | "extensi on": [ | |
683 | { | |
684 | "url ": "urn:va :vista:seq uence", | |
685 | "val ueString": "277STAT- Claim-Data -5-Payer c laim numbe r" | |
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689 | } | |
690 | ], | |
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693 | "categor y": { | |
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698 | ] | |
699 | } | |
700 | } | |
701 | ], | |
702 | "t ype": { | |
703 | "coding": [ | |
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705 | "code" : "Sample Value" | |
706 | } | |
707 | ] | |
708 | } | |
709 | } | |
710 | }, | |
711 | { | |
712 | "ext ension": [ | |
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716 | }, | |
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720 | } | |
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729 | "val ueString": "277STAT- Claim-Data -2-Bill Nu mber" | |
730 | } | |
731 | ], | |
732 | "value": "Sample V alue2" | |
733 | }, | |
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735 | "extensi on": [ | |
736 | { | |
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743 | ], | |
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751 | ] | |
752 | } | |
753 | } | |
754 | ], | |
755 | "t ype": { | |
756 | "coding": [ | |
757 | { | |
758 | "code" : "Sample Value2" | |
759 | } | |
760 | ] | |
761 | } | |
762 | } | |
763 | }, | |
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765 | "ext ension": [ | |
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768 | "valueStri ng": "277S TAT-Claim- Data" | |
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772 | "valueStri ng": "1" | |
773 | } | |
774 | ], | |
775 | "res ource": { | |
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777 | "i dentifier" : [ | |
778 | { | |
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780 | } | |
781 | ], | |
782 | "c ode": { | |
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789 | } | |
790 | }, | |
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797 | { | |
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800 | } | |
801 | ], | |
802 | "res ource": { | |
803 | "r esourceTyp e": "Basic ", | |
804 | "i dentifier" : [ | |
805 | { | |
806 | "value": "Sample V alue2" | |
807 | } | |
808 | ], | |
809 | "c ode": { | |
810 | "coding": [ | |
811 | { | |
812 | "code" : "Sample Value2" | |
813 | } | |
814 | ] | |
815 | } | |
816 | } | |
817 | }, | |
818 | { | |
819 | "ext ension": [ | |
820 | { | |
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828 | ], | |
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830 | "r esourceTyp e": "Claim Response", | |
831 | "c reated": " 2018-09-09 " | |
832 | } | |
833 | }, | |
834 | { | |
835 | "ext ension": [ | |
836 | { | |
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838 | "valueStri ng": "277S TAT-Claim- Data" | |
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846 | "r esourceTyp e": "Claim Response", | |
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848 | } | |
849 | }, | |
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851 | "ext ension": [ | |
852 | { | |
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855 | }, | |
856 | { | |
857 | "url": "ur n:va:vista :occurence ", | |
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860 | ], | |
861 | "res ource": { | |
862 | "r esourceTyp e": "Claim ", | |
863 | "i dentifier" : [ | |
864 | { | |
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866 | } | |
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868 | "i tem": [ | |
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870 | "categor y": { | |
871 | "codin g": [ | |
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876 | } | |
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878 | ] | |
879 | } | |
880 | }, | |
881 | { | |
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898 | ], | |
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908 | } | |
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910 | } | |
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930 | ], | |
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933 | "value": "ABC12343 5" | |
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935 | ], | |
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945 | } | |
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963 | "valueSt ring": "27 7STAT-Clai m-Service- Data-3-Pat ient Name" | |
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966 | "i dentifier" : [ | |
967 | { | |
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969 | } | |
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978 | } | |
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995 | "e xtension": [ | |
996 | { | |
997 | "url": " urn:va:vis ta:sequenc e", | |
998 | "valueSt ring": "27 7STAT-Clai m-Service- Data-7-Sub scriber Na me" | |
999 | } | |
1000 | ], | |
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1002 | { | |
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1005 | ], | |
1006 | "n ame": [ | |
1007 | { | |
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1012 | ] | |
1013 | } | |
1014 | ] | |
1015 | } | |
1016 | }, | |
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1018 | "ext ension": [ | |
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1031 | { | |
1032 | "url": " urn:va:vis ta:sequenc e", | |
1033 | "valueSt ring": "27 7STAT-Clai m-Service- Data-7-Sub scriber Na me" | |
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1035 | ], | |
1036 | "i dentifier" : [ | |
1037 | { | |
1038 | "value": "DEFG8976 2" | |
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1040 | ], | |
1041 | "n ame": [ | |
1042 | { | |
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1047 | ] | |
1048 | } | |
1049 | ] | |
1050 | } | |
1051 | }, | |
1052 | { | |
1053 | "ext ension": [ | |
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1057 | }, | |
1058 | { | |
1059 | "url": "ur n:va:vista :occurence ", | |
1060 | "valueStri ng": "1" | |
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1062 | ], | |
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1067 | "end": "20 18-10-02" | |
1068 | } | |
1069 | } | |
1070 | }, | |
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1072 | "ext ension": [ | |
1073 | { | |
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1077 | { | |
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1086 | "end": "20 18-10-22" | |
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1088 | } | |
1089 | }, | |
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1091 | "ext ension": [ | |
1092 | { | |
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1095 | }, | |
1096 | { | |
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1098 | "valueStri ng": "1" | |
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1101 | "res ource": { | |
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1103 | "i dentifier" : [ | |
1104 | { | |
1105 | "extensi on": [ | |
1106 | { | |
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1108 | "val ueString": "277STAT- Claim-Serv ice-Line-S tatus-Data -2-Bill-Nu mber" | |
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1111 | "value": "Claim-Se rvice-Line -Status-Da ta-2-Bill- Number" | |
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1113 | { | |
1114 | "extensi on": [ | |
1115 | { | |
1116 | "url ": "urn:va :vista:seq uence", | |
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1122 | ], | |
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1124 | { | |
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1135 | } | |
1136 | }, | |
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1139 | { | |
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1142 | }, | |
1143 | { | |
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1169 | ], | |
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1174 | { | |
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1197 | { | |
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1201 | ], | |
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1205 | }, | |
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1207 | "ext ension": [ | |
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1219 | { | |
1220 | "url": " urn:va:vis ta:sequenc e", | |
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1227 | }, | |
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1229 | "ext ension": [ | |
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1234 | { | |
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1241 | { | |
1242 | "url": " urn:va:vis ta:sequenc e", | |
1243 | "valueSt ring": "27 7STAT-Clai mResponse- Service-Li ne-Status- Data-4-War n-Error-In fo-Code" | |
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1249 | }, | |
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1251 | "ext ension": [ | |
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1255 | }, | |
1256 | { | |
1257 | "url": "ur n:va:vista :occurence ", | |
1258 | "valueStri ng": "2" | |
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1263 | { | |
1264 | "url": " urn:va:vis ta:sequenc e", | |
1265 | "valueSt ring": "27 7STAT-Clai mResponse- Service-Li ne-Status- Data-4-War n-Error-In fo-Code" | |
1266 | } | |
1267 | ], | |
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1271 | }, | |
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1273 | "ext ension": [ | |
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1284 | "e xtension": [ | |
1285 | { | |
1286 | "url": " urn:va:vis ta:sequenc e", | |
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1293 | }, | |
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1295 | "ext ension": [ | |
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1307 | { | |
1308 | "url": " urn:va:vis ta:sequenc e", | |
1309 | "valueSt ring": "27 7STAT-Clai mResponse- Service-Li ne-Status- Data-5-Sta tus-Code" | |
1310 | } | |
1311 | ], | |
1312 | "r esourceTyp e": "Claim Response", | |
1313 | "d isposition ": "Sample Value2" | |
1314 | } | |
1315 | }, | |
1316 | { | |
1317 | "ext ension": [ | |
1318 | { | |
1319 | "url": "ur n:va:vista :segment", | |
1320 | "valueStri ng": "277S TAT-Servic e-Line-Sta tus-Data" | |
1321 | }, | |
1322 | { | |
1323 | "url": "ur n:va:vista :occurence ", | |
1324 | "valueStri ng": "1" | |
1325 | } | |
1326 | ], | |
1327 | "res ource": { | |
1328 | "e xtension": [ | |
1329 | { | |
1330 | "url": " urn:va:vis ta:sequenc e", | |
1331 | "valueSt ring": "27 7STAT-Clai mResponse- Service-Li ne-Status- Data-6-Sta tus-Messag e" | |
1332 | } | |
1333 | ], | |
1334 | "r esourceTyp e": "Claim Response", | |
1335 | "d isposition ": "Sample Value" | |
1336 | } | |
1337 | }, | |
1338 | { | |
1339 | "ext ension": [ | |
1340 | { | |
1341 | "url": "ur n:va:vista :urn:va:vi sta:segmen t", | |
1342 | "valueStri ng": "277S TAT-Servic e-Line-Sta tus-Data" | |
1343 | }, | |
1344 | { | |
1345 | "url": "ur n:va:vista :occurence ", | |
1346 | "valueStri ng": "2" | |
1347 | } | |
1348 | ], | |
1349 | "res ource": { | |
1350 | "e xtension": [ | |
1351 | { | |
1352 | "url": " urn:va:vis ta:sequenc e", | |
1353 | "valueSt ring": "27 7STAT-Clai mResponse- Service-Li ne-Status- Data-6-Sta tus-Messag e" | |
1354 | } | |
1355 | ], | |
1356 | "r esourceTyp e": "Claim Response", | |
1357 | "d isposition ": "Sample Value2" | |
1358 | } | |
1359 | }, | |
1360 | { | |
1361 | "ext ension": [ | |
1362 | { | |
1363 | "url": "ur n:va:vista :segment", | |
1364 | "valueStri ng": "277S TAT-Servic e-Line-Sta tus-Data" | |
1365 | }, | |
1366 | { | |
1367 | "url": "ur n:va:vista :occurence ", | |
1368 | "valueStri ng": "1" | |
1369 | } | |
1370 | ], | |
1371 | "res ource": { | |
1372 | "r esourceTyp e": "Commu nicationRe quest", | |
1373 | "p ayload": { | |
1374 | "contentSt ring": "co ntentstrin g" | |
1375 | } | |
1376 | } | |
1377 | }, | |
1378 | { | |
1379 | "ext ension": [ | |
1380 | { | |
1381 | "url": "ur n:va:vista :segment", | |
1382 | "valueStri ng": "277S TAT-Servic e-Line-Sta tus-Data" | |
1383 | }, | |
1384 | { | |
1385 | "url": "ur n:va:vista :occurence ", | |
1386 | "valueStri ng": "2" | |
1387 | } | |
1388 | ], | |
1389 | "res ource": { | |
1390 | "r esourceTyp e": "Commu nicationRe quest", | |
1391 | "p ayload": { | |
1392 | "contentSt ring": "co ntentstrin g2" | |
1393 | } | |
1394 | } | |
1395 | }, | |
1396 | { | |
1397 | "ext ension": [ | |
1398 | { | |
1399 | "url": "ur n:va:vista :segment", | |
1400 | "valueStri ng": "277S TAT-Servic e-Line-Id- Data" | |
1401 | }, | |
1402 | { | |
1403 | "url": "ur n:va:vista :occurence ", | |
1404 | "valueStri ng": "1" | |
1405 | } | |
1406 | ], | |
1407 | "res ource": { | |
1408 | "r esourceTyp e": "Claim ", | |
1409 | "i dentifier" : [ | |
1410 | { | |
1411 | "extensi on": [ | |
1412 | { | |
1413 | "url ": "urn:va :vista:seq uence", | |
1414 | "val ueString": "277STAT- Claim-Serv ice-Line-I d-Data-2-L ineType" | |
1415 | } | |
1416 | ], | |
1417 | "value": "Claim-Se rvice-Line -Id-Data-2 -LineType" | |
1418 | }, | |
1419 | { | |
1420 | "extensi on": [ | |
1421 | { | |
1422 | "url ": "urn:va :vista:seq uence", | |
1423 | "val ueString": "277STAT- Claim-Serv ice-Line-I d-Data-3-S ervice-Lin eNumber" | |
1424 | } | |
1425 | ], | |
1426 | "value": "Claim-Se rvice-Line -Id-Data-3 -Service-L ineNumber" | |
1427 | } | |
1428 | ], | |
1429 | "i tem": [ | |
1430 | { | |
1431 | "quantit y": { | |
1432 | "value ": 100 | |
1433 | }, | |
1434 | "modifie r": { | |
1435 | "codin g": [ | |
1436 | { | |
1437 | "c ode": "mod ifiercode" | |
1438 | } | |
1439 | ] | |
1440 | }, | |
1441 | "program Code": { | |
1442 | "codin g": [ | |
1443 | { | |
1444 | "c ode": "pro gramCodeco de" | |
1445 | } | |
1446 | ] | |
1447 | }, | |
1448 | "revenue ": { | |
1449 | "text" : "revenue text" | |
1450 | }, | |
1451 | "categor y": { | |
1452 | "codin g": [ | |
1453 | { | |
1454 | "c ode": "cod e" | |
1455 | } | |
1456 | ] | |
1457 | } | |
1458 | } | |
1459 | ] | |
1460 | } | |
1461 | }, | |
1462 | { | |
1463 | "ext ension": [ | |
1464 | { | |
1465 | "url": "ur n:va:vista :segment", | |
1466 | "valueStri ng": "277S TAT-Servic e-Line-Id- Data" | |
1467 | }, | |
1468 | { | |
1469 | "url": "ur n:va:vista :occurence ", | |
1470 | "valueStri ng": "2" | |
1471 | } | |
1472 | ], | |
1473 | "res ource": { | |
1474 | "r esourceTyp e": "Claim ", | |
1475 | "i dentifier" : [ | |
1476 | { | |
1477 | "extensi on": [ | |
1478 | { | |
1479 | "url ": "urn:va :vista:seq uence", | |
1480 | "val ueString": "277STAT- Claim-Serv ice-Line-I d-Data-2-L ineType" | |
1481 | } | |
1482 | ], | |
1483 | "value": "Claim-Se rvice-Line -Id-Data-2 -LineType2 " | |
1484 | }, | |
1485 | { | |
1486 | "extensi on": [ | |
1487 | { | |
1488 | "url ": "urn:va :vista:seq uence", | |
1489 | "val ueString": "277STAT- Claim-Serv ice-Line-I d-Data-3-S ervice-Lin eNumber" | |
1490 | } | |
1491 | ], | |
1492 | "value": "Claim-Se rvice-Line -Id-Data-3 -Service-L ineNumber2 " | |
1493 | } | |
1494 | ], | |
1495 | "i tem": [ | |
1496 | { | |
1497 | "quantit y": { | |
1498 | "value ": 102 | |
1499 | }, | |
1500 | "modifie r": { | |
1501 | "codin g": [ | |
1502 | { | |
1503 | "c ode": "mod ifiercode2 " | |
1504 | } | |
1505 | ] | |
1506 | }, | |
1507 | "program Code": { | |
1508 | "codin g": [ | |
1509 | { | |
1510 | "c ode": "pro gramCodeco de2" | |
1511 | } | |
1512 | ] | |
1513 | }, | |
1514 | "revenue ": { | |
1515 | "text" : "revenue text2" | |
1516 | }, | |
1517 | "categor y": { | |
1518 | "codin g": [ | |
1519 | { | |
1520 | "c ode": "cod e2" | |
1521 | } | |
1522 | ] | |
1523 | } | |
1524 | } | |
1525 | ] | |
1526 | } | |
1527 | } | |
1528 | ] | |
1529 | } |
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