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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 | mock-277.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 | mock-277.js | Mon Apr 15 17:59:44 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" : "2 77STAT Bus iness Serv ice API", | |
10 | "liveQue ueName" : "277StatTr ansLive", | |
11 | "testQue ueName" : "277StatTr ansTest", | |
12 | "errorQu eueName" : "277StatT ransError" , | |
13 | "badQueu eName" : " 277StatTra nsBad", | |
14 | "queueAddr ess" : "am qps:// DNS . URL : PORT /fsc-queue s-sqa", | |
15 | "extract Timestamp" : "020419- jws277-1" | |
16 | } | |
17 | ||
18 | module.exp orts.MOCK_ 277 = { | |
19 | "resourc eType": "B undle", | |
20 | "type": "batch", | |
21 | "entry": [ | |
22 | { | |
23 | "res ource": { | |
24 | "r esourceTyp e": "Locat ion", | |
25 | "i dentifier" : [ | |
26 | { | |
27 | "value": "681" | |
28 | } | |
29 | ] | |
30 | } | |
31 | }, | |
32 | { | |
33 | "ext ension": [ | |
34 | { | |
35 | "url": "ur n:va:vista :segment", | |
36 | "valueStri ng": "277S TAT-Header " | |
37 | } | |
38 | ], | |
39 | "res ource": { | |
40 | "r esourceTyp e": "Messa geHeader", | |
41 | "e xtension": [ | |
42 | { | |
43 | "url": " urn:va:vis ta:sequenc e", | |
44 | "valueSt ring": "27 7STAT-Head er-1-Retur n Message ID" | |
45 | } | |
46 | ], | |
47 | "r esponse": { | |
48 | "identifie r": "277ST AT" | |
49 | } | |
50 | } | |
51 | }, | |
52 | { | |
53 | "ext ension": [ | |
54 | { | |
55 | "url": "ur n:va:vista :segment", | |
56 | "valueStri ng": "277S TAT-Header " | |
57 | } | |
58 | ], | |
59 | "res ource": { | |
60 | "r esourceTyp e": "Messa geHeader", | |
61 | "e xtension": [ | |
62 | { | |
63 | "url": " urn:va:vis ta:sequenc e", | |
64 | "valueSt ring": "27 7STAT-Head er-3-Statu s Date" | |
65 | } | |
66 | ], | |
67 | "t imestamp": "2019-01- 01T16:19:5 5.567-04:0 0" | |
68 | } | |
69 | }, | |
70 | { | |
71 | "ext ension": [ | |
72 | { | |
73 | "url": "ur n:va:vista :segment", | |
74 | "valueStri ng": "277S TAT-Header " | |
75 | } | |
76 | ], | |
77 | "res ource": { | |
78 | "r esourceTyp e": "Messa geHeader", | |
79 | "e xtension": [ | |
80 | { | |
81 | "url": " urn:va:vis ta:sequenc e", | |
82 | "valueSt ring": "27 7STAT-Head er-4-Statu s Time" | |
83 | } | |
84 | ], | |
85 | "t imestamp": "2019-01- 01T16:19:5 5.567-04:0 0" | |
86 | } | |
87 | }, | |
88 | { | |
89 | "ext ension": [ | |
90 | { | |
91 | "url": "ur n:va:vista :segment", | |
92 | "valueStri ng": "277S TAT-Header " | |
93 | } | |
94 | ], | |
95 | "res ource": { | |
96 | "r esourceTyp e": "Basic ", | |
97 | "e xtension": [ | |
98 | { | |
99 | "url": " urn:va:vis ta:sequenc e", | |
100 | "valueSt ring": "27 7STAT-Head er-5-MRA s tatus" | |
101 | } | |
102 | ], | |
103 | "c ode": { | |
104 | "coding": [ | |
105 | { | |
106 | "displ ay": "N" | |
107 | } | |
108 | ] | |
109 | } | |
110 | } | |
111 | }, | |
112 | { | |
113 | "ext ension": [ | |
114 | { | |
115 | "url": "ur n:va:vista :segment", | |
116 | "valueStri ng": "277S TAT-Header " | |
117 | } | |
118 | ], | |
119 | "res ource": { | |
120 | "r esourceTyp e": "Basic ", | |
121 | "e xtension": [ | |
122 | { | |
123 | "url": " urn:va:vis ta:sequenc e", | |
124 | "valueSt ring": "27 7STAT-Head er-6-Total Number Cl aims Submi tted" | |
125 | } | |
126 | ], | |
127 | "c ode": { | |
128 | "coding": [ | |
129 | { | |
130 | "displ ay": "2" | |
131 | } | |
132 | ] | |
133 | } | |
134 | } | |
135 | }, | |
136 | { | |
137 | "ext ension": [ | |
138 | { | |
139 | "url": "ur n:va:vista :segment", | |
140 | "valueStri ng": "277S TAT-Header " | |
141 | } | |
142 | ], | |
143 | "res ource": { | |
144 | "r esourceTyp e": "Basic ", | |
145 | "e xtension": [ | |
146 | { | |
147 | "url": " urn:va:vis ta:sequenc e", | |
148 | "valueSt ring": "27 7STAT-Head er-7-Total Number Cl aims Rejec ted" | |
149 | } | |
150 | ], | |
151 | "c ode": { | |
152 | "coding": [ | |
153 | { | |
154 | "displ ay": "1" | |
155 | } | |
156 | ] | |
157 | } | |
158 | } | |
159 | }, | |
160 | { | |
161 | "ext ension": [ | |
162 | { | |
163 | "url": "ur n:va:vista :segment", | |
164 | "valueStri ng": "277S TAT-Header " | |
165 | } | |
166 | ], | |
167 | "res ource": { | |
168 | "r esourceTyp e": "Basic ", | |
169 | "e xtension": [ | |
170 | { | |
171 | "url": " urn:va:vis ta:sequenc e", | |
172 | "valueSt ring": "27 7STAT-Head er-8-Total Charges S ubmitted" | |
173 | } | |
174 | ], | |
175 | "c ode": { | |
176 | "coding": [ | |
177 | { | |
178 | "displ ay": "1000 00" | |
179 | } | |
180 | ] | |
181 | } | |
182 | } | |
183 | }, | |
184 | { | |
185 | "ext ension": [ | |
186 | { | |
187 | "url": "ur n:va:vista :segment", | |
188 | "valueStri ng": "277S TAT-Header " | |
189 | } | |
190 | ], | |
191 | "res ource": { | |
192 | "r esourceTyp e": "Basic ", | |
193 | "e xtension": [ | |
194 | { | |
195 | "url": " urn:va:vis ta:sequenc e", | |
196 | "valueSt ring": "27 7STAT-Head er-9-Total Charges R ejected" | |
197 | } | |
198 | ], | |
199 | "c ode": { | |
200 | "coding": [ | |
201 | { | |
202 | "displ ay": "5000 0" | |
203 | } | |
204 | ] | |
205 | } | |
206 | } | |
207 | }, | |
208 | { | |
209 | "ext ension": [ | |
210 | { | |
211 | "url": "ur n:va:vista :segment", | |
212 | "valueStri ng": "277S TAT-Header " | |
213 | } | |
214 | ], | |
215 | "res ource": { | |
216 | "r esourceTyp e": "Organ ization", | |
217 | "i dentifier" : [ | |
218 | { | |
219 | "value": "12B30I00 00PAYID=12 B30I" | |
220 | } | |
221 | ], | |
222 | "n ame": "BCB S WY FEP" | |
223 | } | |
224 | }, | |
225 | { | |
226 | "ext ension": [ | |
227 | { | |
228 | "url": "ur n:va:vista :segment", | |
229 | "valueStri ng": "277S TAT-Header " | |
230 | } | |
231 | ], | |
232 | "res ource": { | |
233 | "r esourceTyp e": "Basic ", | |
234 | "c ode": { | |
235 | "coding": [ | |
236 | { | |
237 | "code" : "N" | |
238 | } | |
239 | ] | |
240 | } | |
241 | } | |
242 | }, | |
243 | { | |
244 | "ext ension": [ | |
245 | { | |
246 | "url": "ur n:va:vista :segment", | |
247 | "valueStri ng": "277S TAT-Header " | |
248 | } | |
249 | ], | |
250 | "res ource": { | |
251 | "r esourceTyp e": "Messa geHeader", | |
252 | "s ource": { | |
253 | "name": "E MDEON", | |
254 | "software" : "X" | |
255 | } | |
256 | } | |
257 | }, | |
258 | { | |
259 | "ext ension": [ | |
260 | { | |
261 | "url": "ur n:va:vista :segment", | |
262 | "valueStri ng": "277S TAT-Header " | |
263 | } | |
264 | ], | |
265 | "res ource": { | |
266 | "r esourceTyp e": "Messa geHeader", | |
267 | "e xtension": [ | |
268 | { | |
269 | "url": " urn:va:vis ta:sequenc e", | |
270 | "valueSt ring": "27 7STAT-Head er-14-Batc h Referenc e Number" | |
271 | } | |
272 | ], | |
273 | "r esponse": { | |
274 | "identifie r": "Batch _ref#" | |
275 | } | |
276 | } | |
277 | }, | |
278 | { | |
279 | "ext ension": [ | |
280 | { | |
281 | "url": "ur n:va:vista :segment", | |
282 | "valueStri ng": "277S TAT-Messag e-Header" | |
283 | }, | |
284 | { | |
285 | "url": "ur n:va:vista :occurence ", | |
286 | "valueStri ng": "1" | |
287 | } | |
288 | ], | |
289 | "res ource": { | |
290 | "r esourceTyp e": "Claim ", | |
291 | "i dentifier" : [ | |
292 | { | |
293 | "value": "K505YUG" | |
294 | } | |
295 | ], | |
296 | "i tem": [ | |
297 | { | |
298 | "categor y": { | |
299 | "codin g": [ | |
300 | { | |
301 | "c ode": "09" | |
302 | } | |
303 | ] | |
304 | } | |
305 | } | |
306 | ] | |
307 | } | |
308 | }, | |
309 | { | |
310 | "ext ension": [ | |
311 | { | |
312 | "url": "ur n:va:vista :segment", | |
313 | "valueStri ng": "277S TAT-Messag e-Header" | |
314 | }, | |
315 | { | |
316 | "url": "ur n:va:vista :occurence ", | |
317 | "valueStri ng": "2" | |
318 | } | |
319 | ], | |
320 | "res ource": { | |
321 | "r esourceTyp e": "Claim ", | |
322 | "i dentifier" : [ | |
323 | { | |
324 | "value": "K505YV5" | |
325 | } | |
326 | ], | |
327 | "i tem": [ | |
328 | { | |
329 | "categor y": { | |
330 | "codin g": [ | |
331 | { | |
332 | "c ode": "09" | |
333 | } | |
334 | ] | |
335 | } | |
336 | } | |
337 | ] | |
338 | } | |
339 | }, | |
340 | { | |
341 | "ext ension": [ | |
342 | { | |
343 | "url": "ur n:va:vista :segment", | |
344 | "valueStri ng": "277S TAT-Messag e-Header" | |
345 | }, | |
346 | { | |
347 | "url": "ur n:va:vista :occurence ", | |
348 | "valueStri ng": "1" | |
349 | } | |
350 | ], | |
351 | "res ource": { | |
352 | "r esourceTyp e": "Basic ", | |
353 | "i dentifier" : [ | |
354 | { | |
355 | "value": "Message# " | |
356 | } | |
357 | ] | |
358 | } | |
359 | }, | |
360 | { | |
361 | "ext ension": [ | |
362 | { | |
363 | "url": "ur n:va:vista :segment", | |
364 | "valueStri ng": "277S TAT-Messag e-Header" | |
365 | }, | |
366 | { | |
367 | "url": "ur n:va:vista :occurence ", | |
368 | "valueStri ng": "2" | |
369 | } | |
370 | ], | |
371 | "res ource": { | |
372 | "r esourceTyp e": "Basic ", | |
373 | "i dentifier" : [ | |
374 | { | |
375 | "value": "Message# 2" | |
376 | } | |
377 | ] | |
378 | } | |
379 | }, | |
380 | { | |
381 | "ext ension": [ | |
382 | { | |
383 | "url": "ur n:va:vista :segment", | |
384 | "valueStri ng": "277S TAT-Messag e-Header" | |
385 | }, | |
386 | { | |
387 | "url": "ur n:va:vista :occurence ", | |
388 | "valueStri ng": "1" | |
389 | } | |
390 | ], | |
391 | "res ource": { | |
392 | "r esourceTyp e": "Opera tionOutcom e", | |
393 | "i ssue": [ | |
394 | { | |
395 | "diagnos tics": "", | |
396 | "express ion": "" | |
397 | } | |
398 | ] | |
399 | } | |
400 | }, | |
401 | { | |
402 | "ext ension": [ | |
403 | { | |
404 | "url": "ur n:va:vista :segment", | |
405 | "valueStri ng": "277S TAT-Messag e-Header" | |
406 | }, | |
407 | { | |
408 | "url": "ur n:va:vista :occurence ", | |
409 | "valueStri ng": "2" | |
410 | } | |
411 | ], | |
412 | "res ource": { | |
413 | "r esourceTyp e": "Opera tionOutcom e", | |
414 | "i ssue": [ | |
415 | { | |
416 | "diagnos tics": "", | |
417 | "express ion": "" | |
418 | } | |
419 | ] | |
420 | } | |
421 | }, | |
422 | { | |
423 | "ext ension": [ | |
424 | { | |
425 | "url": "ur n:va:vista :segment", | |
426 | "valueStri ng": "277S TAT-Messag e-Data" | |
427 | }, | |
428 | { | |
429 | "url": "ur n:va:vista :occurence ", | |
430 | "valueStri ng": "1" | |
431 | } | |
432 | ], | |
433 | "res ource": { | |
434 | "r esourceTyp e": "Claim ", | |
435 | "i tem": [ | |
436 | { | |
437 | "categor y": { | |
438 | "codin g": [ | |
439 | { | |
440 | "c ode": "10" | |
441 | } | |
442 | ] | |
443 | } | |
444 | } | |
445 | ], | |
446 | "i dentifier" : [ | |
447 | { | |
448 | "value": "K505YUG" | |
449 | } | |
450 | ] | |
451 | } | |
452 | }, | |
453 | { | |
454 | "ext ension": [ | |
455 | { | |
456 | "url": "ur n:va:vista :segment", | |
457 | "valueStri ng": "277S TAT-Messag e-Data" | |
458 | }, | |
459 | { | |
460 | "url": "ur n:va:vista :occurence ", | |
461 | "valueStri ng": "2" | |
462 | } | |
463 | ], | |
464 | "res ource": { | |
465 | "r esourceTyp e": "Claim ", | |
466 | "i tem": [ | |
467 | { | |
468 | "categor y": { | |
469 | "codin g": [ | |
470 | { | |
471 | "c ode": "10" | |
472 | } | |
473 | ] | |
474 | } | |
475 | } | |
476 | ], | |
477 | "i dentifier" : [ | |
478 | { | |
479 | "value": "K505YV5" | |
480 | } | |
481 | ] | |
482 | } | |
483 | }, | |
484 | { | |
485 | "ext ension": [ | |
486 | { | |
487 | "url": "ur n:va:vista :segment", | |
488 | "valueStri ng": "277S TAT-Messag e-Data" | |
489 | }, | |
490 | { | |
491 | "url": "ur n:va:vista :occurence ", | |
492 | "valueStri ng": "1" | |
493 | } | |
494 | ], | |
495 | "res ource": { | |
496 | "e xtension": [ | |
497 | { | |
498 | "url": " urn:va:vis ta:sequenc e", | |
499 | "valueSt ring": "27 7STAT-Mess age-Data-3 -AcceptRej ectCode" | |
500 | } | |
501 | ], | |
502 | "r esourceTyp e": "Claim Response", | |
503 | "d isposition ": "A" | |
504 | } | |
505 | }, | |
506 | { | |
507 | "ext ension": [ | |
508 | { | |
509 | "url": "ur n:va:vista :segment", | |
510 | "valueStri ng": "277S TAT-Messag e-Data" | |
511 | }, | |
512 | { | |
513 | "url": "ur n:va:vista :occurence ", | |
514 | "valueStri ng": "2" | |
515 | } | |
516 | ], | |
517 | "res ource": { | |
518 | "e xtension": [ | |
519 | { | |
520 | "url": " urn:va:vis ta:sequenc e", | |
521 | "valueSt ring": "27 7STAT-Mess age-Data-3 -AcceptRej ectCode" | |
522 | } | |
523 | ], | |
524 | "r esourceTyp e": "Claim Response", | |
525 | "d isposition ": "R" | |
526 | } | |
527 | }, | |
528 | { | |
529 | "ext ension": [ | |
530 | { | |
531 | "url": "ur n:va:vista :segment", | |
532 | "valueStri ng": "277S TAT-Messag e-Data" | |
533 | }, | |
534 | { | |
535 | "url": "ur n:va:vista :occurence ", | |
536 | "valueStri ng": "1" | |
537 | } | |
538 | ], | |
539 | "res ource": { | |
540 | "e xtension": [ | |
541 | { | |
542 | "url": " urn:va:vis ta:sequenc e", | |
543 | "valueSt ring": "27 7STAT-Mess age-Data-4 -WarnError InfoCode" | |
544 | } | |
545 | ], | |
546 | "r esourceTyp e": "Claim Response", | |
547 | "d isposition ": "I" | |
548 | } | |
549 | }, | |
550 | { | |
551 | "ext ension": [ | |
552 | { | |
553 | "url": "ur n:va:vista :segment", | |
554 | "valueStri ng": "277S TAT-Messag e-Data" | |
555 | }, | |
556 | { | |
557 | "url": "ur n:va:vista :occurence ", | |
558 | "valueStri ng": "2" | |
559 | } | |
560 | ], | |
561 | "res ource": { | |
562 | "e xtension": [ | |
563 | { | |
564 | "url": " urn:va:vis ta:sequenc e", | |
565 | "valueSt ring": "27 7STAT-Mess age-Data-4 -WarnError InfoCode" | |
566 | } | |
567 | ], | |
568 | "r esourceTyp e": "Claim Response", | |
569 | "d isposition ": "E" | |
570 | } | |
571 | }, | |
572 | { | |
573 | "ext ension": [ | |
574 | { | |
575 | "url": "ur n:va:vista :segment", | |
576 | "valueStri ng": "277S TAT-Messag e-Data" | |
577 | }, | |
578 | { | |
579 | "url": "ur n:va:vista :occurence ", | |
580 | "valueStri ng": "1" | |
581 | } | |
582 | ], | |
583 | "res ource": { | |
584 | "e xtension": [ | |
585 | { | |
586 | "url": " urn:va:vis ta:sequenc e", | |
587 | "valueSt ring": "27 7STAT-Mess age-Data-5 -StatusCod e" | |
588 | } | |
589 | ], | |
590 | "r esourceTyp e": "Claim Response", | |
591 | "d isposition ": "AE" | |
592 | } | |
593 | }, | |
594 | { | |
595 | "ext ension": [ | |
596 | { | |
597 | "url": "ur n:va:vista :segment", | |
598 | "valueStri ng": "277S TAT-Messag e-Data" | |
599 | }, | |
600 | { | |
601 | "url": "ur n:va:vista :occurence ", | |
602 | "valueStri ng": "2" | |
603 | } | |
604 | ], | |
605 | "res ource": { | |
606 | "e xtension": [ | |
607 | { | |
608 | "url": " urn:va:vis ta:sequenc e", | |
609 | "valueSt ring": "27 7STAT-Mess age-Data-5 -StatusCod e" | |
610 | } | |
611 | ], | |
612 | "r esourceTyp e": "Claim Response", | |
613 | "d isposition ": "8888" | |
614 | } | |
615 | }, | |
616 | { | |
617 | "ext ension": [ | |
618 | { | |
619 | "url": "ur n:va:vista :segment", | |
620 | "valueStri ng": "277S TAT-Messag e-Data" | |
621 | }, | |
622 | { | |
623 | "url": "ur n:va:vista :occurence ", | |
624 | "valueStri ng": "1" | |
625 | } | |
626 | ], | |
627 | "res ource": { | |
628 | "e xtension": [ | |
629 | { | |
630 | "url": " urn:va:vis ta:sequenc e", | |
631 | "valueSt ring": "27 7STAT-Mess age-Data-6 -StatusMes sage" | |
632 | } | |
633 | ], | |
634 | "r esourceTyp e": "Claim Response", | |
635 | "d isposition ": "Accept ed Claim s ent out el ectronical ly" | |
636 | } | |
637 | }, | |
638 | { | |
639 | "ext ension": [ | |
640 | { | |
641 | "url": "ur n:va:vista :segment", | |
642 | "valueStri ng": "277S TAT-Messag e-Data" | |
643 | }, | |
644 | { | |
645 | "url": "ur n:va:vista :occurence ", | |
646 | "valueStri ng": "2" | |
647 | } | |
648 | ], | |
649 | "res ource": { | |
650 | "e xtension": [ | |
651 | { | |
652 | "url": " urn:va:vis ta:sequenc e", | |
653 | "valueSt ring": "27 7STAT-Mess age-Data-6 -StatusMes sage" | |
654 | } | |
655 | ], | |
656 | "r esourceTyp e": "Claim Response", | |
657 | "d isposition ": "TOTAL CLAIMS CHA RGES MISSI NG While u pdating gl obal ^GLB via routin e ^RTN. E N^RTN is t he entry p oint. The re are sti ll more ch aracters t hat will f it on a si ngle 10 re cord but I am going to exceed that numb er to make sure the parsing is working c orrectly. THE END!" | |
658 | } | |
659 | }, | |
660 | { | |
661 | "ext ension": [ | |
662 | { | |
663 | "url": "ur n:va:vista :segment", | |
664 | "valueStri ng": "277S TAT-Claim- Data" | |
665 | }, | |
666 | { | |
667 | "url": "ur n:va:vista :occurence ", | |
668 | "valueStri ng": "1" | |
669 | } | |
670 | ], | |
671 | "res ource": { | |
672 | "r esourceTyp e": "Claim ", | |
673 | "i dentifier" : [ | |
674 | { | |
675 | "extensi on": [ | |
676 | { | |
677 | "url ": "urn:va :vista:seq uence", | |
678 | "val ueString": "277STAT- Claim-Data -2-Bill Nu mber" | |
679 | } | |
680 | ], | |
681 | "value": "K505YUG" | |
682 | }, | |
683 | { | |
684 | "extensi on": [ | |
685 | { | |
686 | "url ": "urn:va :vista:seq uence", | |
687 | "val ueString": "277STAT- Claim-Data -5-Payer c laim numbe r" | |
688 | } | |
689 | ], | |
690 | "value": "Payer_cl aim#" | |
691 | } | |
692 | ], | |
693 | "i tem": [ | |
694 | { | |
695 | "categor y": { | |
696 | "codin g": [ | |
697 | { | |
698 | "c ode": "13" | |
699 | } | |
700 | ] | |
701 | } | |
702 | } | |
703 | ], | |
704 | "t ype": { | |
705 | "coding": [ | |
706 | { | |
707 | "code" : "I" | |
708 | } | |
709 | ] | |
710 | } | |
711 | } | |
712 | }, | |
713 | { | |
714 | "ext ension": [ | |
715 | { | |
716 | "url": "ur n:va:vista :segment", | |
717 | "valueStri ng": "277S TAT-Claim- Data" | |
718 | }, | |
719 | { | |
720 | "url": "ur n:va:vista :occurence ", | |
721 | "valueStri ng": "2" | |
722 | } | |
723 | ], | |
724 | "res ource": { | |
725 | "r esourceTyp e": "Claim ", | |
726 | "i dentifier" : [ | |
727 | { | |
728 | "extensi on": [ | |
729 | { | |
730 | "url ": "urn:va :vista:seq uence", | |
731 | "val ueString": "277STAT- Claim-Data -2-Bill Nu mber" | |
732 | } | |
733 | ], | |
734 | "value": "K505YV5" | |
735 | }, | |
736 | { | |
737 | "extensi on": [ | |
738 | { | |
739 | "url ": "urn:va :vista:seq uence", | |
740 | "val ueString": "277STAT- Claim-Data -5-Payer c laim numbe r" | |
741 | } | |
742 | ], | |
743 | "value": "Payer_cl aim#2" | |
744 | } | |
745 | ], | |
746 | "i tem": [ | |
747 | { | |
748 | "categor y": { | |
749 | "codin g": [ | |
750 | { | |
751 | "c ode": "13" | |
752 | } | |
753 | ] | |
754 | } | |
755 | } | |
756 | ], | |
757 | "t ype": { | |
758 | "coding": [ | |
759 | { | |
760 | "code" : "P" | |
761 | } | |
762 | ] | |
763 | } | |
764 | } | |
765 | }, | |
766 | { | |
767 | "ext ension": [ | |
768 | { | |
769 | "url": "ur n:va:vista :segment", | |
770 | "valueStri ng": "277S TAT-Claim- Data" | |
771 | }, | |
772 | { | |
773 | "url": "ur n:va:vista :occurence ", | |
774 | "valueStri ng": "1" | |
775 | } | |
776 | ], | |
777 | "res ource": { | |
778 | "r esourceTyp e": "Basic ", | |
779 | "i dentifier" : [ | |
780 | { | |
781 | "value": "Trace#" | |
782 | } | |
783 | ], | |
784 | "c ode": { | |
785 | "coding": [ | |
786 | { | |
787 | "code" : "1" | |
788 | } | |
789 | ] | |
790 | } | |
791 | } | |
792 | }, | |
793 | { | |
794 | "ext ension": [ | |
795 | { | |
796 | "url": "ur n:va:vista :segment", | |
797 | "valueStri ng": "277S TAT-Claim- Data" | |
798 | }, | |
799 | { | |
800 | "url": "ur n:va:vista :occurence ", | |
801 | "valueStri ng": "2" | |
802 | } | |
803 | ], | |
804 | "res ource": { | |
805 | "r esourceTyp e": "Basic ", | |
806 | "i dentifier" : [ | |
807 | { | |
808 | "value": "Trace#2" | |
809 | } | |
810 | ], | |
811 | "c ode": { | |
812 | "coding": [ | |
813 | { | |
814 | "code" : "1" | |
815 | } | |
816 | ] | |
817 | } | |
818 | } | |
819 | }, | |
820 | { | |
821 | "ext ension": [ | |
822 | { | |
823 | "url": "ur n:va:vista :segment", | |
824 | "valueStri ng": "277S TAT-Claim- Data" | |
825 | }, | |
826 | { | |
827 | "url": "ur n:va:vista :occurence ", | |
828 | "valueStri ng": "1" | |
829 | } | |
830 | ], | |
831 | "res ource": { | |
832 | "r esourceTyp e": "Claim Response", | |
833 | "c reated": " 2018-09-09 " | |
834 | } | |
835 | }, | |
836 | { | |
837 | "ext ension": [ | |
838 | { | |
839 | "url": "ur n:va:vista :segment", | |
840 | "valueStri ng": "277S TAT-Claim- Data" | |
841 | }, | |
842 | { | |
843 | "url": "ur n:va:vista :occurence ", | |
844 | "valueStri ng": "2" | |
845 | } | |
846 | ], | |
847 | "res ource": { | |
848 | "r esourceTyp e": "Claim Response", | |
849 | "c reated": " 2018-10-10 " | |
850 | } | |
851 | }, | |
852 | { | |
853 | "ext ension": [ | |
854 | { | |
855 | "url": "ur n:va:vista :segment", | |
856 | "valueStri ng": "277S TAT-Claim- Service-Da ta" | |
857 | }, | |
858 | { | |
859 | "url": "ur n:va:vista :occurence ", | |
860 | "valueStri ng": "1" | |
861 | } | |
862 | ], | |
863 | "res ource": { | |
864 | "r esourceTyp e": "Claim ", | |
865 | "i dentifier" : [ | |
866 | { | |
867 | "value": "K505YUG" | |
868 | } | |
869 | ], | |
870 | "i tem": [ | |
871 | { | |
872 | "categor y": { | |
873 | "codin g": [ | |
874 | { | |
875 | "c ode": "15" | |
876 | } | |
877 | ] | |
878 | } | |
879 | } | |
880 | ] | |
881 | } | |
882 | }, | |
883 | { | |
884 | "ext ension": [ | |
885 | { | |
886 | "url": "ur n:va:vista :segment", | |
887 | "valueStri ng": "277S TAT-Claim- Service-Da ta" | |
888 | }, | |
889 | { | |
890 | "url": "ur n:va:vista :occurence ", | |
891 | "valueStri ng": "2" | |
892 | } | |
893 | ], | |
894 | "res ource": { | |
895 | "r esourceTyp e": "Claim ", | |
896 | "i dentifier" : [ | |
897 | { | |
898 | "value": "K505YV5" | |
899 | } | |
900 | ], | |
901 | "i tem": [ | |
902 | { | |
903 | "categor y": { | |
904 | "codin g": [ | |
905 | { | |
906 | "c ode": "15" | |
907 | } | |
908 | ] | |
909 | } | |
910 | } | |
911 | ] | |
912 | } | |
913 | }, | |
914 | { | |
915 | "ext ension": [ | |
916 | { | |
917 | "url": "ur n:va:vista :segment", | |
918 | "valueStri ng": "277S TAT-Claim- Service-Da ta" | |
919 | }, | |
920 | { | |
921 | "url": "ur n:va:vista :occurence ", | |
922 | "valueStri ng": "1" | |
923 | } | |
924 | ], | |
925 | "res ource": { | |
926 | "r esourceTyp e": "Patie nt", | |
927 | "e xtension": [ | |
928 | { | |
929 | "url": " urn:va:vis ta:sequenc e", | |
930 | "valueSt ring": "27 7STAT-Clai m-Service- Data-3-Pat ient Name" | |
931 | } | |
932 | ], | |
933 | "i dentifier" : [ | |
934 | { | |
935 | "value": "Pat_ID#" | |
936 | } | |
937 | ], | |
938 | "n ame": [ | |
939 | { | |
940 | "family" : "Maerdia n", | |
941 | "given": [ | |
942 | "Steff en", | |
943 | "Middl eName" | |
944 | ] | |
945 | } | |
946 | ] | |
947 | } | |
948 | }, | |
949 | { | |
950 | "ext ension": [ | |
951 | { | |
952 | "url": "ur n:va:vista :segment", | |
953 | "valueStri ng": "277S TAT-Claim- Service-Da ta" | |
954 | }, | |
955 | { | |
956 | "url": "ur n:va:vista :occurence ", | |
957 | "valueStri ng": "2" | |
958 | } | |
959 | ], | |
960 | "res ource": { | |
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962 | "e xtension": [ | |
963 | { | |
964 | "url": " urn:va:vis ta:sequenc e", | |
965 | "valueSt ring": "27 7STAT-Clai m-Service- Data-3-Pat ient Name" | |
966 | } | |
967 | ], | |
968 | "i dentifier" : [ | |
969 | { | |
970 | "value": "Pat_ID#2 " | |
971 | } | |
972 | ], | |
973 | "n ame": [ | |
974 | { | |
975 | "family" : "Alfini" , | |
976 | "given": [ | |
977 | "Jeffr ey", | |
978 | "Rober t" | |
979 | ] | |
980 | } | |
981 | ] | |
982 | } | |
983 | }, | |
984 | { | |
985 | "ext ension": [ | |
986 | { | |
987 | "url": "ur n:va:vista :segment", | |
988 | "valueStri ng": "277S TAT-Claim- Service-Da ta" | |
989 | }, | |
990 | { | |
991 | "url": "ur n:va:vista :occurence ", | |
992 | "valueStri ng": "1" | |
993 | } | |
994 | ], | |
995 | "res ource": { | |
996 | "r esourceTyp e": "Patie nt", | |
997 | "e xtension": [ | |
998 | { | |
999 | "url": " urn:va:vis ta:sequenc e", | |
1000 | "valueSt ring": "27 7STAT-Clai m-Service- Data-7-Sub scriber Na me" | |
1001 | } | |
1002 | ], | |
1003 | "i dentifier" : [ | |
1004 | { | |
1005 | "value": "Subscr_I D#" | |
1006 | } | |
1007 | ], | |
1008 | "n ame": [ | |
1009 | { | |
1010 | "family" : "Subscri ber", | |
1011 | "given": [ | |
1012 | "Joe", | |
1013 | "X" | |
1014 | ] | |
1015 | } | |
1016 | ] | |
1017 | } | |
1018 | }, | |
1019 | { | |
1020 | "ext ension": [ | |
1021 | { | |
1022 | "url": "ur n:va:vista :segment", | |
1023 | "valueStri ng": "277S TAT-Claim- Service-Da ta" | |
1024 | }, | |
1025 | { | |
1026 | "url": "ur n:va:vista :occurence ", | |
1027 | "valueStri ng": "2" | |
1028 | } | |
1029 | ], | |
1030 | "res ource": { | |
1031 | "r esourceTyp e": "Patie nt", | |
1032 | "e xtension": [ | |
1033 | { | |
1034 | "url": " urn:va:vis ta:sequenc e", | |
1035 | "valueSt ring": "27 7STAT-Clai m-Service- Data-7-Sub scriber Na me" | |
1036 | } | |
1037 | ], | |
1038 | "i dentifier" : [ | |
1039 | { | |
1040 | "value": "Subscr_I D#2" | |
1041 | } | |
1042 | ], | |
1043 | "n ame": [ | |
1044 | { | |
1045 | "family" : "Subscr" , | |
1046 | "given": [ | |
1047 | "Jim", | |
1048 | "Y" | |
1049 | ] | |
1050 | } | |
1051 | ] | |
1052 | } | |
1053 | }, | |
1054 | { | |
1055 | "ext ension": [ | |
1056 | { | |
1057 | "url": "ur n:va:vista :segment", | |
1058 | "valueStri ng": "277S TAT-Claim- Service-Da ta" | |
1059 | }, | |
1060 | { | |
1061 | "url": "ur n:va:vista :occurence ", | |
1062 | "valueStri ng": "1" | |
1063 | } | |
1064 | ], | |
1065 | "res ource": { | |
1066 | "r esourceTyp e": "Episo deOfCare", | |
1067 | "p eriod": { | |
1068 | "start": " 2018-09-02 ", | |
1069 | "end": "20 18-10-02" | |
1070 | } | |
1071 | } | |
1072 | }, | |
1073 | { | |
1074 | "ext ension": [ | |
1075 | { | |
1076 | "url": "ur n:va:vista :segment", | |
1077 | "valueStri ng": "277S TAT-Claim- Service-Da ta" | |
1078 | }, | |
1079 | { | |
1080 | "url": "ur n:va:vista :occurence ", | |
1081 | "valueStri ng": "2" | |
1082 | } | |
1083 | ], | |
1084 | "res ource": { | |
1085 | "r esourceTyp e": "Episo deOfCare", | |
1086 | "p eriod": { | |
1087 | "start": " 2018-11-02 ", | |
1088 | "end": "20 18-12-02" | |
1089 | } | |
1090 | } | |
1091 | }, | |
1092 | { | |
1093 | "ext ension": [ | |
1094 | { | |
1095 | "url": "ur n:va:vista :segment", | |
1096 | "valueStri ng": "277S TAT-Servic e-Line-Sta tus-Data" | |
1097 | }, | |
1098 | { | |
1099 | "url": "ur n:va:vista :occurence ", | |
1100 | "valueStri ng": "1" | |
1101 | } | |
1102 | ], | |
1103 | "res ource": { | |
1104 | "r esourceTyp e": "Claim ", | |
1105 | "i dentifier" : [ | |
1106 | { | |
1107 | "extensi on": [ | |
1108 | { | |
1109 | "url ": "urn:va :vista:seq uence", | |
1110 | "val ueString": "277STAT- Claim-Serv ice-Line-S tatus-Data -2-Bill-Nu mber" | |
1111 | } | |
1112 | ], | |
1113 | "value": "Claim-Se rvice-Line -Status-Da ta-2-Bill- Number" | |
1114 | }, | |
1115 | { | |
1116 | "extensi on": [ | |
1117 | { | |
1118 | "url ": "urn:va :vista:seq uence", | |
1119 | "val ueString": "277STAT- Claim-Serv ice-Line-S tatus-Data -8-Service -Line-Numb er" | |
1120 | } | |
1121 | ], | |
1122 | "value": "Claim-Se rvice-Line -Status-Da ta-8-Servi ce-Line-Nu mber" | |
1123 | } | |
1124 | ], | |
1125 | "i tem": [ | |
1126 | { | |
1127 | "categor y": { | |
1128 | "codin g": [ | |
1129 | { | |
1130 | "c ode": "cod eValue" | |
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1132 | ] | |
1133 | }, | |
1134 | "urn:va: vista:sequ ence": 1 | |
1135 | } | |
1136 | ] | |
1137 | } | |
1138 | }, | |
1139 | { | |
1140 | "ext ension": [ | |
1141 | { | |
1142 | "url": "ur n:va:vista :segment", | |
1143 | "valueStri ng": "277S TAT-Servic e-Line-Sta tus-Data" | |
1144 | }, | |
1145 | { | |
1146 | "url": "ur n:va:vista :occurence ", | |
1147 | "valueStri ng": "1" | |
1148 | } | |
1149 | ], | |
1150 | "res ource": { | |
1151 | "e xtension": [ | |
1152 | { | |
1153 | "url": " urn:va:vis ta:sequenc e", | |
1154 | "valueSt ring": "27 7STAT-Clai mResponse- Service-Li ne-Status- Data-3-Acc ept-Reject -Code" | |
1155 | } | |
1156 | ], | |
1157 | "r esourceTyp e": "Claim Response", | |
1158 | "d isposition ": "A" | |
1159 | } | |
1160 | }, | |
1161 | { | |
1162 | "ext ension": [ | |
1163 | { | |
1164 | "url": "ur n:va:vista :segment", | |
1165 | "valueStri ng": "277S TAT-Servic e-Line-Sta tus-Data" | |
1166 | }, | |
1167 | { | |
1168 | "url": "ur n:va:vista :occurence ", | |
1169 | "valueStri ng": "1" | |
1170 | } | |
1171 | ], | |
1172 | "res ource": { | |
1173 | "e xtension": [ | |
1174 | { | |
1175 | "url": " urn:va:vis ta:sequenc e", | |
1176 | "valueSt ring": "27 7STAT-Clai mResponse- Service-Li ne-Status- Data-4-War n-Error-In fo-Code" | |
1177 | } | |
1178 | ], | |
1179 | "r esourceTyp e": "Claim Response", | |
1180 | "d isposition ": "I" | |
1181 | } | |
1182 | }, | |
1183 | { | |
1184 | "ext ension": [ | |
1185 | { | |
1186 | "url": "ur n:va:vista :segment", | |
1187 | "valueStri ng": "277S TAT-Servic e-Line-Sta tus-Data" | |
1188 | }, | |
1189 | { | |
1190 | "url": "ur n:va:vista :occurence ", | |
1191 | "valueStri ng": "1" | |
1192 | } | |
1193 | ], | |
1194 | "res ource": { | |
1195 | "e xtension": [ | |
1196 | { | |
1197 | "url": " urn:va:vis ta:sequenc e", | |
1198 | "valueSt ring": "27 7STAT-Clai mResponse- Service-Li ne-Status- Data-5-Sta tus-Code" | |
1199 | } | |
1200 | ], | |
1201 | "r esourceTyp e": "Claim Response", | |
1202 | "d isposition ": "Sample Value" | |
1203 | } | |
1204 | }, | |
1205 | { | |
1206 | "ext ension": [ | |
1207 | { | |
1208 | "url": "ur n:va:vista :segment", | |
1209 | "valueStri ng": "277S TAT-Servic e-Line-Sta tus-Data" | |
1210 | }, | |
1211 | { | |
1212 | "url": "ur n:va:vista :occurence ", | |
1213 | "valueStri ng": "1" | |
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1215 | ], | |
1216 | "res ource": { | |
1217 | "e xtension": [ | |
1218 | { | |
1219 | "url": " urn:va:vis ta:sequenc e", | |
1220 | "valueSt ring": "27 7STAT-Clai mResponse- Service-Li ne-Status- Data-6-Sta tus-Messag e" | |
1221 | } | |
1222 | ], | |
1223 | "r esourceTyp e": "Claim Response", | |
1224 | "d isposition ": "Sample Value" | |
1225 | } | |
1226 | }, | |
1227 | { | |
1228 | "ext ension": [ | |
1229 | { | |
1230 | "url": "ur n:va:vista :segment", | |
1231 | "valueStri ng": "277S TAT-Servic e-Line-Sta tus-Data" | |
1232 | }, | |
1233 | { | |
1234 | "url": "ur n:va:vista :occurence ", | |
1235 | "valueStri ng": "1" | |
1236 | } | |
1237 | ], | |
1238 | "res ource": { | |
1239 | "r esourceTyp e": "Commu nicationRe quest", | |
1240 | "p ayload": { | |
1241 | "contentSt ring": "co ntentstrin g" | |
1242 | } | |
1243 | } | |
1244 | }, | |
1245 | { | |
1246 | "ext ension": [ | |
1247 | { | |
1248 | "url": "ur n:va:vista :segment", | |
1249 | "valueStri ng": "277S TAT-Servic e-Line-Id- Data" | |
1250 | }, | |
1251 | { | |
1252 | "url": "ur n:va:vista :occurence ", | |
1253 | "valueStri ng": "1" | |
1254 | } | |
1255 | ], | |
1256 | "res ource": { | |
1257 | "r esourceTyp e": "Claim ", | |
1258 | "i dentifier" : [ | |
1259 | { | |
1260 | "extensi on": [ | |
1261 | { | |
1262 | "url ": "urn:va :vista:seq uence", | |
1263 | "val ueString": "277STAT- Claim-Serv ice-Line-I d-Data-2-L ineType" | |
1264 | } | |
1265 | ], | |
1266 | "value": "Claim-Se rvice-Line -Id-Data-2 -LineType" | |
1267 | }, | |
1268 | { | |
1269 | "extensi on": [ | |
1270 | { | |
1271 | "url ": "urn:va :vista:seq uence", | |
1272 | "val ueString": "277STAT- Claim-Serv ice-Line-I d-Data-3-S ervice-Lin eNumber" | |
1273 | } | |
1274 | ], | |
1275 | "value": "Claim-Se rvice-Line -Id-Data-3 -Service-L ineNumber" | |
1276 | } | |
1277 | ], | |
1278 | "i tem": [ | |
1279 | { | |
1280 | "quantit y": { | |
1281 | "value ": 100 | |
1282 | }, | |
1283 | "modifie r": { | |
1284 | "codin g": [ | |
1285 | { | |
1286 | "c ode": "mod ifiercode" | |
1287 | } | |
1288 | ] | |
1289 | }, | |
1290 | "program Code": { | |
1291 | "codin g": [ | |
1292 | { | |
1293 | "c ode": "pro gramCodeco de" | |
1294 | } | |
1295 | ] | |
1296 | }, | |
1297 | "revenue ": { | |
1298 | "text" : "revenue text" | |
1299 | }, | |
1300 | "categor y": { | |
1301 | "codin g": [ | |
1302 | { | |
1303 | "c ode": "cod e" | |
1304 | } | |
1305 | ] | |
1306 | } | |
1307 | } | |
1308 | ] | |
1309 | } | |
1310 | }, | |
1311 | { | |
1312 | "ext ension": [ | |
1313 | { | |
1314 | "url": "ur n:va:vista :segment", | |
1315 | "valueStri ng": "277S TAT-Servic e-Line-Id- Data" | |
1316 | }, | |
1317 | { | |
1318 | "url": "ur n:va:vista :occurence ", | |
1319 | "valueStri ng": "2" | |
1320 | } | |
1321 | ], | |
1322 | "res ource": { | |
1323 | "r esourceTyp e": "Claim ", | |
1324 | "i dentifier" : [ | |
1325 | { | |
1326 | "extensi on": [ | |
1327 | { | |
1328 | "url ": "urn:va :vista:seq uence", | |
1329 | "val ueString": "277STAT- Claim-Serv ice-Line-I d-Data-2-L ineType" | |
1330 | } | |
1331 | ], | |
1332 | "value": "Claim-Se rvice-Line -Id-Data-2 -LineType2 " | |
1333 | }, | |
1334 | { | |
1335 | "extensi on": [ | |
1336 | { | |
1337 | "url ": "urn:va :vista:seq uence", | |
1338 | "val ueString": "277STAT- Claim-Serv ice-Line-I d-Data-3-S ervice-Lin eNumber" | |
1339 | } | |
1340 | ], | |
1341 | "value": "Claim-Se rvice-Line -Id-Data-3 -Service-L ineNumber2 " | |
1342 | } | |
1343 | ], | |
1344 | "i tem": [ | |
1345 | { | |
1346 | "quantit y": { | |
1347 | "value ": 102 | |
1348 | }, | |
1349 | "modifie r": { | |
1350 | "codin g": [ | |
1351 | { | |
1352 | "c ode": "mod ifiercode2 " | |
1353 | } | |
1354 | ] | |
1355 | }, | |
1356 | "program Code": { | |
1357 | "codin g": [ | |
1358 | { | |
1359 | "c ode": "pro gramCodeco de2" | |
1360 | } | |
1361 | ] | |
1362 | }, | |
1363 | "revenue ": { | |
1364 | "text" : "revenue text2" | |
1365 | }, | |
1366 | "categor y": { | |
1367 | "codin g": [ | |
1368 | { | |
1369 | "c ode": "cod e2" | |
1370 | } | |
1371 | ] | |
1372 | } | |
1373 | } | |
1374 | ] | |
1375 | } | |
1376 | } | |
1377 | ] | |
1378 | } |
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