<ClaimResponse xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../input-cache/schemas/R5/fhir-single.xsd">
  <!--    On a create, no id will be provided.  One is included here for publishing reasons only    -->
  <id value="example-ClaimResponse-Scen1b" />
  <status value="draft" />
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type" />
      <code value="pharmacy" />
    </coding>
  </type>
  <use value="claim" />
  <patient>
    <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-Subject">
      <valueReference>
        <reference value="Group/RB497867223" />
      </valueReference>
    </extension>
    <display value="Family RB497867223" />
  </patient>
  <created value="2024-05-02" />
  <!-- Current date -->
  <insurer>
    <reference value="Organization/bpcs" />
  </insurer>
  <outcome value="queued" />
  <item>
    <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-ReceiptPlan">
      <valueCoding>
        <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ProgramPlan" />
        <code value="T" />
      </valueCoding>
    </extension>
    <!--    <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-PresetModifier">
      <valueCoding>
        <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ClaimModifier"/>
        <code value="MQ"/>
      </valueCoding>
    </extension>-->
    <!-- This will mirror the Claim.item.sequence for the receipt being responded to -->
    <itemSequence value="1" />
    <reviewOutcome>
      <!--      <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-Info">
        <valueCodeableConcept>
          <coding>
            <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ClaimResponseInfo"/>
            <code value="NOSUB"/>
          </coding>
        </valueCodeableConcept>
      </extension>-->
      <decision>
        <coding>
          <system value="http://hl7.org/fhir/claim-decision" />
          <code value="denied" />
          <!-- currentStatus-->
        </coding>
      </decision>
      <reason>
        <coding>
          <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ClaimResponse" />
          <code value="E1.3" />
        </coding>
      </reason>
      <!--      <reason>
        <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier">
          <valueCoding>
            <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-PreExistingCondition">
              <valueBoolean value="true"/>
            </extension>
            <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifierDefault">
              <valueBoolean value="true"/>
            </extension>
            <system value="https://bpcs.exchange/fhir/CodeSystem/cs-MedicalReason"/>
            <code value="483"/>
          </valueCoding>
        </extension>
        <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier">
          <valueCoding>
            <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-PreExistingCondition">
              <valueBoolean value="true"/>
            </extension>
            <system value="https://bpcs.exchange/fhir/CodeSystem/cs-MedicalReason"/>
            <code value="482"/>
          </valueCoding>
        </extension>
        <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier">
          <valueCoding>
            <system value="https://bpcs.exchange/fhir/CodeSystem/cs-MedicalReason"/>
            <code value="484"/>
          </valueCoding>
        </extension>
        <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier">
          <valueCoding>
            <system value="https://bpcs.exchange/fhir/CodeSystem/cs-MedicalReason"/>
            <code value="979"/>
          </valueCoding>
        </extension>
        <coding>
          <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ClaimResponse"/>
          <code value="MI"/>
        </coding>
      </reason>-->
    </reviewOutcome>
    <adjudication>
      <category>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/adjudication" />
          <code value="eligible" />
        </coding>
      </category>
      <amount>
        <value value="0" />
        <currency value="CAD" />
      </amount>
    </adjudication>
    <adjudication>
      <category>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/adjudication" />
          <code value="benefit" />
        </coding>
      </category>
      <amount>
        <value value="0" />
        <currency value="CAD" />
      </amount>
    </adjudication>
  </item>
  <item>
    <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-ReceiptPlan">
      <valueCoding>
        <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ProgramPlan" />
        <code value="T" />
      </valueCoding>
    </extension>
    <!--    <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-PresetModifier">
      <valueCoding>
        <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ClaimModifier"/>
        <code value="MQ"/>
      </valueCoding>
    </extension>-->
    <!-- This will mirror the Claim.item.sequence for the receipt being responded to -->
    <itemSequence value="2" />
    <reviewOutcome>
      <!--      <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-Info">
        <valueCodeableConcept>
          <coding>
            <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ClaimResponseInfo"/>
            <code value="NOSUB"/>
          </coding>
        </valueCodeableConcept>
      </extension>-->
      <decision>
        <coding>
          <system value="http://hl7.org/fhir/claim-decision" />
          <code value="denied" />
          <!-- currentStatus-->
        </coding>
      </decision>
      <reason>
        <coding>
          <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ClaimResponse" />
          <code value="E1.3" />
        </coding>
      </reason>
      <!--      <reason>
        <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier">
          <valueCoding>
            <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-PreExistingCondition">
              <valueBoolean value="true"/>
            </extension>
            <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifierDefault">
              <valueBoolean value="true"/>
            </extension>
            <system value="https://bpcs.exchange/fhir/CodeSystem/cs-MedicalReason"/>
            <code value="483"/>
          </valueCoding>
        </extension>
        <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier">
          <valueCoding>
            <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-PreExistingCondition">
              <valueBoolean value="true"/>
            </extension>
            <system value="https://bpcs.exchange/fhir/CodeSystem/cs-MedicalReason"/>
            <code value="482"/>
          </valueCoding>
        </extension>
        <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier">
          <valueCoding>
            <system value="https://bpcs.exchange/fhir/CodeSystem/cs-MedicalReason"/>
            <code value="484"/>
          </valueCoding>
        </extension>
        <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-ClaimResponse-AllowedModifier">
          <valueCoding>
            <system value="https://bpcs.exchange/fhir/CodeSystem/cs-MedicalReason"/>
            <code value="979"/>
          </valueCoding>
        </extension>
        <coding>
          <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ClaimResponse"/>
          <code value="MI"/>
        </coding>
      </reason>-->
    </reviewOutcome>
    <adjudication>
      <category>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/adjudication" />
          <code value="eligible" />
        </coding>
      </category>
      <amount>
        <value value="0" />
        <currency value="CAD" />
      </amount>
    </adjudication>
    <adjudication>
      <category>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/adjudication" />
          <code value="benefit" />
        </coding>
      </category>
      <amount>
        <value value="0" />
        <currency value="CAD" />
      </amount>
    </adjudication>
  </item>
  <!--
  <responseCodes>
    <string>E2</string>
  </responseCodes>
  <updatedReceiptDto>
    <medCond></medCond> (reason for use code)
    <programId>TR</programId>
    <paymentStatus>U</paymentStatus>
    <planCode>T</planCode>
    <responseCds reference="../../responseCodes"/>
    <others/>
  </updatedReceiptDto>
-->
</ClaimResponse>