Benefit Program Client System API Layer | Claim-submit-Scen1c

<!--  TODO:
Do we need to pass in receivedDate for the receipts?  -->
<Claim xmlns="http://hl7.org/fhir">
    <!--     The id may be missing when assessing a claim.  If present, it will be a concatenation of the odbNum or applicationNum, the receivedDate and the seqNo.  Ids are only assigned when the claim is held or submitted.  The id here is present for publication purposes.     -->
    <id value="example-Claim-submit-Scen1c" />
    <contained>
        <MedicationDispense>
            <id value="dispense1" />
            <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-MedicationDispense-PrescriberLicense">
                <valueCoding>
                    <system value="https://bpcs.exchange/fhir/CodeSystem/cs-PrescriberLicense" />
                    <code value="44" />
                </valueCoding>
            </extension>
            <identifier>
                <value value="000000001" />
            </identifier>
            <status value="completed" />
            <medication>
                <concept>
                    <coding>
                        <system value="http://hl7.org/fhir/NamingSystem/ca-hc-din" />
                        <code value="02357658" />
                    </coding>
                </concept>
            </medication>
            <subject>
                <reference value="Patient/7902617849" />
            </subject>
            <quantity>
                <value value="5.0" />
            </quantity>
            <daysSupply>
                <value value="10" />
                <system value="http://unitsofmeasure.org" />
                <code value="d" />
            </daysSupply>
            <whenHandedOver value="2023-01-01T05:00:00.0Z" />
        </MedicationDispense>
    </contained>
    <contained>
        <MedicationDispense>
            <id value="dispense2" />
            <!--       <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-MedicationDispense-PrescriberLicense">
        <valueCoding>
          <system value="https://bpcs.exchange/fhir/CodeSystem/cs-PrescriberLicense"/>
          <code value="44"/>
        </valueCoding>
      </extension> -->
            <identifier>
                <value value="000000002" />
            </identifier>
            <status value="completed" />
            <medication>
                <concept>
                    <coding>
                        <system value="http://hl7.org/fhir/NamingSystem/ca-hc-din" />
                        <code value="02432226" />
                    </coding>
                </concept>
            </medication>
            <subject>
                <reference value="Patient/7902617849" />
            </subject>
            <quantity>
                <value value="2.0" />
            </quantity>
            <daysSupply>
                <value value="10" />
                <system value="http://unitsofmeasure.org" />
                <code value="d" />
            </daysSupply>
            <whenHandedOver value="2023-01-02T05:00:00.0Z" />
        </MedicationDispense>
    </contained>
    <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-Note">
        <valueString value="Commit batch test" />
    </extension>
    <status value="active" />
    <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="RB497867223 Family" />
    </patient>
    <created value="2023-03-01" />
    <!--  This isn't stored, but is required by FHIR  -->
    <insurer>
        <reference value="Organization/bpcs" />
    </insurer>
    <supportingInfo>
        <sequence value="1" />
        <category>
            <coding>
                <system value="http://terminology.hl7.org/CodeSystem/claiminformationcategory" />
                <code value="info" />
            </coding>
        </category>
        <valueReference>
            <reference value="#dispense1" />
        </valueReference>
    </supportingInfo>
    <supportingInfo>
        <sequence value="2" />
        <category>
            <coding>
                <system value="http://terminology.hl7.org/CodeSystem/claiminformationcategory" />
                <code value="info" />
            </coding>
        </category>
        <valueReference>
            <reference value="#dispense2" />
        </valueReference>
    </supportingInfo>
    <item>
        <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-ReceiptPatient">
            <valueReference>
                <reference value="Patient/7902617849" />
            </valueReference>
        </extension>
        <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-ReceivedDate">
            <valueDate value="2023-01-01" />
        </extension>
        <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-Mode">
            <valueCoding>
                <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationMode" />
                <code value="ELECTRONIC" />
                <display value="electronic data" />
            </valueCoding>
        </extension>
        <!--     <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-OverrideNet">
      <valueMoney>
        <value value="8.0"/>
        <currency value="CAD"/>
      </valueMoney>
    </extension>
    <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-OverriddenReasons">
      <valueCoding>
        <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ClaimResponse"/>
        <code value="NE"/>
      </valueCoding>
    </extension>
    <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-OverrideReason">
      <valueString value="Some reason"/>
    </extension> -->
        <sequence value="1" />
        <informationSequence value="1" />
        <productOrService>
            <coding>
                <system value="http://hl7.org/fhir/NamingSystem/ca-hc-din" />
                <code value="02357658" />
                <display value="Vimpat" />
            </coding>
            <coding>
                <system value="http://terminology.hl7.org/CodeSystem/hc-CCDD" />
                <display value="LACOSAMIDE" />
            </coding>
        </productOrService>
        <modifier>
            <coding>
                <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ClaimModifier" />
                <code value="_PI-1" />
            </coding>
        </modifier>
        <modifier>
            <coding>
                <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ClaimResponse" />
                <code value="E1.3" />
            </coding>
        </modifier>
        <servicedDate value="2023-01-01" />
        <patientPaid>
            <value value="8.0" />
            <currency value="CAD" />
        </patientPaid>
        <quantity>
            <value value="5.0" />
        </quantity>
        <net>
            <value value="8.0" />
            <currency value="CAD" />
        </net>
        <detail>
            <sequence value="1" />
            <productOrService>
                <coding>
                    <system value="https://bpcs.exchange/fhir/CodeSystem/cs-CostFee" />
                    <code value="drugCost" />
                </coding>
            </productOrService>
            <net>
                <value value="5.0" />
                <currency value="CAD" />
            </net>
        </detail>
        <detail>
            <sequence value="2" />
            <productOrService>
                <coding>
                    <system value="https://bpcs.exchange/fhir/CodeSystem/cs-CostFee" />
                    <code value="pharmacistFee" />
                </coding>
            </productOrService>
            <net>
                <value value="3.0" />
                <currency value="CAD" />
            </net>
        </detail>
    </item>
    <item>
        <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-ReceiptPatient">
            <valueReference>
                <reference value="Patient/7902617849" />
            </valueReference>
        </extension>
        <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-ReceivedDate">
            <valueDate value="2023-01-02" />
        </extension>
        <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Resource-Mode">
            <valueCoding>
                <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationMode" />
                <code value="ELECTRONIC" />
                <display value="electronic data" />
            </valueCoding>
        </extension>
        <!--     <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-OverrideNet">
      <valueMoney>
        <value value="7.0"/>
        <currency value="CAD"/>
      </valueMoney>
    </extension>
    <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-OverriddenReasons">
      <valueCoding>
        <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ClaimResponse"/>
        <code value="NE"/>
      </valueCoding>
    </extension>
    <extension url="https://bpcs.exchange/fhir/StructureDefinition/ext-Claim-OverrideReason">
      <valueString value="Some reason"/>
    </extension> -->
        <sequence value="2" />
        <informationSequence value="2" />
        <productOrService>
            <coding>
                <system value="http://hl7.org/fhir/NamingSystem/ca-hc-din" />
                <code value="02432226" />
                <display value="Harvoni" />
            </coding>
            <coding>
                <system value="http://terminology.hl7.org/CodeSystem/hc-CCDD" />
                <display value="LEDIPASVIR &amp; SOFOSBUVIR" />
            </coding>
        </productOrService>
        <modifier>
            <coding>
                <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ClaimModifier" />
                <code value="_PI-1" />
            </coding>
        </modifier>
        <modifier>
            <coding>
                <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ClaimResponse" />
                <code value="E1.3" />
            </coding>
        </modifier>
        <servicedDate value="2023-01-02" />
        <patientPaid>
            <value value="7.0" />
            <currency value="CAD" />
        </patientPaid>
        <quantity>
            <value value="2.0" />
        </quantity>
        <net>
            <value value="7.0" />
            <currency value="CAD" />
        </net>
        <detail>
            <sequence value="1" />
            <productOrService>
                <coding>
                    <system value="https://bpcs.exchange/fhir/CodeSystem/cs-CostFee" />
                    <code value="drugCost" />
                </coding>
            </productOrService>
            <net>
                <value value="4.0" />
                <currency value="CAD" />
            </net>
        </detail>
        <detail>
            <sequence value="2" />
            <productOrService>
                <coding>
                    <system value="https://bpcs.exchange/fhir/CodeSystem/cs-CostFee" />
                    <code value="pharmacistFee" />
                </coding>
            </productOrService>
            <net>
                <value value="3.0" />
                <currency value="CAD" />
            </net>
        </detail>
    </item>
    <!-- 
 -->
</Claim>
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Claim-submit-Scen1c

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