{ "resourceType": "Bundle", "id": "f199bcd1-ce99-468a-8645-ee97bb9609dd", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-24T16:13:58.651+03:00", "entry": [ { "fullUrl": "http://nphies.sa/MessageHeader/d9eeff14-fae6-4f48-bda8-f006749dbd5a", "resource": { "resourceType": "MessageHeader", "id": "d9eeff14-fae6-4f48-bda8-f006749dbd5a", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ], "tag": [ { "system": "http://nphies.sa/terminology/CodeSystem/meta-tags", "code": "queued-messages" } ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "poll-response" }, "destination": [ { "endpoint": "http://nphies.sa/license/provider-license/10000300062591", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/nphies", "value": "NPHIES" } }, "source": { "endpoint": "http://nphies.sa/" }, "response": { "identifier": "49ea0f36-f394-4370-85c5-7f55ba35b56e", "code": "ok" } } }, { "fullUrl": "http://nphies.sa/Task/924e190a-3530-445e-bd42-5a3534452d2c", "resource": { "resourceType": "Task", "id": "924e190a-3530-445e-bd42-5a3534452d2c", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/task|1.0.0" ], "tag": [ { "code": "NPHIES generated", "display": "NPHIES generated" } ] }, "identifier": [ { "system": "http://www.ALKholood.com/Task", "value": "747" } ], "status": "completed", "intent": "order", "priority": "stat", "code": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/task-code", "code": "poll" } ] }, "authoredOn": "2026-09-24", "lastModified": "2026-10-24", "requester": { "reference": "Organization/9" }, "owner": { "identifier": { "system": "http://nphies.sa/license/nphies", "value": "NPHIES" } }, "input": [ { "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/task-input-type", "code": "include-message-type" } ] }, "valueCode": "claim-response" }, { "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/task-input-type", "code": "period" } ] }, "valuePeriod": { "start": "2026-09-24T00:00:00.000+03:00", "end": "2026-10-24T23:59:59.999+03:00" } }, { "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/task-input-type", "code": "count" } ] }, "valuePositiveInt": 10 } ], "output": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:42:38.667+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/22fbc77e-fc6e-48d7-88bb-c4d32f773f66" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:42:38.677+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/2d5e3064-26f8-49ab-ad62-26a3ef989315" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:42:38.704+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/9aa63821-94db-457d-90be-c5ebf4bb6e2c" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:42:38.709+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/e3e42c77-8471-4cfa-aa61-51b58212c817" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:42:38.732+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/46cde99c-1829-4c51-8050-e11e6ca95179" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:42:38.795+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/658caa91-84e8-4898-a9e7-eb8bcc6db011" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:42:38.887+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/94d46046-df9f-4519-beb8-481faf56ad1d" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:42:38.985+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/94fdb249-3cba-4f4a-9b8e-ae134a562c98" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:42:39.079+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/8961f924-b5cd-4ecb-b6ac-bfa57624b262" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:42:39.145+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/115fece0-e872-4c2e-8867-ffa85435d6b2" } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/22fbc77e-fc6e-48d7-88bb-c4d32f773f66", "resource": { "resourceType": "Bundle", "id": "22fbc77e-fc6e-48d7-88bb-c4d32f773f66", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:42:38.342+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/4d7dc643-c217-43aa-963c-7038dfe960cb", "resource": { "resourceType": "MessageHeader", "id": "4d7dc643-c217-43aa-963c-7038dfe960cb", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "02cccfd3-7d0d-43a3-a32a-eaf96b137754", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/0a5048b2-77a1-4c57-baa0-3c8603677b29" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/0a5048b2-77a1-4c57-baa0-3c8603677b29", "resource": { "resourceType": "ClaimResponse", "id": "0a5048b2-77a1-4c57-baa0-3c8603677b29", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "772" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "0a5048b2-77a1-4c57-baa0-3c8603677b29" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/f05d6798-ab65-4319-863a-48447e2226d6" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/3e55fb6b-e194-4bdc-9e73-99aeb5e1d13c" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/91a5b905-5c87-4555-abab-ab15352adcc5" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "44141099260910" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "83273" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 44.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 32, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 4.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 44.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 44.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 32, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 44.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 4.8, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/d634b785-11ca-44cc-a73f-47f32530747b" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/f05d6798-ab65-4319-863a-48447e2226d6", "resource": { "resourceType": "Patient", "id": "f05d6798-ab65-4319-863a-48447e2226d6", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2190001392" } ], "active": true, "name": [ { "use": "official", "text": "ABDULSAMAD adam Mohamad", "given": [ "ABDULSAMAD", "adam", "Mohamad" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1973-01-01", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/91a5b905-5c87-4555-abab-ab15352adcc5", "resource": { "resourceType": "Organization", "id": "91a5b905-5c87-4555-abab-ab15352adcc5", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/3e55fb6b-e194-4bdc-9e73-99aeb5e1d13c", "resource": { "resourceType": "Organization", "id": "3e55fb6b-e194-4bdc-9e73-99aeb5e1d13c", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/d634b785-11ca-44cc-a73f-47f32530747b", "resource": { "resourceType": "Coverage", "id": "d634b785-11ca-44cc-a73f-47f32530747b", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002190001392001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/0ae34d0d-17d9-44ae-a43a-21c23d501664" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/d7b08421-378d-41fa-bd02-dc824565433a" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/f05d6798-ab65-4319-863a-48447e2226d6" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/3e55fb6b-e194-4bdc-9e73-99aeb5e1d13c" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "57785840", "name": "HEBAT ALLAH EST Basic B" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/0ae34d0d-17d9-44ae-a43a-21c23d501664", "resource": { "resourceType": "Organization", "id": "0ae34d0d-17d9-44ae-a43a-21c23d501664", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/d7b08421-378d-41fa-bd02-dc824565433a", "resource": { "resourceType": "Patient", "id": "d7b08421-378d-41fa-bd02-dc824565433a", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2190001392" } ], "active": true, "name": [ { "use": "official", "text": "ABDULSAMAD adam Mohamad", "given": [ "ABDULSAMAD", "adam", "Mohamad" ] } ], "telecom": [ { "system": "phone", "value": "0592085803" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1973-01-01", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/2d5e3064-26f8-49ab-ad62-26a3ef989315", "resource": { "resourceType": "Bundle", "id": "2d5e3064-26f8-49ab-ad62-26a3ef989315", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:42:37.898+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/851fcc33-b6dc-4ac2-9087-879f69f03af2", "resource": { "resourceType": "MessageHeader", "id": "851fcc33-b6dc-4ac2-9087-879f69f03af2", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "47ab95fe-9911-4ea3-9ded-8e4e64aacbfc", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/8944e5d6-b0f4-43aa-be0f-135af54f0d41" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/8944e5d6-b0f4-43aa-be0f-135af54f0d41", "resource": { "resourceType": "ClaimResponse", "id": "8944e5d6-b0f4-43aa-be0f-135af54f0d41", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "2424" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "8944e5d6-b0f4-43aa-be0f-135af54f0d41" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/3a26acd7-3884-4fa1-a1fc-255103fc9993" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/7ebbef1d-58d1-4648-9bf5-e33e593a941c" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/a2fddc1c-4d68-4ded-bb7f-909282906fd1" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "88186713260928" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "100937" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/a60c58aa-86ef-4485-bbb9-2e890bcbb5de" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/3a26acd7-3884-4fa1-a1fc-255103fc9993", "resource": { "resourceType": "Patient", "id": "3a26acd7-3884-4fa1-a1fc-255103fc9993", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2285378754" } ], "active": true, "name": [ { "use": "official", "text": "MOHAMMED JUMAA MUHAMMAD", "given": [ "MOHAMMED", "MUHAMMAD", "MUHAMMAD" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1988-10-25", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/a2fddc1c-4d68-4ded-bb7f-909282906fd1", "resource": { "resourceType": "Organization", "id": "a2fddc1c-4d68-4ded-bb7f-909282906fd1", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/7ebbef1d-58d1-4648-9bf5-e33e593a941c", "resource": { "resourceType": "Organization", "id": "7ebbef1d-58d1-4648-9bf5-e33e593a941c", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/a60c58aa-86ef-4485-bbb9-2e890bcbb5de", "resource": { "resourceType": "Coverage", "id": "a60c58aa-86ef-4485-bbb9-2e890bcbb5de", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002285378754001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/24c676c8-7132-418a-b394-30055b583ec1" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/875435c6-0878-4829-90bd-47e9167b9e0a" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/3a26acd7-3884-4fa1-a1fc-255103fc9993" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/7ebbef1d-58d1-4648-9bf5-e33e593a941c" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "50765128", "name": "MOHAMED ABDULLAH ALS Basic B" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/24c676c8-7132-418a-b394-30055b583ec1", "resource": { "resourceType": "Organization", "id": "24c676c8-7132-418a-b394-30055b583ec1", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/875435c6-0878-4829-90bd-47e9167b9e0a", "resource": { "resourceType": "Patient", "id": "875435c6-0878-4829-90bd-47e9167b9e0a", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2285378754" } ], "active": true, "name": [ { "use": "official", "text": "MOHAMMED JUMAA MUHAMMAD", "given": [ "MOHAMMED", "MUHAMMAD", "MUHAMMAD" ] } ], "telecom": [ { "system": "phone", "value": "0535016643" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1988-10-25", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/9aa63821-94db-457d-90be-c5ebf4bb6e2c", "resource": { "resourceType": "Bundle", "id": "9aa63821-94db-457d-90be-c5ebf4bb6e2c", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:42:38.367+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/3e006c93-c550-43b5-a261-b3197c222a5a", "resource": { "resourceType": "MessageHeader", "id": "3e006c93-c550-43b5-a261-b3197c222a5a", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "5c91f807-370a-4bab-9555-77bbc940e655", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/f0edc365-fb1a-4dd9-975b-e2ca635f80a6" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/f0edc365-fb1a-4dd9-975b-e2ca635f80a6", "resource": { "resourceType": "ClaimResponse", "id": "f0edc365-fb1a-4dd9-975b-e2ca635f80a6", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "partial" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "695" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "f0edc365-fb1a-4dd9-975b-e2ca635f80a6" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "oral" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/40f556e3-efc7-45b5-803b-17623f33fef5" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/7e375d6b-0042-44d7-a022-a35f9ef01085" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/b8a52b84-740f-42ca-9ffd-c5274690f41e" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "61138598260909" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "82313" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 88, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 123.2, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 13.2, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 22, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 123.2, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "rejected" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "82313" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 18.48, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 3.3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 18.48, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "reason": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason", "code": "MN-1-1" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 0 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "82313" } } ], "itemSequence": 3, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 49.28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 35.2, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 5.28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 8.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 49.28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 190.96, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 123.2, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 34.1, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 190.96, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 18.48, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/1cae8d36-2b10-4df1-8ecb-7c6305daac85" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/40f556e3-efc7-45b5-803b-17623f33fef5", "resource": { "resourceType": "Patient", "id": "40f556e3-efc7-45b5-803b-17623f33fef5", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2210626830" } ], "active": true, "name": [ { "use": "official", "text": "USAMA KALID ALRIMI ALRIMI", "given": [ "USAMA", "ALRIMI", "ALRIMI" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "2002-03-26", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/b8a52b84-740f-42ca-9ffd-c5274690f41e", "resource": { "resourceType": "Organization", "id": "b8a52b84-740f-42ca-9ffd-c5274690f41e", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/7e375d6b-0042-44d7-a022-a35f9ef01085", "resource": { "resourceType": "Organization", "id": "7e375d6b-0042-44d7-a022-a35f9ef01085", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/1cae8d36-2b10-4df1-8ecb-7c6305daac85", "resource": { "resourceType": "Coverage", "id": "1cae8d36-2b10-4df1-8ecb-7c6305daac85", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002210626830001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/177169ab-fade-4886-bdba-80aa7097c86d" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/5073f8b1-a7c9-4181-9f3c-68bc9abb558e" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/40f556e3-efc7-45b5-803b-17623f33fef5" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/7e375d6b-0042-44d7-a022-a35f9ef01085" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "54456149", "name": "BINDAWOOD SUPER STORES TRADIR" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/177169ab-fade-4886-bdba-80aa7097c86d", "resource": { "resourceType": "Organization", "id": "177169ab-fade-4886-bdba-80aa7097c86d", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/5073f8b1-a7c9-4181-9f3c-68bc9abb558e", "resource": { "resourceType": "Patient", "id": "5073f8b1-a7c9-4181-9f3c-68bc9abb558e", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2210626830" } ], "active": true, "name": [ { "use": "official", "text": "USAMA KALID ALRIMI ALRIMI", "given": [ "USAMA", "ALRIMI", "ALRIMI" ] } ], "telecom": [ { "system": "phone", "value": "0541428243" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "2002-03-26", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/e3e42c77-8471-4cfa-aa61-51b58212c817", "resource": { "resourceType": "Bundle", "id": "e3e42c77-8471-4cfa-aa61-51b58212c817", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:42:38.371+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/3f8800c3-5da7-40eb-9ec3-3913710c0403", "resource": { "resourceType": "MessageHeader", "id": "3f8800c3-5da7-40eb-9ec3-3913710c0403", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "abcfceb3-1358-4368-9c68-5a093124b23d", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/89ec776c-ad28-41a8-a4ff-50cebf60f534" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/89ec776c-ad28-41a8-a4ff-50cebf60f534", "resource": { "resourceType": "ClaimResponse", "id": "89ec776c-ad28-41a8-a4ff-50cebf60f534", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "partial" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "814" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "89ec776c-ad28-41a8-a4ff-50cebf60f534" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/c880b76d-d0c5-4791-b797-589c39fd66ad" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/bf1fd0ce-982b-4799-b218-52fbf82effeb" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/7f55717e-4508-4d3b-9d98-f00779a47cce" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "98142354260910" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "rejected" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "83777" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "reason": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason", "code": "MN-1-1" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 30.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 30.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5.5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 0 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "83777" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 58.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 10.5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 58.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/797482fe-5ce7-4483-9498-563cd54a9ff2" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/c880b76d-d0c5-4791-b797-589c39fd66ad", "resource": { "resourceType": "Patient", "id": "c880b76d-d0c5-4791-b797-589c39fd66ad", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/patient-identifier-type", "code": "BN", "display": "border number" } ] }, "system": "http://nphies.sa/identifier/bordernumber", "value": "4659620787" } ], "active": true, "name": [ { "use": "official", "text": "adam mehmood hamdy", "given": [ "adam", "mehmood", "hamdy" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "2022-03-29", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/7f55717e-4508-4d3b-9d98-f00779a47cce", "resource": { "resourceType": "Organization", "id": "7f55717e-4508-4d3b-9d98-f00779a47cce", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/bf1fd0ce-982b-4799-b218-52fbf82effeb", "resource": { "resourceType": "Organization", "id": "bf1fd0ce-982b-4799-b218-52fbf82effeb", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/797482fe-5ce7-4483-9498-563cd54a9ff2", "resource": { "resourceType": "Coverage", "id": "797482fe-5ce7-4483-9498-563cd54a9ff2", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002561865342202" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/8c3b5fea-2293-4ceb-9f34-e512d5d77e77" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/d932a813-a6bb-4f00-ad74-443a1d4198c2" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/c880b76d-d0c5-4791-b797-589c39fd66ad" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/bf1fd0ce-982b-4799-b218-52fbf82effeb" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "51956786", "name": "Smeer Saleh abu ghalia o" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/8c3b5fea-2293-4ceb-9f34-e512d5d77e77", "resource": { "resourceType": "Organization", "id": "8c3b5fea-2293-4ceb-9f34-e512d5d77e77", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/d932a813-a6bb-4f00-ad74-443a1d4198c2", "resource": { "resourceType": "Patient", "id": "d932a813-a6bb-4f00-ad74-443a1d4198c2", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/patient-identifier-type", "code": "BN", "display": "border number" } ] }, "system": "http://nphies.sa/identifier/bordernumber", "value": "4659620787" } ], "active": true, "name": [ { "use": "official", "text": "adam mehmood hamdy", "given": [ "adam", "mehmood", "hamdy" ] } ], "telecom": [ { "system": "phone", "value": "0540486997" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "2022-03-29", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/46cde99c-1829-4c51-8050-e11e6ca95179", "resource": { "resourceType": "Bundle", "id": "46cde99c-1829-4c51-8050-e11e6ca95179", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:42:38.014+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/d412ebf4-3fe2-4bc4-975c-45bf911c53d0", "resource": { "resourceType": "MessageHeader", "id": "d412ebf4-3fe2-4bc4-975c-45bf911c53d0", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "66ab2b7f-1aa6-4fdb-b4dd-6c8f1a6dbbb0", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/f71930e4-915d-413d-ab21-0b577ac15634" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/f71930e4-915d-413d-ab21-0b577ac15634", "resource": { "resourceType": "ClaimResponse", "id": "f71930e4-915d-413d-ab21-0b577ac15634", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "2367" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "f71930e4-915d-413d-ab21-0b577ac15634" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/ade28a20-f7cc-483d-bf1c-a043ff5b5a76" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/379f04b6-1c42-49ea-ab96-b28fc7a2c435" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/c5541138-a2a5-49b9-b191-213d90a63f92" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "39185006260927" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "100256" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/5ebc97ce-8a1b-4ef6-a8f5-cb738508f914" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/ade28a20-f7cc-483d-bf1c-a043ff5b5a76", "resource": { "resourceType": "Patient", "id": "ade28a20-f7cc-483d-bf1c-a043ff5b5a76", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1063107294" } ], "active": true, "name": [ { "use": "official", "text": "MARWAH abdulaziz KAL MOHAMAD AREF", "given": [ "MARWAH", "KAL MOHAMAD", "AREF" ] } ], "gender": "female", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "female", "display": "female" } ] } } ] }, "birthDate": "1989-10-15", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/c5541138-a2a5-49b9-b191-213d90a63f92", "resource": { "resourceType": "Organization", "id": "c5541138-a2a5-49b9-b191-213d90a63f92", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/379f04b6-1c42-49ea-ab96-b28fc7a2c435", "resource": { "resourceType": "Organization", "id": "379f04b6-1c42-49ea-ab96-b28fc7a2c435", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/5ebc97ce-8a1b-4ef6-a8f5-cb738508f914", "resource": { "resourceType": "Coverage", "id": "5ebc97ce-8a1b-4ef6-a8f5-cb738508f914", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "001063107294001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/049996c3-1ee1-4f77-a558-61a024e8c7c6" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/10c61e8f-609f-4a1d-a636-bfdebec7949d" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/ade28a20-f7cc-483d-bf1c-a043ff5b5a76" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/379f04b6-1c42-49ea-ab96-b28fc7a2c435" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "55284501", "name": "Arab Group for Devel Basic B" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/049996c3-1ee1-4f77-a558-61a024e8c7c6", "resource": { "resourceType": "Organization", "id": "049996c3-1ee1-4f77-a558-61a024e8c7c6", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/10c61e8f-609f-4a1d-a636-bfdebec7949d", "resource": { "resourceType": "Patient", "id": "10c61e8f-609f-4a1d-a636-bfdebec7949d", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1063107294" } ], "active": true, "name": [ { "use": "official", "text": "MARWAH abdulaziz KAL MOHAMAD AREF", "given": [ "MARWAH", "KAL MOHAMAD", "AREF" ] } ], "telecom": [ { "system": "phone", "value": "0543331249" } ], "gender": "female", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "female", "display": "female" } ] } } ] }, "birthDate": "1989-10-15", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/658caa91-84e8-4898-a9e7-eb8bcc6db011", "resource": { "resourceType": "Bundle", "id": "658caa91-84e8-4898-a9e7-eb8bcc6db011", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:42:38.380+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/f308e3d8-e976-4760-acb9-fe8b80038621", "resource": { "resourceType": "MessageHeader", "id": "f308e3d8-e976-4760-acb9-fe8b80038621", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "bbb7df8c-3b86-4076-b9a1-7f651536ba85", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/25bf9471-aee2-4cf1-8552-36368fe7b019" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/25bf9471-aee2-4cf1-8552-36368fe7b019", "resource": { "resourceType": "ClaimResponse", "id": "25bf9471-aee2-4cf1-8552-36368fe7b019", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "partial" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "704" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "25bf9471-aee2-4cf1-8552-36368fe7b019" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/ccc805f7-4b44-43c6-b645-1079e6f1a5ee" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/5d92d873-26ed-4a2e-8337-0142104a4f97" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/790c92bc-8996-4ec0-94ed-9bec707a8590" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "72138875260909" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "rejected" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "82437" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 30.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 30.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "reason": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason", "code": "MN-1-1" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5.5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 0 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "82437" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 8.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 5.28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 49.28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 49.28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 35.2, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "82437" } } ], "itemSequence": 3, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 44.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 44.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 4.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 32, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "82437" } } ], "itemSequence": 4, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 6.16, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.1, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 6.16, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 4.4, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0.66, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "rejected" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "82437" } } ], "itemSequence": 5, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 80.08, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 14.3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 80.08, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "reason": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason", "code": "AD-1-4" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 0 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 211.12, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 71.6, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 37.7, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 211.12, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 10.74, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/e353d30c-104c-4bc6-8267-8040a1be3b0f" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/ccc805f7-4b44-43c6-b645-1079e6f1a5ee", "resource": { "resourceType": "Patient", "id": "ccc805f7-4b44-43c6-b645-1079e6f1a5ee", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1094720305" } ], "active": true, "name": [ { "use": "official", "text": "IBRAHIM YOUSSEF IBRAHIM ALMEKRAN", "given": [ "IBRAHIM", "IBRAHIM", "ALMEKRAN" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1996-04-03", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/790c92bc-8996-4ec0-94ed-9bec707a8590", "resource": { "resourceType": "Organization", "id": "790c92bc-8996-4ec0-94ed-9bec707a8590", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/5d92d873-26ed-4a2e-8337-0142104a4f97", "resource": { "resourceType": "Organization", "id": "5d92d873-26ed-4a2e-8337-0142104a4f97", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/e353d30c-104c-4bc6-8267-8040a1be3b0f", "resource": { "resourceType": "Coverage", "id": "e353d30c-104c-4bc6-8267-8040a1be3b0f", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "001094720305001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/7f265b04-ac6c-4c6f-975a-ee5232e3a2c5" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/d4ce6f95-8ac6-435f-9004-9d37a8e0c5f2" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/ccc805f7-4b44-43c6-b645-1079e6f1a5ee" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/5d92d873-26ed-4a2e-8337-0142104a4f97" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "54991243", "name": "UNITED PHARMACEUTICAL COMPANY" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/7f265b04-ac6c-4c6f-975a-ee5232e3a2c5", "resource": { "resourceType": "Organization", "id": "7f265b04-ac6c-4c6f-975a-ee5232e3a2c5", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/d4ce6f95-8ac6-435f-9004-9d37a8e0c5f2", "resource": { "resourceType": "Patient", "id": "d4ce6f95-8ac6-435f-9004-9d37a8e0c5f2", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1094720305" } ], "active": true, "name": [ { "use": "official", "text": "IBRAHIM YOUSSEF IBRAHIM ALMEKRAN", "given": [ "IBRAHIM", "IBRAHIM", "ALMEKRAN" ] } ], "telecom": [ { "system": "phone", "value": "0565961912" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1996-04-03", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/94d46046-df9f-4519-beb8-481faf56ad1d", "resource": { "resourceType": "Bundle", "id": "94d46046-df9f-4519-beb8-481faf56ad1d", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:42:36.843+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/b2947ade-c4b9-497c-9972-a022a4f7bc9f", "resource": { "resourceType": "MessageHeader", "id": "b2947ade-c4b9-497c-9972-a022a4f7bc9f", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "5bc8f732-f3ec-426f-b9eb-739a0031c49d", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/aefcea53-62ac-4f67-ac09-c572b2105362" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/aefcea53-62ac-4f67-ac09-c572b2105362", "resource": { "resourceType": "ClaimResponse", "id": "aefcea53-62ac-4f67-ac09-c572b2105362", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "845" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "aefcea53-62ac-4f67-ac09-c572b2105362" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/846b2411-b274-4e15-ac6b-9de670884c7f" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/e64ca3e4-f2d2-4af4-b36b-b9a2d0d716f1" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/55511d2a-0c1c-45b1-a716-a528c17f0aa2" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "12143012260910" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "84016" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/c3a0d8e4-8966-44db-89af-12ea7058d9c1" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/846b2411-b274-4e15-ac6b-9de670884c7f", "resource": { "resourceType": "Patient", "id": "846b2411-b274-4e15-ac6b-9de670884c7f", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2604591392" } ], "active": true, "name": [ { "use": "official", "text": "MALEK WALID KAMEL ZUHEIR", "given": [ "MALEK", "KAMEL", "ZUHEIR" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "2018-07-11", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/55511d2a-0c1c-45b1-a716-a528c17f0aa2", "resource": { "resourceType": "Organization", "id": "55511d2a-0c1c-45b1-a716-a528c17f0aa2", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/e64ca3e4-f2d2-4af4-b36b-b9a2d0d716f1", "resource": { "resourceType": "Organization", "id": "e64ca3e4-f2d2-4af4-b36b-b9a2d0d716f1", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/c3a0d8e4-8966-44db-89af-12ea7058d9c1", "resource": { "resourceType": "Coverage", "id": "c3a0d8e4-8966-44db-89af-12ea7058d9c1", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002327170128211" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/f24d2a8e-b4c7-43be-88cf-f80425c6ac68" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/838a0f86-e8c0-4225-b3bd-934e9a4ae63d" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/846b2411-b274-4e15-ac6b-9de670884c7f" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/e64ca3e4-f2d2-4af4-b36b-b9a2d0d716f1" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "54643652", "name": "HATEM MAHMOUD SINDI EST Basic B" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/f24d2a8e-b4c7-43be-88cf-f80425c6ac68", "resource": { "resourceType": "Organization", "id": "f24d2a8e-b4c7-43be-88cf-f80425c6ac68", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/838a0f86-e8c0-4225-b3bd-934e9a4ae63d", "resource": { "resourceType": "Patient", "id": "838a0f86-e8c0-4225-b3bd-934e9a4ae63d", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2604591392" } ], "active": true, "name": [ { "use": "official", "text": "MALEK WALID KAMEL ZUHEIR", "given": [ "MALEK", "KAMEL", "ZUHEIR" ] } ], "telecom": [ { "system": "phone", "value": "0534565645" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "2018-07-11", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/94fdb249-3cba-4f4a-9b8e-ae134a562c98", "resource": { "resourceType": "Bundle", "id": "94fdb249-3cba-4f4a-9b8e-ae134a562c98", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:42:38.681+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/dc2df6fd-8510-4d2e-842f-37c2e5199f0a", "resource": { "resourceType": "MessageHeader", "id": "dc2df6fd-8510-4d2e-842f-37c2e5199f0a", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "c6d9c472-914a-4bf3-bc61-cc5374af5cdf", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/35a87528-9c2b-474e-a445-5125f36c6e6e" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/35a87528-9c2b-474e-a445-5125f36c6e6e", "resource": { "resourceType": "ClaimResponse", "id": "35a87528-9c2b-474e-a445-5125f36c6e6e", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "1417" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "35a87528-9c2b-474e-a445-5125f36c6e6e" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/d14488dd-ff99-4e10-a177-25fbcb71c4ea" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/54fe6487-0270-4b76-8f5c-6d5c99e49c56" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/6fae21ab-cc73-4837-b450-c4082d456444" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "50159244260917" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "90405" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "90405" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3.3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 22, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5.5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 30.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 30.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 58.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 42, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 10.5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 58.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 6.3, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/2feb136c-4306-40df-a28e-da358d2789e7" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/d14488dd-ff99-4e10-a177-25fbcb71c4ea", "resource": { "resourceType": "Patient", "id": "d14488dd-ff99-4e10-a177-25fbcb71c4ea", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2556220081" } ], "active": true, "name": [ { "use": "official", "text": "MOHAMMED MOHULDEEN SHALABI shalaby", "given": [ "MOHAMMED", "SHALABI", "shalaby" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1997-12-05", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/6fae21ab-cc73-4837-b450-c4082d456444", "resource": { "resourceType": "Organization", "id": "6fae21ab-cc73-4837-b450-c4082d456444", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/54fe6487-0270-4b76-8f5c-6d5c99e49c56", "resource": { "resourceType": "Organization", "id": "54fe6487-0270-4b76-8f5c-6d5c99e49c56", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/2feb136c-4306-40df-a28e-da358d2789e7", "resource": { "resourceType": "Coverage", "id": "2feb136c-4306-40df-a28e-da358d2789e7", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002556220081001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/acfcb281-ed94-4a8c-95a8-e089c4852ccc" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/68c416ae-3130-44f6-8a62-93af1f05bc4a" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/d14488dd-ff99-4e10-a177-25fbcb71c4ea" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/54fe6487-0270-4b76-8f5c-6d5c99e49c56" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "54720179", "name": "AL HOTY CO LTD MAINTENANCE BRANCH" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/acfcb281-ed94-4a8c-95a8-e089c4852ccc", "resource": { "resourceType": "Organization", "id": "acfcb281-ed94-4a8c-95a8-e089c4852ccc", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/68c416ae-3130-44f6-8a62-93af1f05bc4a", "resource": { "resourceType": "Patient", "id": "68c416ae-3130-44f6-8a62-93af1f05bc4a", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2556220081" } ], "active": true, "name": [ { "use": "official", "text": "MOHAMMED MOHULDEEN SHALABI shalaby", "given": [ "MOHAMMED", "SHALABI", "shalaby" ] } ], "telecom": [ { "system": "phone", "value": "0561691896" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1997-12-05", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/8961f924-b5cd-4ecb-b6ac-bfa57624b262", "resource": { "resourceType": "Bundle", "id": "8961f924-b5cd-4ecb-b6ac-bfa57624b262", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:42:38.743+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/80f6e8d2-a02c-4e67-b513-6ea461de3806", "resource": { "resourceType": "MessageHeader", "id": "80f6e8d2-a02c-4e67-b513-6ea461de3806", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "ea4fd1a2-4e86-4065-be00-861ae0a912e7", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/1b4fe384-fecb-4c9e-ad40-b71e5105dcec" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/1b4fe384-fecb-4c9e-ad40-b71e5105dcec", "resource": { "resourceType": "ClaimResponse", "id": "1b4fe384-fecb-4c9e-ad40-b71e5105dcec", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "1721" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "1b4fe384-fecb-4c9e-ad40-b71e5105dcec" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/f3f3dab2-fad3-42ba-9b75-d4254b155fc3" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/f22aab5f-dcb3-4bdb-9c11-efc8e174b488" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/a9912130-0a95-4409-8210-8407b1fbcc67" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "9167423260920" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "93546" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/023a770b-cc61-462a-a233-005568249223" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/f3f3dab2-fad3-42ba-9b75-d4254b155fc3", "resource": { "resourceType": "Patient", "id": "f3f3dab2-fad3-42ba-9b75-d4254b155fc3", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1087698948" } ], "active": true, "name": [ { "use": "official", "text": "riham abdelgadir abdelgadir FALMBAN", "given": [ "riham", "abdelgadir", "FALMBAN" ] } ], "gender": "female", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "female", "display": "female" } ] } } ] }, "birthDate": "1987-09-20", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/a9912130-0a95-4409-8210-8407b1fbcc67", "resource": { "resourceType": "Organization", "id": "a9912130-0a95-4409-8210-8407b1fbcc67", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/f22aab5f-dcb3-4bdb-9c11-efc8e174b488", "resource": { "resourceType": "Organization", "id": "f22aab5f-dcb3-4bdb-9c11-efc8e174b488", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/023a770b-cc61-462a-a233-005568249223", "resource": { "resourceType": "Coverage", "id": "023a770b-cc61-462a-a233-005568249223", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002100837786102" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/71e3c3f3-41d2-4938-9ccc-7f2a8a599238" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/fa3dae51-e370-4eda-9fa9-e2b08e19ff35" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/f3f3dab2-fad3-42ba-9b75-d4254b155fc3" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/f22aab5f-dcb3-4bdb-9c11-efc8e174b488" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "53534228", "name": "MEDICAL AND PHARM SERVICES COMPANY" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/71e3c3f3-41d2-4938-9ccc-7f2a8a599238", "resource": { "resourceType": "Organization", "id": "71e3c3f3-41d2-4938-9ccc-7f2a8a599238", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/fa3dae51-e370-4eda-9fa9-e2b08e19ff35", "resource": { "resourceType": "Patient", "id": "fa3dae51-e370-4eda-9fa9-e2b08e19ff35", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1087698948" } ], "active": true, "name": [ { "use": "official", "text": "riham abdelgadir abdelgadir FALMBAN", "given": [ "riham", "abdelgadir", "FALMBAN" ] } ], "telecom": [ { "system": "phone", "value": "0580904091" } ], "gender": "female", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "female", "display": "female" } ] } } ] }, "birthDate": "1987-09-20", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/115fece0-e872-4c2e-8867-ffa85435d6b2", "resource": { "resourceType": "Bundle", "id": "115fece0-e872-4c2e-8867-ffa85435d6b2", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:42:38.710+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/16066523-4cb4-4921-8cc5-ef3591b2ed40", "resource": { "resourceType": "MessageHeader", "id": "16066523-4cb4-4921-8cc5-ef3591b2ed40", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "cad66feb-fc5e-4bd6-be11-68513b448915", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/15ec0d98-138e-4bb7-bbdb-d0e371a02f24" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/15ec0d98-138e-4bb7-bbdb-d0e371a02f24", "resource": { "resourceType": "ClaimResponse", "id": "15ec0d98-138e-4bb7-bbdb-d0e371a02f24", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "partial" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "2338" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "15ec0d98-138e-4bb7-bbdb-d0e371a02f24" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/e431234c-b079-484a-bfe1-45654c387833" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/ba56d097-cec7-4ee8-858d-42beaf947858" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/34915479-6a90-411e-ba9f-3b6f05806576" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "24184221260927" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "rejected" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "100011" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "reason": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason", "code": "AD-1-4" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 61.6, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 61.6, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 11, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 0 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "100011" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 89.6, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 16, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 89.6, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/3a34bc92-b5d7-4849-a9db-ff77e80a02c5" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/e431234c-b079-484a-bfe1-45654c387833", "resource": { "resourceType": "Patient", "id": "e431234c-b079-484a-bfe1-45654c387833", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1153555907" } ], "active": true, "name": [ { "use": "official", "text": "AHMED ABDULRAHMAN ahmed Alkhataby", "given": [ "AHMED", "ahmed", "Alkhataby" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "2011-01-22", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/34915479-6a90-411e-ba9f-3b6f05806576", "resource": { "resourceType": "Organization", "id": "34915479-6a90-411e-ba9f-3b6f05806576", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/ba56d097-cec7-4ee8-858d-42beaf947858", "resource": { "resourceType": "Organization", "id": "ba56d097-cec7-4ee8-858d-42beaf947858", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/3a34bc92-b5d7-4849-a9db-ff77e80a02c5", "resource": { "resourceType": "Coverage", "id": "3a34bc92-b5d7-4849-a9db-ff77e80a02c5", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "001010265039201" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/39a4bf52-1389-441f-ae4f-263cee280a7f" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/7889a3c8-0511-4cbb-ae4e-8d3f0ac68a67" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/e431234c-b079-484a-bfe1-45654c387833" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/ba56d097-cec7-4ee8-858d-42beaf947858" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "54456146", "name": "BINDAWOOD SUPER STORES TRADIR" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/39a4bf52-1389-441f-ae4f-263cee280a7f", "resource": { "resourceType": "Organization", "id": "39a4bf52-1389-441f-ae4f-263cee280a7f", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/7889a3c8-0511-4cbb-ae4e-8d3f0ac68a67", "resource": { "resourceType": "Patient", "id": "7889a3c8-0511-4cbb-ae4e-8d3f0ac68a67", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1153555907" } ], "active": true, "name": [ { "use": "official", "text": "AHMED ABDULRAHMAN ahmed Alkhataby", "given": [ "AHMED", "ahmed", "Alkhataby" ] } ], "telecom": [ { "system": "phone", "value": "0595519019" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "2011-01-22", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://www.ALKholood.com/Organization/9", "resource": { "resourceType": "Organization", "id": "9", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "use": "official", "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } } ] }