Error Al-Kholood Medical Company - AlHaj claim-response

All traces
Trace
60d612bf-7f95-4955-b406-473c035d7d1e
Started
2026-10-31 17:22:09.500 +03:00
Branch
Al-Kholood Medical Company - AlHaj (9)
Mode
Middleware
Service URL
https://nphies.careofme.net/api/v1/nphies/send
HTTP
200 in 1711 ms
Bundle / Request
6f88186f-1123-4094-a0d2-007fdae758df / 212019
Parsed items
0
Total duration
1714 ms
Error
Cannot open database "NitcoSysLog" requested by the login. The login failed. Login failed for user 'NitcoWebcenter'.
Open raw Download 5,152 characters
{
  "resourceType": "Bundle",
  "id": "6f88186f-1123-4094-a0d2-007fdae758df",
  "meta": {
    "profile": [
      "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
    ]
  },
  "type": "message",
  "timestamp": "2026-10-31T17:22:09.50\u002B03:00",
  "entry": [
    {
      "fullUrl": "urn:uuid:a14458ce-2c38-4af8-8457-a44d2c206a03",
      "resource": {
        "resourceType": "MessageHeader",
        "id": "a14458ce-2c38-4af8-8457-a44d2c206a03",
        "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": "poll-request"
        },
        "destination": [
          {
            "endpoint": "http://nphies.sa",
            "receiver": {
              "type": "Organization",
              "identifier": {
                "system": "http://nphies.sa/license/nphies",
                "value": "NPHIES"
              }
            }
          }
        ],
        "sender": {
          "type": "Organization",
          "identifier": {
            "system": "http://nphies.sa/license/provider-license",
            "value": "10000300062591"
          }
        },
        "source": {
          "endpoint": "http://nphies.sa/license/provider-license/10000300062591"
        },
        "focus": [
          {
            "reference": "http://www.ALKholood.com/Task/212019"
          }
        ]
      }
    },
    {
      "fullUrl": "http://www.ALKholood.com/Task/212019",
      "resource": {
        "resourceType": "Task",
        "id": "212019",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/task|1.0.0"
          ]
        },
        "identifier": [
          {
            "use": "official",
            "system": "http://www.ALKholood.com/Task",
            "value": "PlReq_920261031172209"
          }
        ],
        "status": "requested",
        "intent": "order",
        "priority": "stat",
        "code": {
          "coding": [
            {
              "system": "http://nphies.sa/terminology/CodeSystem/task-code",
              "code": "poll"
            }
          ]
        },
        "authoredOn": "2026-09-30",
        "lastModified": "2026-10-31",
        "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": "2026-09-30T00:00:00.000\u002B03:00",
              "end": "2026-10-31T23:59:59.999\u002B03:00"
            }
          },
          {
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/CodeSystem/task-input-type",
                  "code": "count"
                }
              ]
            },
            "valuePositiveInt": 10
          }
        ]
      }
    },
    {
      "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"
      }
    }
  ]
}

The middleware wrapper exactly as posted. MessageBody is elided because it is only base64 of the FHIR bundle on the Request tab.

Open raw Download 271 characters
{
  "Credentials": {
    "user": "TEMP-NNIC-PROV",
    "password": "TEMP-NNIC-PROV",
    "providerno": "10000300062591"
  },
  "MessageBody": "\u003Cbase64 of the FHIR bundle omitted \u2014 3840 chars\u003E",
  "BundleID": "6f88186f-1123-4094-a0d2-007fdae758df"
}
Open raw Download 312,539 characters
{
  "resourceType": "Bundle",
  "id": "d32d683f-fc3e-44d7-8c94-a10fbbd443d4",
  "meta": {
    "profile": [
      "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
    ]
  },
  "type": "message",
  "timestamp": "2026-10-31T17:22:10.580\u002B03:00",
  "entry": [
    {
      "fullUrl": "http://nphies.sa/MessageHeader/6ed7c8de-6641-490e-9b91-de68a94cf174",
      "resource": {
        "resourceType": "MessageHeader",
        "id": "6ed7c8de-6641-490e-9b91-de68a94cf174",
        "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": "a14458ce-2c38-4af8-8457-a44d2c206a03",
          "code": "ok"
        }
      }
    },
    {
      "fullUrl": "http://nphies.sa/Task/d2018c36-c5a4-4603-91d9-db5b053336de",
      "resource": {
        "resourceType": "Task",
        "id": "d2018c36-c5a4-4603-91d9-db5b053336de",
        "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": "136"
          }
        ],
        "status": "completed",
        "intent": "order",
        "priority": "stat",
        "code": {
          "coding": [
            {
              "system": "http://nphies.sa/terminology/CodeSystem/task-code",
              "code": "poll"
            }
          ]
        },
        "authoredOn": "2026-09-30",
        "lastModified": "2026-10-31",
        "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": "2026-09-30T00:00:00.000\u002B03:00",
              "end": "2026-10-31T23:59:59.999\u002B03:00"
            }
          },
          {
            "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": "2026-10-22T08:31:12.965\u002B00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/6c3cd007-e8f7-27a7-b41d-cf75d58d50ab"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T08:31:14.051\u002B00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/b3ba83fe-75dd-3561-ada2-ae6c09de0d18"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T08:31:15.362\u002B00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/e24b6b6f-6aea-39ad-952e-32b6b321ed6d"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T08:31:16.168\u002B00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/b3f8a02a-a050-4399-94f1-e835240dab9b"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T08:31:17.432\u002B00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/3e233baa-6658-1ef9-9ce8-5979742480fb"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T08:31:18.218\u002B00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/54b17b89-7ded-14c4-bd00-444968560a2b"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T08:31:19.215\u002B00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/9b74f533-9dc5-42e7-bbe6-dfa1e91859d1"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T08:31:19.921\u002B00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/5c1c2942-4fd0-2e22-90bd-badc41980d7a"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T08:31:20.643\u002B00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/73dcd6f0-5a60-4f3b-bf9c-a3ec27d2bb5e"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T08:31:21.399\u002B00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/a834eea4-b915-5c42-a53c-3481528feccc"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/6c3cd007-e8f7-27a7-b41d-cf75d58d50ab",
      "resource": {
        "resourceType": "Bundle",
        "id": "6c3cd007-e8f7-27a7-b41d-cf75d58d50ab",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-22T11:31:12.481\u002B03:00",
        "entry": [
          {
            "fullUrl": "http://globemedsaudi.com/MessageHeader/553e574b-861a-3e53-921b-2b0729be5a24",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "553e574b-861a-3e53-921b-2b0729be5a24",
              "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://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/payer-license",
                  "value": "7001463160"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001463160"
              },
              "response": {
                "identifier": "b00a13a0-7d91-4f24-8853-a5745b3637de",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://globemedsaudi.com/ClaimResponse/168588"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/ClaimResponse/168588",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "168588",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-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": "rejected"
                      }
                    ]
                  }
                },
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason",
                        "code": "audit"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://globemedsaudi.com/ClaimResponse/",
                  "value": "147710472"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://globemedsaudi.com/Patient/445797"
              },
              "created": "2026-10-22",
              "insurer": {
                "reference": "http://globemedsaudi.com/Organization/445799"
              },
              "requestor": {
                "reference": "http://globemedsaudi.com/Organization/445798"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "5279858260926"
                }
              },
              "outcome": "complete",
              "payeeType": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/payeetype",
                    "code": "provider"
                  }
                ]
              },
              "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": "98557"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "noteNumber": [
                    1
                  ],
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "CV-1-4"
                          },
                          {
                            "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": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "deductible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 14.69,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 18.36,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "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": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 18.36,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "deductible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 14.69,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0,
                    "currency": "SAR"
                  }
                }
              ],
              "processNote": [
                {
                  "number": 1,
                  "type": "display",
                  "text": "The Drug Is Rejected Because It Is Not Considered As Medically Necessary"
                },
                {
                  "number": 1,
                  "type": "display",
                  "text": "The Service Is Rejected Because Of Policy General Exclusion Related To Hair Loss"
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://globemedsaudi.com/Coverage/168589"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Patient/445797",
            "resource": {
              "resourceType": "Patient",
              "id": "445797",
              "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"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2553647229"
                }
              ],
              "active": true,
              "name": [
                {
                  "text": "GHAZEL  osama ALNADAF",
                  "given": [
                    "GHAZEL",
                    "osama",
                    "ALNADAF"
                  ]
                }
              ],
              "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"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "2017-09-09",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "U"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Coverage/168589",
            "resource": {
              "resourceType": "Coverage",
              "id": "168589",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://payer.com/memberid",
                  "value": "44836089"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://globemedsaudi.com/Organization/445800"
              },
              "beneficiary": {
                "reference": "http://globemedsaudi.com/Patient/445797"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://globemedsaudi.com/Organization/445799"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "2581065",
                  "name": "BAAN BAKERY COMPANY FOR BREAD"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/445798",
            "resource": {
              "resourceType": "Organization",
              "id": "445798",
              "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"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/445799",
            "resource": {
              "resourceType": "Organization",
              "id": "445799",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001549059"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/445800",
            "resource": {
              "resourceType": "Organization",
              "id": "445800",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/organization-license",
                  "value": "2581065"
                }
              ],
              "active": true,
              "name": "BAAN BAKERY COMPANY FOR BREAD"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/b3ba83fe-75dd-3561-ada2-ae6c09de0d18",
      "resource": {
        "resourceType": "Bundle",
        "id": "b3ba83fe-75dd-3561-ada2-ae6c09de0d18",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-22T11:31:13.355\u002B03:00",
        "entry": [
          {
            "fullUrl": "http://globemedsaudi.com/MessageHeader/8edfdcc6-7ab7-4523-ba5f-f40cedc5a105",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "8edfdcc6-7ab7-4523-ba5f-f40cedc5a105",
              "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://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/payer-license",
                  "value": "7001463160"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001463160"
              },
              "response": {
                "identifier": "51f9ecf7-0edf-4f2d-b185-e97b1ef00393",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://globemedsaudi.com/ClaimResponse/168603"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/ClaimResponse/168603",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "168603",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-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": "audit"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://globemedsaudi.com/ClaimResponse/",
                  "value": "147710476"
                }
              ],
              "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": "http://globemedsaudi.com/Patient/437406"
              },
              "created": "2026-10-22",
              "insurer": {
                "reference": "http://globemedsaudi.com/Organization/437408"
              },
              "requestor": {
                "reference": "http://globemedsaudi.com/Organization/437407"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "77158370260916"
                }
              },
              "outcome": "complete",
              "payeeType": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/payeetype",
                    "code": "provider"
                  }
                ]
              },
              "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": "partial"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "90044"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "noteNumber": [
                    1
                  ],
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 55,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-6"
                          },
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-7"
                          }
                        ]
                      },
                      "amount": {
                        "value": 44,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 11,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "deductible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 10,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 11,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 63.1,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 44,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 55,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 11,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 6.6,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 63.1,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "deductible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 10,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 11,
                    "currency": "SAR"
                  }
                }
              ],
              "processNote": [
                {
                  "number": 1,
                  "type": "display",
                  "text": "Wrong Vat Applied"
                },
                {
                  "number": 1,
                  "type": "display",
                  "text": "Wrong Calculation Of The PatientS Deductable"
                },
                {
                  "number": 1,
                  "type": "display",
                  "text": "Wrong Calculation Of The PatientS Deductable"
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://globemedsaudi.com/Coverage/168604"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Patient/437406",
            "resource": {
              "resourceType": "Patient",
              "id": "437406",
              "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"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2234053367"
                }
              ],
              "active": true,
              "name": [
                {
                  "text": "ALAA ABDULLAH SIDIK SIDIK",
                  "given": [
                    "ALAA",
                    "SIDIK",
                    "SIDIK"
                  ]
                }
              ],
              "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"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "2007-01-25",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "U"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Coverage/168604",
            "resource": {
              "resourceType": "Coverage",
              "id": "168604",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://payer.com/memberid",
                  "value": "43779113"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://globemedsaudi.com/Organization/437409"
              },
              "beneficiary": {
                "reference": "http://globemedsaudi.com/Patient/437406"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://globemedsaudi.com/Organization/437408"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "2557159",
                  "name": "Small Group-2557159"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/437407",
            "resource": {
              "resourceType": "Organization",
              "id": "437407",
              "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"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/437408",
            "resource": {
              "resourceType": "Organization",
              "id": "437408",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001549059"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/437409",
            "resource": {
              "resourceType": "Organization",
              "id": "437409",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/organization-license",
                  "value": "2557159"
                }
              ],
              "active": true,
              "name": "Small Group-2557159"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/e24b6b6f-6aea-39ad-952e-32b6b321ed6d",
      "resource": {
        "resourceType": "Bundle",
        "id": "e24b6b6f-6aea-39ad-952e-32b6b321ed6d",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-22T11:31:15.010\u002B03:00",
        "entry": [
          {
            "fullUrl": "http://globemedsaudi.com/MessageHeader/8223225d-27bf-1083-b7b2-9a99334b13e9",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "8223225d-27bf-1083-b7b2-9a99334b13e9",
              "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://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/payer-license",
                  "value": "7001463160"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001463160"
              },
              "response": {
                "identifier": "c3b30bdb-152e-4e3a-bf5c-f6a4eaf6ded0",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://globemedsaudi.com/ClaimResponse/168623"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/ClaimResponse/168623",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "168623",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-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": "audit"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://globemedsaudi.com/ClaimResponse/",
                  "value": "147710483"
                }
              ],
              "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": "http://globemedsaudi.com/Patient/437710"
              },
              "created": "2026-10-22",
              "insurer": {
                "reference": "http://globemedsaudi.com/Organization/437712"
              },
              "requestor": {
                "reference": "http://globemedsaudi.com/Organization/437711"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "27166074260920"
                }
              },
              "outcome": "complete",
              "payeeType": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/payeetype",
                    "code": "provider"
                  }
                ]
              },
              "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": "partial"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "93109"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "noteNumber": [
                    1
                  ],
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 39,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-6"
                          },
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-7"
                          }
                        ]
                      },
                      "amount": {
                        "value": 31.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 7.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "deductible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 7.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.68,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 7.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 44.85,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "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-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "93109"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "noteNumber": [
                    2
                  ],
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 30,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-6"
                          },
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-7"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "deductible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 34.35,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 55.2,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 69,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 13.8,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 8.28,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 79.2,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "deductible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 12.8,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 13.8,
                    "currency": "SAR"
                  }
                }
              ],
              "processNote": [
                {
                  "number": 1,
                  "type": "display",
                  "text": "Wrong Calculation Of The PatientS Deductable"
                },
                {
                  "number": 1,
                  "type": "display",
                  "text": "Wrong Vat Applied"
                },
                {
                  "number": 1,
                  "type": "display",
                  "text": "Wrong Calculation Of The PatientS Deductable"
                },
                {
                  "number": 2,
                  "type": "display",
                  "text": "Wrong Vat Applied"
                },
                {
                  "number": 2,
                  "type": "display",
                  "text": "Wrong Calculation Of The PatientS Deductable"
                },
                {
                  "number": 2,
                  "type": "display",
                  "text": "Wrong Calculation Of The PatientS Deductable"
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://globemedsaudi.com/Coverage/168624"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Patient/437710",
            "resource": {
              "resourceType": "Patient",
              "id": "437710",
              "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"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2158019915"
                }
              ],
              "active": true,
              "name": [
                {
                  "text": "HABIBA  muhammad ALI",
                  "given": [
                    "HABIBA",
                    "muhammad",
                    "ALI"
                  ]
                }
              ],
              "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"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "1991-01-01",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "M"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Coverage/168624",
            "resource": {
              "resourceType": "Coverage",
              "id": "168624",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://payer.com/memberid",
                  "value": "43759338"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://globemedsaudi.com/Organization/437713"
              },
              "beneficiary": {
                "reference": "http://globemedsaudi.com/Patient/437710"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://globemedsaudi.com/Organization/437712"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "2561695",
                  "name": "Small Group-2561695"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/437711",
            "resource": {
              "resourceType": "Organization",
              "id": "437711",
              "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"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/437712",
            "resource": {
              "resourceType": "Organization",
              "id": "437712",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001549059"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/437713",
            "resource": {
              "resourceType": "Organization",
              "id": "437713",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/organization-license",
                  "value": "2561695"
                }
              ],
              "active": true,
              "name": "Small Group-2561695"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/b3f8a02a-a050-4399-94f1-e835240dab9b",
      "resource": {
        "resourceType": "Bundle",
        "id": "b3f8a02a-a050-4399-94f1-e835240dab9b",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-22T11:31:15.726\u002B03:00",
        "entry": [
          {
            "fullUrl": "http://globemedsaudi.com/MessageHeader/f95c57f9-db31-2bc4-bb51-5abc241e6ca4",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "f95c57f9-db31-2bc4-bb51-5abc241e6ca4",
              "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://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/payer-license",
                  "value": "7001463160"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001463160"
              },
              "response": {
                "identifier": "9ad67b62-231c-48f5-8165-acc323598891",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://globemedsaudi.com/ClaimResponse/168635"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/ClaimResponse/168635",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "168635",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-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": "audit"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://globemedsaudi.com/ClaimResponse/",
                  "value": "147710485"
                }
              ],
              "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": "http://globemedsaudi.com/Patient/437479"
              },
              "created": "2026-10-22",
              "insurer": {
                "reference": "http://globemedsaudi.com/Organization/437481"
              },
              "requestor": {
                "reference": "http://globemedsaudi.com/Organization/437480"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "21164095260919"
                }
              },
              "outcome": "complete",
              "payeeType": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/payeetype",
                    "code": "provider"
                  }
                ]
              },
              "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": "partial"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "92263"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "noteNumber": [
                    1
                  ],
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 60,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-6"
                          },
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-7"
                          }
                        ]
                      },
                      "amount": {
                        "value": 48,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "deductible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 7.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 69,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "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-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "92263"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "noteNumber": [
                    2
                  ],
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 150,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-6"
                          },
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-7"
                          }
                        ]
                      },
                      "amount": {
                        "value": 120,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 30,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "deductible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 30,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 18,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 30,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 172.5,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 168,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 210,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 42,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 25.2,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 241.5,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "deductible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 42,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 42,
                    "currency": "SAR"
                  }
                }
              ],
              "processNote": [
                {
                  "number": 1,
                  "type": "display",
                  "text": "Wrong Calculation Of The PatientS Deductable"
                },
                {
                  "number": 1,
                  "type": "display",
                  "text": "Wrong Vat Applied"
                },
                {
                  "number": 1,
                  "type": "display",
                  "text": "Wrong Calculation Of The PatientS Deductable"
                },
                {
                  "number": 2,
                  "type": "display",
                  "text": "Wrong Calculation Of The PatientS Deductable"
                },
                {
                  "number": 2,
                  "type": "display",
                  "text": "Wrong Vat Applied"
                },
                {
                  "number": 2,
                  "type": "display",
                  "text": "Wrong Calculation Of The PatientS Deductable"
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://globemedsaudi.com/Coverage/168637"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Patient/437479",
            "resource": {
              "resourceType": "Patient",
              "id": "437479",
              "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"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/nationalid",
                  "value": "1079298830"
                }
              ],
              "active": true,
              "name": [
                {
                  "text": "NORAH  SALEM alfahmi",
                  "given": [
                    "NORAH",
                    "SALEM",
                    "alfahmi"
                  ]
                }
              ],
              "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"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "1989-03-08",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "M"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Coverage/168637",
            "resource": {
              "resourceType": "Coverage",
              "id": "168637",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://payer.com/memberid",
                  "value": "43727837"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://globemedsaudi.com/Organization/437482"
              },
              "beneficiary": {
                "reference": "http://globemedsaudi.com/Patient/437479"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://globemedsaudi.com/Organization/437481"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "2574742",
                  "name": "Small Group-2574742"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/437480",
            "resource": {
              "resourceType": "Organization",
              "id": "437480",
              "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"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/437481",
            "resource": {
              "resourceType": "Organization",
              "id": "437481",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001549059"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/437482",
            "resource": {
              "resourceType": "Organization",
              "id": "437482",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/organization-license",
                  "value": "2574742"
                }
              ],
              "active": true,
              "name": "Small Group-2574742"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/3e233baa-6658-1ef9-9ce8-5979742480fb",
      "resource": {
        "resourceType": "Bundle",
        "id": "3e233baa-6658-1ef9-9ce8-5979742480fb",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-22T11:31:17.119\u002B03:00",
        "entry": [
          {
            "fullUrl": "http://globemedsaudi.com/MessageHeader/0df9103c-a2f0-373e-a5c2-f91c33f984f2",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "0df9103c-a2f0-373e-a5c2-f91c33f984f2",
              "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://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/payer-license",
                  "value": "7001463160"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001463160"
              },
              "response": {
                "identifier": "e6b5be97-4249-44d7-9b05-53488be34042",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://globemedsaudi.com/ClaimResponse/168664"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/ClaimResponse/168664",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "168664",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-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": "audit"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://globemedsaudi.com/ClaimResponse/",
                  "value": "147710496"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://globemedsaudi.com/Patient/444685"
              },
              "created": "2026-10-22",
              "insurer": {
                "reference": "http://globemedsaudi.com/Organization/444687"
              },
              "requestor": {
                "reference": "http://globemedsaudi.com/Organization/444686"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "36257028260916"
                }
              },
              "outcome": "complete",
              "payeeType": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/payeetype",
                    "code": "provider"
                  }
                ]
              },
              "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": "89554"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 13.63,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 10.9,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.73,
                        "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
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.73,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 13.63,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 10.9,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 13.63,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 2.73,
                    "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": 13.63,
                    "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": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 2.73,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://globemedsaudi.com/Coverage/168665"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Patient/444685",
            "resource": {
              "resourceType": "Patient",
              "id": "444685",
              "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"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/bordernumber",
                  "value": "4788457283"
                }
              ],
              "active": true,
              "name": [
                {
                  "text": "fatemah tareq  MUHAMMAD",
                  "given": [
                    "fatemah",
                    "MUHAMMAD",
                    "MUHAMMAD"
                  ]
                }
              ],
              "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"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "2006-07-07",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "M"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Coverage/168665",
            "resource": {
              "resourceType": "Coverage",
              "id": "168665",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://payer.com/memberid",
                  "value": "44140471"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://globemedsaudi.com/Organization/444688"
              },
              "beneficiary": {
                "reference": "http://globemedsaudi.com/Patient/444685"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://globemedsaudi.com/Organization/444687"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "2540657",
                  "name": "Madaras Al-Amjad Eli-2540657"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/444686",
            "resource": {
              "resourceType": "Organization",
              "id": "444686",
              "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"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/444687",
            "resource": {
              "resourceType": "Organization",
              "id": "444687",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001549059"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/444688",
            "resource": {
              "resourceType": "Organization",
              "id": "444688",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/organization-license",
                  "value": "2540657"
                }
              ],
              "active": true,
              "name": "Madaras Al-Amjad Eli-2540657"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/54b17b89-7ded-14c4-bd00-444968560a2b",
      "resource": {
        "resourceType": "Bundle",
        "id": "54b17b89-7ded-14c4-bd00-444968560a2b",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-22T11:31:17.725\u002B03:00",
        "entry": [
          {
            "fullUrl": "http://globemedsaudi.com/MessageHeader/b6db276f-531d-5752-8212-1bab5be2fe0b",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "b6db276f-531d-5752-8212-1bab5be2fe0b",
              "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://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/payer-license",
                  "value": "7001463160"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001463160"
              },
              "response": {
                "identifier": "013a7c67-4cc7-4645-8125-732df13c7f6b",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://globemedsaudi.com/ClaimResponse/168666"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/ClaimResponse/168666",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "168666",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-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": "audit"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://globemedsaudi.com/ClaimResponse/",
                  "value": "147710497"
                }
              ],
              "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": "http://globemedsaudi.com/Patient/438961"
              },
              "created": "2026-10-22",
              "insurer": {
                "reference": "http://globemedsaudi.com/Organization/438963"
              },
              "requestor": {
                "reference": "http://globemedsaudi.com/Organization/438962"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "58184733260927"
                }
              },
              "outcome": "complete",
              "payeeType": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/payeetype",
                    "code": "provider"
                  }
                ]
              },
              "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": "100167"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 30,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6,
                        "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
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 33.6,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "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": "100167"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 54,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 43.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 10.8,
                        "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": 3
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.48,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 10.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 60.48,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "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": "100167"
                      }
                    }
                  ],
                  "itemSequence": 3,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 96,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 76.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 19.2,
                        "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
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 11.52,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 19.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 107.52,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "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": "100167"
                      }
                    }
                  ],
                  "itemSequence": 4,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 19.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.8,
                        "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
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.88,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 26.88,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "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": "100167"
                      }
                    }
                  ],
                  "itemSequence": 5,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 60,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 48,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12,
                        "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
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 7.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 67.2,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 211.2,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 264,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 52.8,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 31.68,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 295.68,
                    "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": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 52.8,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://globemedsaudi.com/Coverage/168667"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Patient/438961",
            "resource": {
              "resourceType": "Patient",
              "id": "438961",
              "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"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2625754086"
                }
              ],
              "active": true,
              "name": [
                {
                  "text": "ASMAA  ishaq raheem",
                  "given": [
                    "ASMAA",
                    "ishaq",
                    "raheem"
                  ]
                }
              ],
              "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"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "2000-01-01",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "M"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Coverage/168667",
            "resource": {
              "resourceType": "Coverage",
              "id": "168667",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://payer.com/memberid",
                  "value": "44111011"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://globemedsaudi.com/Organization/438964"
              },
              "beneficiary": {
                "reference": "http://globemedsaudi.com/Patient/438961"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://globemedsaudi.com/Organization/438963"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "2559170",
                  "name": "nezar qader"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/438962",
            "resource": {
              "resourceType": "Organization",
              "id": "438962",
              "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"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/438963",
            "resource": {
              "resourceType": "Organization",
              "id": "438963",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001549059"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/438964",
            "resource": {
              "resourceType": "Organization",
              "id": "438964",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/organization-license",
                  "value": "2559170"
                }
              ],
              "active": true,
              "name": "nezar qader"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/9b74f533-9dc5-42e7-bbe6-dfa1e91859d1",
      "resource": {
        "resourceType": "Bundle",
        "id": "9b74f533-9dc5-42e7-bbe6-dfa1e91859d1",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-22T11:31:18.817\u002B03:00",
        "entry": [
          {
            "fullUrl": "http://globemedsaudi.com/MessageHeader/20b05862-8c85-1fb2-8972-7ecd400549d0",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "20b05862-8c85-1fb2-8972-7ecd400549d0",
              "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://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/payer-license",
                  "value": "7001463160"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001463160"
              },
              "response": {
                "identifier": "9bc43baf-f5df-4fd8-9866-97a1254b3d22",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://globemedsaudi.com/ClaimResponse/168683"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/ClaimResponse/168683",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "168683",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-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": "audit"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://globemedsaudi.com/ClaimResponse/",
                  "value": "147710500"
                }
              ],
              "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": "http://globemedsaudi.com/Patient/434102"
              },
              "created": "2026-10-22",
              "insurer": {
                "reference": "http://globemedsaudi.com/Organization/434104"
              },
              "requestor": {
                "reference": "http://globemedsaudi.com/Organization/434103"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "38125591260902"
                }
              },
              "outcome": "complete",
              "payeeType": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/payeetype",
                    "code": "provider"
                  }
                ]
              },
              "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": "76686"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 40,
                        "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": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8,
                        "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
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 44.8,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "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": "76686"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "noteNumber": [
                    1
                  ],
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "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": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "deductible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 50.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 70.56,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "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-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76686"
                      }
                    }
                  ],
                  "itemSequence": 3,
                  "noteNumber": [
                    2
                  ],
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 33,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "CV-3-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 26.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "deductible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 26.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.96,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 73.92,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 58.4,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 73,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 14.6,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 8.76,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 189.28,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "deductible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 76.8,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 14.6,
                    "currency": "SAR"
                  }
                }
              ],
              "processNote": [
                {
                  "number": 1,
                  "type": "display",
                  "text": "The ItemService Is Rejected Because It Is Not Considered As Medically Necessary"
                },
                {
                  "number": 2,
                  "type": "display",
                  "text": "Max Qty Approved By Globemed Saudi"
                },
                {
                  "number": 2,
                  "type": "display",
                  "text": "Max Qty Approved By Globemed Saudi"
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://globemedsaudi.com/Coverage/168684"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Patient/434102",
            "resource": {
              "resourceType": "Patient",
              "id": "434102",
              "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"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2024589901"
                }
              ],
              "active": true,
              "name": [
                {
                  "text": "HAJERA KHATIU azeez ahman",
                  "given": [
                    "HAJERA",
                    "azeez",
                    "ahman"
                  ]
                }
              ],
              "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"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "1957-07-01",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "M"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Coverage/168684",
            "resource": {
              "resourceType": "Coverage",
              "id": "168684",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://payer.com/memberid",
                  "value": "43999506"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://globemedsaudi.com/Organization/434105"
              },
              "beneficiary": {
                "reference": "http://globemedsaudi.com/Patient/434102"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://globemedsaudi.com/Organization/434104"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "2543463",
                  "name": "SME-2543463"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/434103",
            "resource": {
              "resourceType": "Organization",
              "id": "434103",
              "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"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/434104",
            "resource": {
              "resourceType": "Organization",
              "id": "434104",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001549059"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/434105",
            "resource": {
              "resourceType": "Organization",
              "id": "434105",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/organization-license",
                  "value": "2543463"
                }
              ],
              "active": true,
              "name": "SME-2543463"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/5c1c2942-4fd0-2e22-90bd-badc41980d7a",
      "resource": {
        "resourceType": "Bundle",
        "id": "5c1c2942-4fd0-2e22-90bd-badc41980d7a",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-22T11:31:19.608\u002B03:00",
        "entry": [
          {
            "fullUrl": "http://globemedsaudi.com/MessageHeader/753f1601-9203-4f7e-927b-25894c2d6c07",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "753f1601-9203-4f7e-927b-25894c2d6c07",
              "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://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/payer-license",
                  "value": "7001463160"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001463160"
              },
              "response": {
                "identifier": "393906f4-05ac-4e0a-b403-3c3f7031495d",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://globemedsaudi.com/ClaimResponse/168699"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/ClaimResponse/168699",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "168699",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-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": "audit"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://globemedsaudi.com/ClaimResponse/",
                  "value": "147710505"
                }
              ],
              "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": "http://globemedsaudi.com/Patient/478888"
              },
              "created": "2026-10-22",
              "insurer": {
                "reference": "http://globemedsaudi.com/Organization/478890"
              },
              "requestor": {
                "reference": "http://globemedsaudi.com/Organization/478889"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "73183368260927"
                }
              },
              "outcome": "complete",
              "payeeType": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/payeetype",
                    "code": "provider"
                  }
                ]
              },
              "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": "99737"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 159,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 127.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 31.8,
                        "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
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 19.08,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 31.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 178.08,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "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": "99737"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 30,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6,
                        "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
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 33.6,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "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": "99737"
                      }
                    }
                  ],
                  "itemSequence": 3,
                  "noteNumber": [
                    1
                  ],
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "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": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "deductible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 76.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 107.52,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 151.2,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 189,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 37.8,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 22.68,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 319.2,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "deductible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 76.8,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 37.8,
                    "currency": "SAR"
                  }
                }
              ],
              "processNote": [
                {
                  "number": 1,
                  "type": "display",
                  "text": "The ItemService Is Rejected Because It Is Not Considered As Medically Necessary"
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://globemedsaudi.com/Coverage/168700"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Patient/478888",
            "resource": {
              "resourceType": "Patient",
              "id": "478888",
              "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"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2047135120"
                }
              ],
              "active": true,
              "name": [
                {
                  "text": "USAMA ABDULLATIF ALNDAF ALNADDAF",
                  "given": [
                    "USAMA",
                    "ALNDAF",
                    "ALNADDAF"
                  ]
                }
              ],
              "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"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "1990-01-18",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "M"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Coverage/168700",
            "resource": {
              "resourceType": "Coverage",
              "id": "168700",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://payer.com/memberid",
                  "value": "44190204"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://globemedsaudi.com/Organization/478891"
              },
              "beneficiary": {
                "reference": "http://globemedsaudi.com/Patient/478888"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://globemedsaudi.com/Organization/478890"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "2581065",
                  "name": "BAAN BAKERY COMPANY FOR BREAD"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/478889",
            "resource": {
              "resourceType": "Organization",
              "id": "478889",
              "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"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/478890",
            "resource": {
              "resourceType": "Organization",
              "id": "478890",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001549059"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/478891",
            "resource": {
              "resourceType": "Organization",
              "id": "478891",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/organization-license",
                  "value": "2581065"
                }
              ],
              "active": true,
              "name": "BAAN BAKERY COMPANY FOR BREAD"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/73dcd6f0-5a60-4f3b-bf9c-a3ec27d2bb5e",
      "resource": {
        "resourceType": "Bundle",
        "id": "73dcd6f0-5a60-4f3b-bf9c-a3ec27d2bb5e",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-22T11:31:20.294\u002B03:00",
        "entry": [
          {
            "fullUrl": "http://globemedsaudi.com/MessageHeader/7cc2a617-c336-15eb-8420-1356ecc06b7a",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "7cc2a617-c336-15eb-8420-1356ecc06b7a",
              "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://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/payer-license",
                  "value": "7001463160"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001463160"
              },
              "response": {
                "identifier": "c378c8ba-00a8-4c99-8bf8-f17d826d30e2",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://globemedsaudi.com/ClaimResponse/168707"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/ClaimResponse/168707",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "168707",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-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": "audit"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://globemedsaudi.com/ClaimResponse/",
                  "value": "147710507"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://globemedsaudi.com/Patient/445134"
              },
              "created": "2026-10-22",
              "insurer": {
                "reference": "http://globemedsaudi.com/Organization/445136"
              },
              "requestor": {
                "reference": "http://globemedsaudi.com/Organization/445135"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "97268121260921"
                }
              },
              "outcome": "complete",
              "payeeType": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/payeetype",
                    "code": "provider"
                  }
                ]
              },
              "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": "93912"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 10.21,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.17,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.04,
                        "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
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.04,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 10.21,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "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": "93912"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "noteNumber": [
                    1
                  ],
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "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-3-7"
                          },
                          {
                            "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": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "deductible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 21.96,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 27.45,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 8.17,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 10.21,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 2.04,
                    "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": 37.66,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "deductible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 21.96,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 2.04,
                    "currency": "SAR"
                  }
                }
              ],
              "processNote": [
                {
                  "number": 1,
                  "type": "display",
                  "text": "Recugel Age Should Be Between 4745 And 40150 Days. The Age Of The Patient Is 2428 Days."
                },
                {
                  "number": 1,
                  "type": "display",
                  "text": "The Drug Is Rejected Because Of Age Incompatibility"
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://globemedsaudi.com/Coverage/168708"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Patient/445134",
            "resource": {
              "resourceType": "Patient",
              "id": "445134",
              "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"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2491719536"
                }
              ],
              "active": true,
              "name": [
                {
                  "text": "ZOBEDh  ismail GAMURALDEEN",
                  "given": [
                    "ZOBEDh",
                    "ismail",
                    "GAMURALDEEN"
                  ]
                }
              ],
              "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"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "2020-02-12",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "M"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Coverage/168708",
            "resource": {
              "resourceType": "Coverage",
              "id": "168708",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://payer.com/memberid",
                  "value": "44157499"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://globemedsaudi.com/Organization/445137"
              },
              "beneficiary": {
                "reference": "http://globemedsaudi.com/Patient/445134"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://globemedsaudi.com/Organization/445136"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "2546607",
                  "name": "Small Group-2546607"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/445135",
            "resource": {
              "resourceType": "Organization",
              "id": "445135",
              "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"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/445136",
            "resource": {
              "resourceType": "Organization",
              "id": "445136",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001549059"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/445137",
            "resource": {
              "resourceType": "Organization",
              "id": "445137",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/organization-license",
                  "value": "2546607"
                }
              ],
              "active": true,
              "name": "Small Group-2546607"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/a834eea4-b915-5c42-a53c-3481528feccc",
      "resource": {
        "resourceType": "Bundle",
        "id": "a834eea4-b915-5c42-a53c-3481528feccc",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-22T11:31:20.990\u002B03:00",
        "entry": [
          {
            "fullUrl": "http://globemedsaudi.com/MessageHeader/b30ab3c6-acf6-3636-9234-6e0fda60ec87",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "b30ab3c6-acf6-3636-9234-6e0fda60ec87",
              "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://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/payer-license",
                  "value": "7001463160"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001463160"
              },
              "response": {
                "identifier": "c3b9509e-f732-4629-969b-9f4780b50961",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://globemedsaudi.com/ClaimResponse/168730"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/ClaimResponse/168730",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "168730",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-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": "audit"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://globemedsaudi.com/ClaimResponse/",
                  "value": "147710512"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://globemedsaudi.com/Patient/444724"
              },
              "created": "2026-10-22",
              "insurer": {
                "reference": "http://globemedsaudi.com/Organization/444726"
              },
              "requestor": {
                "reference": "http://globemedsaudi.com/Organization/444725"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "90256715260916"
                }
              },
              "outcome": "complete",
              "payeeType": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/payeetype",
                    "code": "provider"
                  }
                ]
              },
              "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": "89446"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 69.97,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 57.1,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.87,
                        "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
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.87,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 69.97,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "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-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "89446"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "noteNumber": [
                    1
                  ],
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 17.86,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-6"
                          }
                        ]
                      },
                      "amount": {
                        "value": 9.92,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 9.93,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "deductible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 7.94,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 9.93,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 17.86,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "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": "89446"
                      }
                    }
                  ],
                  "itemSequence": 3,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 39.1,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 31.28,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 7.82,
                        "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
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 7.82,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 39.1,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "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": "89446"
                      }
                    }
                  ],
                  "itemSequence": 4,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 46.53,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 37.22,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 9.31,
                        "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
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 9.31,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 46.53,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 135.52,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 173.46,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 39.93,
                    "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": 173.46,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "deductible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 7.94,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 39.93,
                    "currency": "SAR"
                  }
                }
              ],
              "processNote": [
                {
                  "number": 1,
                  "type": "display",
                  "text": "Discount Calculated Is Different From The Agreed Upon"
                },
                {
                  "number": 1,
                  "type": "display",
                  "text": "Discount Calculated Is Different From The Agreed Upon"
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://globemedsaudi.com/Coverage/168731"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Patient/444724",
            "resource": {
              "resourceType": "Patient",
              "id": "444724",
              "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"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2216371357"
                }
              ],
              "active": true,
              "name": [
                {
                  "text": "SOHEB ABDULSALAM MOHAMMED BAKHSH",
                  "given": [
                    "SOHEB",
                    "MOHAMMED",
                    "BAKHSH"
                  ]
                }
              ],
              "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"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "2004-06-02",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "U"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Coverage/168731",
            "resource": {
              "resourceType": "Coverage",
              "id": "168731",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://payer.com/memberid",
                  "value": "43787465"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://globemedsaudi.com/Organization/444727"
              },
              "beneficiary": {
                "reference": "http://globemedsaudi.com/Patient/444724"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://globemedsaudi.com/Organization/444726"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "2548606",
                  "name": "Mubarak Ali Bin Omar Al Shamrani General Contracting Est"
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/444725",
            "resource": {
              "resourceType": "Organization",
              "id": "444725",
              "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"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/444726",
            "resource": {
              "resourceType": "Organization",
              "id": "444726",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001549059"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://globemedsaudi.com/Organization/444727",
            "resource": {
              "resourceType": "Organization",
              "id": "444727",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/organization-license",
                  "value": "2548606"
                }
              ],
              "active": true,
              "name": "Mubarak Ali Bin Omar Al Shamrani General Contracting Est"
            }
          }
        ]
      }
    },
    {
      "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"
      }
    }
  ]
}

No stored-procedure executions recorded

Either the poll failed before reaching the database, or SQL capture is switched off in the Diagnostics configuration section.