Dr. Harish Kumar Health claims and medical audit

NHCX claim bundle checks

Paste a sample FHIR claim bundle and see what is missing or inconsistent before it goes to the National Health Claims Exchange (NHCX). Synthetic data only.

The question it answers

Is this claim bundle complete and consistent before it is sent?

You give it: A FHIR claim bundle as JSON: a synthetic sample, your edit of it, or your own.

You get: A list of findings, each with where it is, what was found and what was expected.

The idea

A claim travels as a structured bundle, so the check is whether every part is present, points to something real and adds up.

Rules that run, in order

  1. The bundle holds a Claim
  2. Required elements for the Claim, Patient, Organization and Coverage
  3. Every reference resolves to the right kind of resource
  4. Item amounts add up to the claim total
  5. Amounts in rupees and dates that exist

How well the rules are sourced

The required elements are read from the NRCeS profile pages (Official text); the full specification was not checked for every cardinality. The reference, total, currency and date checks are the author’s own (Draft) and are labelled so.

What it does not do

It does not certify a bundle, does not connect to NHCX, and must never be used with real patient data.

Steps

  1. Load or paste a bundle. Pick a synthetic sample or edit the JSON in the box. Nothing leaves your browser, so do not paste real patient data.
  2. The shape is checked. It must be a Bundle with entries, each holding a resource, and it must contain a Claim.
  3. Required elements are checked. For the Claim, Patient, Organization and Coverage, the worksheet looks for the elements the NRCeS profile pages show as required.
  4. References must resolve. Every reference has to point to a resource inside the bundle, and to the right kind of resource.
  5. Sanity checks. Item amounts must add up to the claim total, amounts must be in rupees, and dates must exist. These are my own checks and are labelled as such, not as profile rules.
  6. Read the findings. Each finding names the place, what was found and what was expected, and whether it came from the profile or from a sanity check. This is a structure check, not certification.

Every case on this site is synthetic. These are working drafts and illustrations, not a claim decision or legal advice. The interactive worksheets need JavaScript; nothing is sent anywhere.