{
"claimId": "CLM-001",
"patient": {
"name": "John Doe",
"dob": "1985-06-15",
"gender": "Male",
"address": "123 Main St, Anytown, USA",
"insurance": {
"provider": "Blue Cross",
"policyNumber": "BC123456789",
"groupNumber": "GRP987654"
}
},
"provider": {
"name": "Dr. Smith",
"npi": "1234567890",
"specialty": "Internal Medicine"
},
"diagnosis": [
{
"code": "J10.1",
"description": "Influenza with other respiratory manifestations, seasonal influenza virus identified"
},
{
"code": "E86.0",
"description": "Dehydration"
}
],
"procedures": [
{
"code": "99213",
"description": "Office or other outpatient visit"
}
],
"status": "Approved",
"processedDate": "2023-05-15T14:30:00Z",
"amount": {
"billed": 150.00,
"allowed": 120.00,
"paid": 96.00,
"patientResponsibility": 24.00
}
}