{
  "Submission": {
    "Header": {
      "SenderID": "7109",
      "ReceiverID": "TPA004",
      "TransactionDate": "27/09/2023 16:09",
      "RecordCount": "1",
      "DispositionFlag": "TEST",
      "PayerID": "INS008"
    },
    "Claim": [
      {
        "ID": "TPA004_INS008_27_09_2023_9_37",
        "IDPayer": null,
        "Type": "Submission",
        "MemberId": "sdfsdfsdfsf22",
        "DispensedID": null,
        "ProviderID": "7109",
        "Weight": null,
        "NationalIDNumber": "999-9999-9999999-9",
        "Gross": "70.00",
        "PatientShare": "20.0",
        "Net": "50.00",
        "ReferenceNumber": null,
        "DateOfBirth": "26/09/1991 00:00",
        "Gender": "Male",
        "Encounter": {
          "FacilityID": "7109",
          "Type": "1",
          "PatientID": "37",
          "Start": "27/09/2023 00:00",
          "End": "27/09/2023 00:00",
          "StartType": "1",
          "EndType": "1",
          "TransferSource": null,
          "TransferDestination": null
        },
        "Diagnosis": [
          {
            "Type": "Principal",
            "Code": "R50.9",
            "DxInfo": null
          },
          {
            "Type": "Secondary",
            "Code": "M79.10",
            "DxInfo": null
          }
        ],
        "Activity": [
          {
            "ID": "1",
            "ActivityReference": null,
            "Start": "27/09/2023 00:00",
            "Type": "8",
            "Code": "9",
            "Location": null,
            "Quantity": "1.00",
            "Unit": null,
            "Net": "5.00",
            "Clinician": "D72194",
            "PatientShare": null,
            "Duration": null,
            "UnitId": null,
            "Refills": null,
            "RoutOfAdmin": null,
            "Instructions": null,
            "Frequency": null,
            "PriorAuthorizationID": null,
            "DenialCode": null,
            "List": null,
            "PaymentAmount": null,
            "DispensedActivityID": null,
            "Observation": [
              {
                "Type": "Text",
                "Code": "Description",
                "Value": "FEVER AND COLD",
                "ValueType": "Other"
              }
            ]
          },
          {
            "ID": "2",
            "ActivityReference": null,
            "Start": "27/09/2023 00:00",
            "Type": "3",
            "Code": "80061",
            "Location": null,
            "Quantity": "1.00",
            "Unit": null,
            "Net": "45.00",
            "Clinician": "D72194",
            "PatientShare": null,
            "Duration": null,
            "UnitId": null,
            "Refills": null,
            "RoutOfAdmin": null,
            "Instructions": null,
            "Frequency": null,
            "PriorAuthorizationID": null,
            "DenialCode": null,
            "List": null,
            "PaymentAmount": null,
            "DispensedActivityID": null,
            "Observation": []
          }
        ],
        "Resubmission": null
      }
    ]
  }
}