{
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    "Header": {
      "SenderID": "Docmate",
      "ReceiverID": "TPA002",
      "TransactionDate": "11/10/2024 22:05",
      "RecordCount": "1",
      "DispositionFlag": "TEST",
      "PayerID": "INS027"
    },
    "Claim": [
      {
        "ID": "TPA002_INS027_11_10_2024_24765_100060",
        "IDPayer": null,
        "Type": "Submission",
        "MemberId": "11223344",
        "DispensedID": null,
        "ProviderID": "Docmate",
        "Weight": null,
        "NationalIDNumber": "784-1990-0518093-2",
        "Gross": "55.00",
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        "ReferenceNumber": null,
        "DateOfBirth": "31/03/1990 00:00",
        "Gender": "Male",
        "Encounter": {
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          "PatientID": "100060",
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          "End": "11/10/2024 00:00",
          "StartType": "1",
          "EndType": "1",
          "TransferSource": null,
          "TransferDestination": null
        },
        "Diagnosis": [
          {
            "Type": "Principal",
            "Code": "A01.00",
            "DxInfo": null
          },
          {
            "Type": "Secondary",
            "Code": "S50.01XA",
            "DxInfo": null
          },
          {
            "Type": "Secondary",
            "Code": "S50.01XD",
            "DxInfo": null
          },
          {
            "Type": "Secondary",
            "Code": "S50.01XS",
            "DxInfo": null
          }
        ],
        "Activity": [
          {
            "ID": "1",
            "ActivityReference": null,
            "Start": "11/10/2024 00:00",
            "Type": "8",
            "Code": "10.01",
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            "Unit": null,
            "Net": "0.00",
            "Clinician": "D4422",
            "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",
                "ValueType": "Other"
              },
              {
                "Type": "OfflineAuthorization",
                "Code": "OfflineAuthorization",
                "Value": "1",
                "ValueType": "OfflineAuthorization"
              }
            ]
          },
          {
            "ID": "2",
            "ActivityReference": null,
            "Start": "11/10/2024 00:00",
            "Type": "3",
            "Code": "80061",
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            "Quantity": "1.00",
            "Unit": null,
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            "Duration": null,
            "UnitId": null,
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            "RoutOfAdmin": null,
            "Instructions": null,
            "Frequency": null,
            "PriorAuthorizationID": null,
            "DenialCode": null,
            "List": null,
            "PaymentAmount": null,
            "DispensedActivityID": null,
            "Observation": [
              {
                "Type": "OfflineAuthorization",
                "Code": "OfflineAuthorization",
                "Value": "2",
                "ValueType": "OfflineAuthorization"
              }
            ]
          },
          {
            "ID": "3",
            "ActivityReference": null,
            "Start": "11/10/2024 00:00",
            "Type": "3",
            "Code": "96375",
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            "Quantity": "1.00",
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            "RoutOfAdmin": null,
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            "Frequency": null,
            "PriorAuthorizationID": null,
            "DenialCode": null,
            "List": null,
            "PaymentAmount": null,
            "DispensedActivityID": null,
            "Observation": [
              {
                "Type": "OfflineAuthorization",
                "Code": "OfflineAuthorization",
                "Value": "3",
                "ValueType": "OfflineAuthorization"
              }
            ]
          },
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            "ID": "4",
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            "Start": "11/10/2024 00:00",
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            "PriorAuthorizationID": null,
            "DenialCode": null,
            "List": null,
            "PaymentAmount": null,
            "DispensedActivityID": null,
            "Observation": [
              {
                "Type": "OfflineAuthorization",
                "Code": "OfflineAuthorization",
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                "ValueType": "OfflineAuthorization"
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            ]
          }
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        "Resubmission": null
      }
    ]
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}