@prefix fhir: . @prefix owl: . @prefix rdfs: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:ClaimResponse; fhir:nodeRole fhir:treeRoot; fhir:Resource.id [ fhir:value "example-01"]; fhir:Resource.meta [ fhir:Meta.profile [ fhir:value "https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse"; fhir:index 0; fhir:link ] ]; fhir:DomainResource.text [ fhir:Narrative.status [ fhir:value "generated" ]; fhir:Narrative.div "

Generated Narrative: ClaimResponse

Resource ClaimResponse \"example-01\"

Profile: ClaimResponse

identifier: id: R3500

status: active

type: Oral (Claim Type Codes#oral)

subType: Emergency Claim (Example Claim SubType Codes#emergency)

use: claim

patient: Patient/example-01 \"\"

created: 2014-08-16

insurer:

requestor: Organization/example-01 \"XYZ Lab Pvt.Ltd.\"

request: Claim/example-01

outcome: complete

disposition: Claim settled as per contract.

payeeType: Provider (Claim Payee Type Codes#provider)

item

itemSequence: 1

adjudication

category: Eligible Amount (Adjudication Value Codes#eligible)

reason: Not covered (Adjudication Reason Codes#ar001)

Amounts

-ValueCurrency
*135.57INR

adjudication

category: CoPay (Adjudication Value Codes#copay)

reason: Not covered (Adjudication Reason Codes#ar001)

Amounts

-ValueCurrency
*10.00INR

adjudication

category: Eligible % (Adjudication Value Codes#eligpercent)

reason: Not covered (Adjudication Reason Codes#ar001)

value: 80.00

adjudication

category: benefit ([not stated]#benefit)

reason: Plan Limit Reached (Adjudication Reason Codes#ar002)

Amounts

-ValueCurrency
*90.47INR

total

category: Submitted Amount (Adjudication Value Codes#submitted)

Amounts

-ValueCurrency
*135.57INR

total

category: Benefit Amount (Adjudication Value Codes#benefit)

Amounts

-ValueCurrency
*90.47INR

payment

type: Complete (Example Payment Type Codes#complete)

date: 2014-08-31

Amounts

-ValueCurrency
*100.47INR

identifier: id: 201408-2-1569478

" ]; fhir:ClaimResponse.identifier [ fhir:index 0; fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/remittance" ]; fhir:Identifier.value [ fhir:value "R3500" ] ]; fhir:ClaimResponse.status [ fhir:value "active"]; fhir:ClaimResponse.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ]; fhir:Coding.code [ fhir:value "oral" ] ] ]; fhir:ClaimResponse.subType [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-claimsubtype" ]; fhir:Coding.code [ fhir:value "emergency" ] ] ]; fhir:ClaimResponse.use [ fhir:value "claim"]; fhir:ClaimResponse.patient [ fhir:link ; fhir:Reference.reference [ fhir:value "Patient/example-01" ] ]; fhir:ClaimResponse.created [ fhir:value "2014-08-16"^^xsd:date]; fhir:ClaimResponse.insurer [ fhir:Reference.identifier [ fhir:Identifier.system [ fhir:value "http://www.jurisdiction.org/insurers" ]; fhir:Identifier.value [ fhir:value "555123" ] ] ]; fhir:ClaimResponse.requestor [ fhir:link ; fhir:Reference.reference [ fhir:value "Organization/example-01" ] ]; fhir:ClaimResponse.request [ fhir:link ; fhir:Reference.reference [ fhir:value "Claim/example-01" ] ]; fhir:ClaimResponse.outcome [ fhir:value "complete"]; fhir:ClaimResponse.disposition [ fhir:value "Claim settled as per contract."]; fhir:ClaimResponse.payeeType [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payeetype" ]; fhir:Coding.code [ fhir:value "provider" ] ] ]; fhir:ClaimResponse.item [ fhir:index 0; fhir:ClaimResponse.item.itemSequence [ fhir:value "1"^^xsd:positiveInteger ]; fhir:ClaimResponse.item.adjudication [ fhir:index 0; fhir:ClaimResponse.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "eligible" ] ] ]; fhir:ClaimResponse.item.adjudication.reason [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication-reason" ]; fhir:Coding.code [ fhir:value "ar001" ]; fhir:Coding.display [ fhir:value "Not covered" ] ] ]; fhir:ClaimResponse.item.adjudication.amount [ fhir:Money.value [ fhir:value "135.57"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "INR" ] ] ], [ fhir:index 1; fhir:ClaimResponse.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "copay" ] ] ]; fhir:ClaimResponse.item.adjudication.reason [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication-reason" ]; fhir:Coding.code [ fhir:value "ar001" ]; fhir:Coding.display [ fhir:value "Not covered" ] ] ]; fhir:ClaimResponse.item.adjudication.amount [ fhir:Money.value [ fhir:value "10.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "INR" ] ] ], [ fhir:index 2; fhir:ClaimResponse.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "eligpercent" ] ] ]; fhir:ClaimResponse.item.adjudication.reason [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication-reason" ]; fhir:Coding.code [ fhir:value "ar001" ]; fhir:Coding.display [ fhir:value "Not covered" ] ] ]; fhir:ClaimResponse.item.adjudication.value [ fhir:value "80.00"^^xsd:decimal ] ], [ fhir:index 3; fhir:ClaimResponse.item.adjudication.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "benefit" ] ] ]; fhir:ClaimResponse.item.adjudication.reason [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication-reason" ]; fhir:Coding.code [ fhir:value "ar002" ]; fhir:Coding.display [ fhir:value "Plan Limit Reached" ] ] ]; fhir:ClaimResponse.item.adjudication.amount [ fhir:Money.value [ fhir:value "90.47"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "INR" ] ] ] ]; fhir:ClaimResponse.total [ fhir:index 0; fhir:ClaimResponse.total.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "submitted" ] ] ]; fhir:ClaimResponse.total.amount [ fhir:Money.value [ fhir:value "135.57"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "INR" ] ] ], [ fhir:index 1; fhir:ClaimResponse.total.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ]; fhir:Coding.code [ fhir:value "benefit" ] ] ]; fhir:ClaimResponse.total.amount [ fhir:Money.value [ fhir:value "90.47"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "INR" ] ] ]; fhir:ClaimResponse.payment [ fhir:ClaimResponse.payment.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-paymenttype" ]; fhir:Coding.code [ fhir:value "complete" ] ] ]; fhir:ClaimResponse.payment.date [ fhir:value "2014-08-31"^^xsd:date ]; fhir:ClaimResponse.payment.amount [ fhir:Money.value [ fhir:value "100.47"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "INR" ] ]; fhir:ClaimResponse.payment.identifier [ fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/paymentidentifier" ]; fhir:Identifier.value [ fhir:value "201408-2-1569478" ] ] ] . # - ontology header ------------------------------------------------------------ a owl:Ontology; owl:imports fhir:fhir.ttl . # -------------------------------------------------------------------------------------