FHIR Implementation Guide for ABDM
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FHIR Implementation Guide for ABDM - Local Development build (v3.0.1). See the Directory of published versions

: ClaimResponse/example-01 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - 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 <https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ClaimResponse</b><a name=\"example-01\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource ClaimResponse \"example-01\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ClaimResponse.html\">ClaimResponse</a></p></div><p><b>identifier</b>: id: R3500</p><p><b>status</b>: active</p><p><b>type</b>: Oral <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#oral)</span></p><p><b>subType</b>: Emergency Claim <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-ex-claimsubtype.html\">Example Claim SubType Codes</a>#emergency)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient-example-01.html\">Patient/example-01</a> \"\"</p><p><b>created</b>: 2014-08-16</p><p><b>insurer</b>: <span></span></p><p><b>requestor</b>: <a href=\"Organization-example-01.html\">Organization/example-01</a> \"XYZ Lab Pvt.Ltd.\"</p><p><b>request</b>: <a href=\"Claim-example-01.html\">Claim/example-01</a></p><p><b>outcome</b>: complete</p><p><b>disposition</b>: Claim settled as per contract.</p><p><b>payeeType</b>: Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-payeetype.html\">Claim Payee Type Codes</a>#provider)</span></p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: Eligible Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#eligible)</span></p><p><b>reason</b>: Not covered <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-adjudication-reason.html\">Adjudication Reason Codes</a>#ar001)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>135.57</td><td>INR</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: CoPay <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#copay)</span></p><p><b>reason</b>: Not covered <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-adjudication-reason.html\">Adjudication Reason Codes</a>#ar001)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>10.00</td><td>INR</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Eligible % <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#eligpercent)</span></p><p><b>reason</b>: Not covered <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-adjudication-reason.html\">Adjudication Reason Codes</a>#ar001)</span></p><p><b>value</b>: 80.00</p></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: benefit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#benefit)</span></p><p><b>reason</b>: Plan Limit Reached <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-adjudication-reason.html\">Adjudication Reason Codes</a>#ar002)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>90.47</td><td>INR</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: Submitted Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>135.57</td><td>INR</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: Benefit Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#benefit)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>90.47</td><td>INR</td></tr></table></blockquote><blockquote><p><b>payment</b></p><p><b>type</b>: Complete <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-ex-paymenttype.html\">Example Payment Type Codes</a>#complete)</span></p><p><b>date</b>: 2014-08-31</p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>100.47</td><td>INR</td></tr></table><p><b>identifier</b>: id: 201408-2-1569478</p></blockquote></div>"
  ];
  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: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:Reference.reference [ fhir:value "Organization/example-01" ]
  ];
  fhir:ClaimResponse.request [
     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.