@prefix fhir: . @prefix owl: . @prefix rdfs: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:ClaimResponse ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "example-01"] ; # fhir:meta [ fhir:profile ( [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse"^^xsd:anyURI ; fhir:link ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir: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: id: 555123

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