FHIR Implementation Guide for ABDM
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FHIR Implementation Guide for ABDM - Local Development build (v3.1.0). See the Directory of published versions

: CoverageEligibilityResponse/benefit-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 sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:CoverageEligibilityResponse ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "benefit-example-01"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse"^^xsd:anyURI ;
fhir:link <https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse>     ] )
  ] ; # 
  fhir:language [ fhir:v "en"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p><b>Generated Narrative: CoverageEligibilityResponse</b><a name=\"benefit-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 CoverageEligibilityResponse &quot;benefit-example-01&quot;  (Language &quot;en&quot;) </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-CoverageEligibilityResponse.html\">CoverageEligibilityResponse</a></p></div><p><b>status</b>: active</p><p><b>purpose</b>: validation, benefits</p><p><b>patient</b>: <a href=\"Patient-example-01.html\">Patient/example-01</a> &quot;&quot;</p><p><b>serviced</b>: 2023-08-07</p><p><b>created</b>: 2022-08-07</p><p><b>requestor</b>: <a href=\"Practitioner-example-01.html\">Practitioner/example-01</a> &quot;&quot;</p><p><b>request</b>: <a href=\"CoverageEligibilityRequest-benefit-example-01.html\">CoverageEligibilityRequest/benefit-example-01</a></p><p><b>outcome</b>: queued</p><p><b>disposition</b>: Policy is currently in-force.</p><p><b>insurer</b>: <a href=\"Organization-example-01.html\">Organization/example-01</a> &quot;XYZ Lab Pvt.Ltd.&quot;</p><blockquote><p><b>insurance</b></p><blockquote><p><b>id</b></p>21233</blockquote><p><b>coverage</b>: <a href=\"Coverage-example-01.html\">Coverage/example-01</a></p><p><b>inforce</b>: true</p><p><b>benefitPeriod</b>: 2022-05-07 --&gt; 2025-08-07</p><blockquote><p><b>item</b></p><p><b>productOrService</b>: Removal of foreign body <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#10849003)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Benefit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html\">Benefit Type Codes</a>#benefit)</span></p><p><b>allowed</b>: <span title=\"Indian Rupee\">₹150,000.00</span> (INR)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Copayment maximum per service <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html\">Benefit Type Codes</a>#copay-maximum)</span></p><p><b>allowed</b>: <span title=\"Indian Rupee\">₹200,000.00</span> (INR)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Copayment Percent per service <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html\">Benefit Type Codes</a>#copay-percent)</span></p><p><b>allowed</b>: 20</p></blockquote></blockquote></blockquote></div>"
  ] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:purpose ( [ fhir:v "validation"] [ fhir:v "benefits"] ) ; # 
  fhir:patient [
fhir:reference [ fhir:v "Patient/example-01" ]
  ] ; # 
  fhir:serviced [ fhir:v "2023-08-07"^^xsd:date] ; # 
  fhir:created [ fhir:v "2022-08-07"^^xsd:date] ; # 
  fhir:requestor [
fhir:reference [ fhir:v "Practitioner/example-01" ]
  ] ; # 
  fhir:request [
fhir:reference [ fhir:v "CoverageEligibilityRequest/benefit-example-01" ]
  ] ; # 
  fhir:outcome [ fhir:v "queued"] ; # 
  fhir:disposition [ fhir:v "Policy is currently in-force."] ; # 
  fhir:insurer [
fhir:reference [ fhir:v "Organization/example-01" ]
  ] ; # 
  fhir:insurance ( [
fhir:id [ fhir:v "21233" ] ;
fhir:coverage [
fhir:reference [ fhir:v "Coverage/example-01" ]     ] ;
fhir:inforce [ fhir:v "true"^^xsd:boolean ] ;
fhir:benefitPeriod [
fhir:start [ fhir:v "2022-05-07"^^xsd:date ] ;
fhir:end [ fhir:v "2025-08-07"^^xsd:date ]     ] ;
    ( fhir:item [
fhir:productOrService [
        ( fhir:coding [
a sct:10849003 ;
fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
fhir:code [ fhir:v "10849003" ] ;
fhir:display [ fhir:v "Removal of foreign body" ]         ] )       ] ;
      ( fhir:benefit [
fhir:type [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "benefit" ]           ] )         ] ;
fhir:allowed [
a fhir:Money ;
fhir:value [ fhir:v "150000"^^xsd:decimal ] ;
fhir:currency [ fhir:v "INR" ]         ]       ] [
fhir:type [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "copay-maximum" ]           ] )         ] ;
fhir:allowed [
a fhir:Money ;
fhir:value [ fhir:v "200000"^^xsd:decimal ] ;
fhir:currency [ fhir:v "INR" ]         ]       ] [
fhir:type [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "copay-percent" ]           ] )         ] ;
fhir:allowed [ fhir:v "20"^^xsd:nonNegativeInteger ]       ] )     ] )
  ] ) . #