@prefix fhir: . @prefix owl: . @prefix rdfs: . @prefix sct: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:Bundle ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "ClaimResponseBundle-predeter-example-01"] ; # fhir:meta [ fhir:profile ( [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponseBundle"^^xsd:anyURI ; fhir:link ] ) ; fhir:security ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-Confidentiality"^^xsd:anyURI ] ; fhir:code [ fhir:v "V" ] ; fhir:display [ fhir:v "very restricted" ] ] ) ] ; # fhir:identifier [ fhir:system [ fhir:v "http://hip.in"^^xsd:anyURI ] ; fhir:value [ fhir:v "bc3c6c57-2053-4d0e-ac40-139ccccff645" ] ] ; # fhir:type [ fhir:v "collection"] ; # fhir:timestamp [ fhir:v "2020-07-09T15:32:26.605+05:30"^^xsd:dateTime] ; # fhir:entry ( [ fhir:fullUrl [ fhir:v "ClaimResponse/ClaimResponse-predeter-example-01"^^xsd:anyURI ] ; fhir:resource ( ) ] [ fhir:fullUrl [ fhir:v "Patient/Patient-example-01"^^xsd:anyURI ] ; fhir:resource ( ) ] [ fhir:fullUrl [ fhir:v "Organization/Organization-example-01"^^xsd:anyURI ] ; fhir:resource ( ) ] [ fhir:fullUrl [ fhir:v "Claim/Claim-predeter-example-01"^^xsd:anyURI ] ; fhir:resource ( ) ] [ fhir:fullUrl [ fhir:v "Coverage/Coverage-example-01"^^xsd:anyURI ] ; fhir:resource ( ) ] ) . # a fhir:ClaimResponse ; fhir:id [ fhir:v "ClaimResponse-predeter-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 "ClaimResponse-predeter-example-01"

Profile: ClaimResponse

status: active

type: Management of health status after discharge from hospital (procedure) (SNOMED CT#710967003)

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

use: predetermination

patient: See above (Patient/Patient-example-01)

created: 2023-09-07 15:32:26+0530

insurer: See above (Organization/Organization-example-01)

request: See above (Claim/Claim-predeter-example-01)

outcome: complete

payeeType: Provider (Payee Type Codes#provider)

addItem
itemSequence: 1
productOrService: Consultant (SNOMED CT#768839008)
Nets
- Value Currency
* 500.00 INR
adjudication
category: Eligible Amount (Adjudication Value Codes#eligible)
reason: Covered (SNOMED CT#255334000)
amount
₹500.00 (INR)

addItem
itemSequence: 2
productOrService: Metformin hydrochloride 500 mg prolonged-release oral tablet (SNOMED CT#765507008)
Nets
- Value Currency
* 910.28 INR
adjudication
category: Eligible Amount (Adjudication Value Codes#eligible)
reason: Covered (SNOMED CT#255334000)
amount
₹910.28 (INR)

total
category: Submitted Amount (Adjudication Value Codes#submitted)
Amounts
- Value Currency
* 1410.28 INR

Insurances

-	Sequence	Focal	Coverage
*	1	true	See above (Coverage/Coverage-example-01)

" ] ; # fhir:status [ fhir:v "active"] ; # fhir:type [ fhir:coding ( [ a sct:710967003 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "710967003" ] ; fhir:display [ fhir:v "Management of health status after discharge from hospital (procedure)" ] ] ) ] ; # 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 "predetermination"] ; # fhir:patient [ fhir:link ; fhir:reference [ fhir:v "Patient/Patient-example-01" ] ] ; # fhir:created [ fhir:v "2023-09-07T15:32:26.605+05:30"^^xsd:dateTime] ; # fhir:insurer [ fhir:link ; fhir:reference [ fhir:v "Organization/Organization-example-01" ] ] ; # fhir:request [ fhir:link ; fhir:reference [ fhir:v "Claim/Claim-predeter-example-01" ] ] ; # fhir:outcome [ fhir:v "complete"] ; # fhir:payeeType [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ] ; fhir:code [ fhir:v "provider" ] ] ) ] ; # fhir:addItem ( [ fhir:itemSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ a sct:768839008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "768839008" ] ; fhir:display [ fhir:v "Consultant" ] ] ) ] ; fhir:net [ fhir:value [ fhir:v "500.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; fhir:code [ fhir:v "eligible" ] ; fhir:display [ fhir:v "Eligible Amount" ] ] ) ] ; fhir:reason [ fhir:coding ( [ a sct:255334000 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "255334000" ] ; fhir:display [ fhir:v "Covered" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "500"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] ) ] [ fhir:itemSequence ( [ fhir:v "2"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ a sct:765507008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "765507008" ] ; fhir:display [ fhir:v "Metformin hydrochloride 500 mg prolonged-release oral tablet" ] ] ) ] ; fhir:net [ fhir:value [ fhir:v "910.28"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; fhir:code [ fhir:v "eligible" ] ; fhir:display [ fhir:v "Eligible Amount" ] ] ) ] ; fhir:reason [ fhir:coding ( [ a sct:255334000 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "255334000" ] ; fhir:display [ fhir:v "Covered" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "910.28"^^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 "1410.28"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] ) ; # fhir:insurance ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:focal [ fhir:v "true"^^xsd:boolean ] ; fhir:coverage [ fhir:link ; fhir:reference [ fhir:v "Coverage/Coverage-example-01" ] ] ] ) . # a fhir:Patient ; fhir:id [ fhir:v "Patient-example-01"] ; # fhir:meta [ fhir:versionId [ fhir:v "1" ] ; fhir:lastUpdated [ fhir:v "2023-09-07T14:58:58.181+05:30"^^xsd:dateTime ] ; fhir:profile ( [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient"^^xsd:anyURI ; fhir:link ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "

Generated Narrative: Patient

Resource Patient "Patient-example-01" Version "1" Updated "2023-09-07 14:58:58+0530"

Profile: Patient

identifier: Adhaar number: 7225-4829-5255

name: Adarsh Agrawal

telecom: +919818512600

gender: male

birthDate: 1981-01-12

" ] ; # fhir:identifier ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code"^^xsd:anyURI ] ; fhir:code [ fhir:v "ADN" ] ; fhir:display [ fhir:v "Adhaar number" ] ] ) ] ; fhir:system [ fhir:v "https://uidai.gov.in/"^^xsd:anyURI ] ; fhir:value [ fhir:v "7225-4829-5255" ] ] ) ; # fhir:name ( [ fhir:text [ fhir:v "Adarsh Agrawal" ] ] ) ; # fhir:telecom ( [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "+919818512600" ] ; fhir:use [ fhir:v "home" ] ] ) ; # fhir:gender [ fhir:v "male"] ; # fhir:birthDate [ fhir:v "1981-01-12"^^xsd:date] . # a fhir:Organization ; fhir:id [ fhir:v "Organization-example-01"] ; # fhir:meta [ fhir:profile ( [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"^^xsd:anyURI ; fhir:link ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "

Generated Narrative: Organization

Resource Organization "Organization-example-01"

Profile: Organization

identifier: Provider number: 4567878

type: Insurance Company (Organization type#ins)

name: XYZ Insurance Co. Ltd.

telecom: +91 243 2634 1234, contact@xyz.org

" ] ; # fhir:identifier ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "PRN" ] ; fhir:display [ fhir:v "Provider number" ] ] ) ] ; fhir:system [ fhir:v "https://facility.ndhm.gov.in"^^xsd:anyURI ] ; fhir:value [ fhir:v "4567878" ] ] ) ; # fhir:type ( [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/organization-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "ins" ] ; fhir:display [ fhir:v "Insurance Company" ] ] ) ] ) ; # fhir:name [ fhir:v "XYZ Insurance Co. Ltd."] ; # fhir:telecom ( [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "+91 243 2634 1234" ] ; fhir:use [ fhir:v "work" ] ] [ fhir:system [ fhir:v "email" ] ; fhir:value [ fhir:v "contact@xyz.org" ] ; fhir:use [ fhir:v "work" ] ] ) . # a fhir:Claim ; fhir:id [ fhir:v "Claim-predeter-example-01"] ; # fhir:meta [ fhir:profile ( [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim"^^xsd:anyURI ; fhir:link ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "

Generated Narrative: Claim

Resource Claim "Claim-predeter-example-01"

Profile: Claim

identifier: id: 7612345

status: active

type: Management of health status after discharge from hospital (procedure) (SNOMED CT#710967003)

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

use: predetermination

patient: See above (Patient/Patient-example-01)

created: 2023-09-07

insurer: See above (Organization/Organization-example-01)

provider: See above (Organization/Organization-example-01)

priority: Immediate (Process Priority Codes#stat)

Payees

-	Type
*	Provider (Payee Type Codes#provider)

Diagnoses

-	Sequence	Diagnosis[x]	Type
*	1	Type 2 diabetes mellitus : Without complications (ICD-10#E11.9)	Final diagnosis (discharge) (contextual qualifier) (qualifier value) (SNOMED CT#89100005)

Procedures

-	Sequence	Procedure[x]
*	1	Consultant (SNOMED CT#768839008)

Insurances

-	Sequence	Focal	Coverage	PreAuthRef
*	1	true	See above (Coverage/Coverage-example-01)	12S52

item
sequence: 1
careTeamSequence: 1
productOrService: Consultant (SNOMED CT#768839008)
serviced: 2023-09-07
UnitPrices
- Value Currency
* 500.00 INR
Nets
- Value Currency
* 500.00 INR

item
sequence: 2
careTeamSequence: 1
productOrService: Metformin hydrochloride 500 mg prolonged-release oral tablet (SNOMED CT#765507008)
serviced: 2023-09-07
UnitPrices
- Value Currency
* 910.28 INR
Nets
- Value Currency
* 910.28 INR

" ] ; # fhir:identifier ( [ fhir:system [ fhir:v "https://irdai.gov.in"^^xsd:anyURI ] ; fhir:value [ fhir:v "7612345" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type [ fhir:coding ( [ a sct:710967003 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "710967003" ] ; fhir:display [ fhir:v "Management of health status after discharge from hospital (procedure)" ] ] ) ] ; # fhir:subType [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-claimsubtype"^^xsd:anyURI ] ; fhir:code [ fhir:v "emergency" ] ; fhir:display [ fhir:v "Emergency Claim" ] ] ) ] ; # fhir:use [ fhir:v "predetermination"] ; # fhir:patient [ fhir:link ; fhir:reference [ fhir:v "Patient/Patient-example-01" ] ] ; # fhir:created [ fhir:v "2023-09-07"^^xsd:date] ; # fhir:insurer [ fhir:link ; fhir:reference [ fhir:v "Organization/Organization-example-01" ] ] ; # fhir:provider [ fhir:link ; fhir:reference [ fhir:v "Organization/Organization-example-01" ] ] ; # fhir:priority [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ; fhir:code [ fhir:v "stat" ] ; fhir:display [ fhir:v "Immediate" ] ] ) ] ; # fhir:payee [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ] ; fhir:code [ fhir:v "provider" ] ; fhir:display [ fhir:v "Provider" ] ] ) ] ] ; # fhir:diagnosis ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:diagnosis [ a fhir:CodeableConcept ; fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/sid/icd-10"^^xsd:anyURI ] ; fhir:code [ fhir:v "E11.9" ] ; fhir:display [ fhir:v "Type 2 diabetes mellitus : Without complications" ] ] ) ] ; fhir:type ( [ fhir:coding ( [ a sct:89100005 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "89100005" ] ; fhir:display [ fhir:v "Final diagnosis (discharge) (contextual qualifier) (qualifier value)" ] ] ) ] ) ] ) ; # fhir:procedure ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:procedure [ a fhir:CodeableConcept ; fhir:coding ( [ a sct:768839008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "768839008" ] ; fhir:display [ fhir:v "Consultant" ] ] ) ] ] ) ; # fhir:insurance ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:focal [ fhir:v "true"^^xsd:boolean ] ; fhir:coverage [ fhir:link ; fhir:reference [ fhir:v "Coverage/Coverage-example-01" ] ] ; fhir:preAuthRef ( [ fhir:v "12S52" ] ) ] ) ; # fhir:item ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ a sct:768839008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "768839008" ] ; fhir:display [ fhir:v "Consultant" ] ] ) ] ; fhir:serviced [ fhir:v "2023-09-07"^^xsd:date ] ; fhir:unitPrice [ fhir:value [ fhir:v "500.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ; fhir:net [ fhir:value [ fhir:v "500.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] [ fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ; fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ a sct:765507008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "765507008" ] ; fhir:display [ fhir:v "Metformin hydrochloride 500 mg prolonged-release oral tablet" ] ] ) ] ; fhir:serviced [ fhir:v "2023-09-07"^^xsd:date ] ; fhir:unitPrice [ fhir:value [ fhir:v "910.28"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ; fhir:net [ fhir:value [ fhir:v "910.28"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] ) . # a fhir:Coverage ; fhir:id [ fhir:v "Coverage-example-01"] ; # fhir:meta [ fhir:profile ( [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Coverage"^^xsd:anyURI ; fhir:link ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "

Generated Narrative: Coverage

Resource Coverage "Coverage-example-01"

Profile: Coverage

identifier: id: SP12345678

status: active

type: PAY (Coverage SelfPay Codes#pay)

subscriber: See above (Patient/Patient-example-01)

beneficiary: See above (Patient/Patient-example-01)

relationship: Self (SubscriberPolicyholder Relationship Codes#self)

period: ?? --> 2026-03-17

payor: See above (Organization/Organization-example-01)

" ] ; # fhir:identifier ( [ fhir:system [ fhir:v "http://hospitalx.com/selfpayagreement"^^xsd:anyURI ] ; fhir:value [ fhir:v "SP12345678" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-selfpay"^^xsd:anyURI ] ; fhir:code [ fhir:v "pay" ] ; fhir:display [ fhir:v "PAY" ] ] ) ] ; # fhir:subscriber [ fhir:link ; fhir:reference [ fhir:v "Patient/Patient-example-01" ] ] ; # fhir:beneficiary [ fhir:link ; fhir:reference [ fhir:v "Patient/Patient-example-01" ] ] ; # fhir:relationship [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ] ; fhir:code [ fhir:v "self" ] ] ) ] ; # fhir:period [ fhir:end [ fhir:v "2026-03-17"^^xsd:date ] ] ; # fhir:payor ( [ fhir:link ; fhir:reference [ fhir:v "Organization/Organization-example-01" ] ] ) . # # -------------------------------------------------------------------------------------