@prefix fhir: . @prefix owl: . @prefix rdfs: . @prefix sct: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:ClaimResponse ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "preauth-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 "preauth-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: preauthorization

patient: Patient/example-01 ""

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

insurer: Organization/example-02 "XYZ Insurance Co. Ltd."

requestor: Practitioner/example-01 ""

request: Claim/preauth-example-01

outcome: complete

disposition: The enclosed services are authorized for your provision within 30 days of this notice.

preAuthRef: 12S52

payeeType: Provider (Payee Type Codes#provider)

addItem

itemSequence: 1

productOrService: Consultant (SNOMED CT#768839008)

Nets

-ValueCurrency
*500.00INR

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

-ValueCurrency
*910.28INR

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

-ValueCurrency
*1410.28INR

Insurances

-SequenceFocalCoverage
*1trueCoverage/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 "preauthorization"] ; # fhir:patient [ fhir:link ; fhir:reference [ fhir:v "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/example-02" ] ] ; # fhir:requestor [ fhir:link ; fhir:reference [ fhir:v "Practitioner/example-01" ] ] ; # fhir:request [ fhir:link ; fhir:reference [ fhir:v "Claim/preauth-example-01" ] ] ; # fhir:outcome [ fhir:v "complete"] ; # fhir:disposition [ fhir:v "The enclosed services are authorized for your provision within 30 days of this notice."] ; # fhir:preAuthRef [ fhir:v "12S52"] ; # 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/example-01" ] ] ] ) . # # -------------------------------------------------------------------------------------