@prefix fhir: . @prefix owl: . @prefix rdfs: . @prefix sct: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:ClaimResponse ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "ClaimResponse-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 "ClaimResponse-preauth-example-01"

Profile: ClaimResponse

status: active

type: Inpatient care management (procedure) (SNOMED CT#737481003)

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

use: preauthorization

patient: Patient/example-01 ""

created: 2023-12-12 15:32:26+0530

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

requestor: Organization/example-03 "Maharashtra State Government"

request: Claim/Claim-preauth-example-01

outcome: complete

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

preAuthRef: 123456

payeeType: Provider (Payee Type Codes#provider)

addItem

itemSequence: 1

productOrService: Angiography (SNOMED CT#77343006)

Nets

-ValueCurrency
*10000.00INR

adjudication

category: Eligible Amount (Adjudication Value Codes#eligible)

reason: Covered (SNOMED CT#255334000)

amount

₹10,000.00 (INR)

addItem

itemSequence: 2

productOrService: Angioplasty of blood vessel (SNOMED CT#418285008)

Nets

-ValueCurrency
*40000INR

adjudication

category: Eligible Amount (Adjudication Value Codes#eligible)

reason: Covered (SNOMED CT#255334000)

amount

₹40,000.00 (INR)

addItem

itemSequence: 3

productOrService: Intensive care unit (SNOMED CT#309904001)

quantity: 10 day

UnitPrices

-ValueCurrency
*2000INR

Nets

-ValueCurrency
*20000INR

adjudication

category: Eligible Amount (Adjudication Value Codes#eligible)

reason: Covered (SNOMED CT#255334000)

amount

₹20,000.00 (INR)

addItem

itemSequence: 4

productOrService: Aspirin 75 mg oral tablet (SNOMED CT#319775004)

UnitPrices

-ValueCurrency
*100INR

Nets

-ValueCurrency
*100INR

adjudication

category: Eligible Amount (Adjudication Value Codes#eligible)

reason: Covered (SNOMED CT#255334000)

amount

₹100.00 (INR)

total

category: Submitted Amount (Adjudication Value Codes#submitted)

Amounts

-ValueCurrency
*70100INR

Insurances

-SequenceFocalCoverage
*1trueCoverage/example-02
" ] ; # fhir:status [ fhir:v "active"] ; # fhir:type [ fhir:coding ( [ a sct:737481003 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "737481003" ] ; fhir:display [ fhir:v "Inpatient care management (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 "2023-12-12T15:32:26.605+05:30"^^xsd:dateTime] ; # fhir:insurer [ fhir:link ; fhir:reference [ fhir:v "Organization/example-02" ] ] ; # fhir:requestor [ fhir:link ; fhir:reference [ fhir:v "Organization/example-03" ] ] ; # fhir:request [ fhir:link ; fhir:reference [ fhir:v "Claim/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 "123456"] ; # 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:77343006 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "77343006" ] ; fhir:display [ fhir:v "Angiography" ] ] ) ] ; fhir:net [ fhir:value [ fhir:v "10000.00"^^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 "10000.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] ) ] [ fhir:itemSequence ( [ fhir:v "2"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ a sct:418285008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "418285008" ] ; fhir:display [ fhir:v "Angioplasty of blood vessel" ] ] ) ] ; fhir:net [ fhir:value [ fhir:v "40000"^^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 "40000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] ) ] [ fhir:itemSequence ( [ fhir:v "3"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ a sct:309904001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "309904001" ] ; fhir:display [ fhir:v "Intensive care unit" ] ] ) ] ; fhir:quantity [ fhir:value [ fhir:v "10"^^xsd:decimal ] ; fhir:unit [ fhir:v "day" ] ] ; fhir:unitPrice [ fhir:value [ fhir:v "2000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ; fhir:net [ fhir:value [ fhir:v "20000"^^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 "20000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] ) ] [ fhir:itemSequence ( [ fhir:v "4"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ a sct:319775004 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "319775004" ] ; fhir:display [ fhir:v "Aspirin 75 mg oral tablet" ] ] ) ] ; fhir:unitPrice [ fhir:value [ fhir:v "100"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ; fhir:net [ fhir:value [ fhir:v "100"^^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 "100"^^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 "70100"^^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-02" ] ] ] ) . # # -------------------------------------------------------------------------------------