FHIR Implementation Guide for ABDM
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FHIR Implementation Guide for ABDM - Local Development build (v5.0.0). See the Directory of published versions

: ClaimResponse/ClaimResponse-settlement-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:ClaimResponse ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "ClaimResponse-settlement-example-01"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse"^^xsd:anyURI ;
fhir:link <https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ClaimResponse</b><a name=\"ClaimResponse-settlement-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 ClaimResponse &quot;ClaimResponse-settlement-example-01&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ClaimResponse.html\">ClaimResponse</a></p></div><p><b>status</b>: active</p><p><b>type</b>: Inpatient care management (procedure) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#737481003)</span></p><p><b>subType</b>: Emergency Claim <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-ex-claimsubtype.html\">Example Claim SubType Codes</a>#emergency)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient-example-01.html\">Patient/example-01</a> &quot;&quot;</p><p><b>created</b>: 2023-12-30 15:32:26+0530</p><p><b>insurer</b>: <a href=\"Organization-example-02.html\">Organization/example-02</a> &quot;XYZ Insurance Co. Ltd.&quot;</p><p><b>requestor</b>: <a href=\"Organization-example-03.html\">Organization/example-03</a> &quot;Maharashtra State Government&quot;</p><p><b>request</b>: <a href=\"Claim-Claim-settlement-example-01.html\">Claim/Claim-settlement-example-01</a></p><p><b>outcome</b>: complete</p><p><b>disposition</b>: The claim will be processed within 30 days of this notice.</p><p><b>preAuthRef</b>: 123456</p><p><b>payeeType</b>: Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-payeetype.html\">Payee Type Codes</a>#provider)</span></p><blockquote><p><b>addItem</b></p><p><b>itemSequence</b>: 1</p><p><b>productOrService</b>: Angiography <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#77343006)</span></p><p><b>quantity</b>: 2 Angiography</p><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20000.00</td><td>INR</td></tr></table><blockquote><p><b>adjudication</b></p><p><b>category</b>: Eligible Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#eligible)</span></p><p><b>reason</b>: Covered <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#255334000)</span></p><blockquote><p><b>amount</b></p><p><span title=\"Indian Rupee\">₹20,000.00</span> (INR)</p></blockquote></blockquote></blockquote><blockquote><p><b>addItem</b></p><p><b>itemSequence</b>: 2</p><p><b>productOrService</b>: Angioplasty of blood vessel <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#418285008)</span></p><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>50000</td><td>INR</td></tr></table><blockquote><p><b>adjudication</b></p><p><b>category</b>: Eligible Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#eligible)</span></p><p><b>reason</b>: Covered <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#255334000)</span></p><blockquote><p><b>amount</b></p><p><span title=\"Indian Rupee\">₹50,000.00</span> (INR)</p></blockquote></blockquote></blockquote><blockquote><p><b>addItem</b></p><p><b>itemSequence</b>: 3</p><p><b>productOrService</b>: Intensive care unit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#309904001)</span></p><p><b>quantity</b>: 10 day</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>2000</td><td>INR</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20000</td><td>INR</td></tr></table><blockquote><p><b>adjudication</b></p><p><b>category</b>: Eligible Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#eligible)</span></p><p><b>reason</b>: Covered <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#255334000)</span></p><blockquote><p><b>amount</b></p><p><span title=\"Indian Rupee\">₹20,000.00</span> (INR)</p></blockquote></blockquote></blockquote><blockquote><p><b>addItem</b></p><p><b>itemSequence</b>: 4</p><p><b>productOrService</b>: Aspirin 75 mg oral tablet <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#319775004)</span></p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>100</td><td>INR</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>100</td><td>INR</td></tr></table><blockquote><p><b>adjudication</b></p><p><b>category</b>: Eligible Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#eligible)</span></p><p><b>reason</b>: Covered <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#255334000)</span></p><blockquote><p><b>amount</b></p><p><span title=\"Indian Rupee\">₹100.00</span> (INR)</p></blockquote></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: Submitted Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>90100</td><td>INR</td></tr></table></blockquote><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-example-02.html\">Coverage/example-02</a></td></tr></table></div>"
  ] ; # 
  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 "claim"] ; # 
  fhir:patient [
fhir:reference [ fhir:v "Patient/example-01" ]
  ] ; # 
  fhir:created [ fhir:v "2023-12-30T15:32:26.605+05:30"^^xsd:dateTime] ; # 
  fhir:insurer [
fhir:reference [ fhir:v "Organization/example-02" ]
  ] ; # 
  fhir:requestor [
fhir:reference [ fhir:v "Organization/example-03" ]
  ] ; # 
  fhir:request [
fhir:reference [ fhir:v "Claim/Claim-settlement-example-01" ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:disposition [ fhir:v "The claim will be processed 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:quantity [
fhir:value [ fhir:v "2"^^xsd:decimal ] ;
fhir:unit [ fhir:v "Angiography" ]     ] ;
fhir:net [
fhir:value [ fhir:v "20000.00"^^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 "20000.00"^^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 "50000"^^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 "50000"^^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 "90100"^^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:reference [ fhir:v "Coverage/example-02" ]     ]
  ] ) . #