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

Profile: Claim

identifier: https://irdai.gov.in/7612345

status: active

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

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

use: predetermination

patient: Patient/example-01 ""

billablePeriod: 2023-12-09 11:01:00+0500 --> 2023-12-30 11:01:00+0500

created: 2023-12-11 11:01:00+0500

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

provider: Organization/example-03 "XYZ Hospital Co. Ltd."

priority: Normal (Process Priority Codes#normal)

prescription: MedicationRequest/example-03

CareTeams

-SequenceProviderRoleQualification
*1Practitioner/example-01 ""Healthcare professional (occupation) (SNOMED CT#223366009)Clinical specialty (qualifier value) (SNOMED CT#394658006)

SupportingInfos

-SequenceCategoryCodeValue[x]
*1Document Type - Investigation (SupportingInfo Category#INV)Angiography (SNOMED CT#77343006)DocumentReference/example-03

Diagnoses

-SequenceDiagnosis[x]Type
*1Cardiac arrest, unspecified (ICD-10#I46.9)Final diagnosis (discharge) (contextual qualifier) (qualifier value) (SNOMED CT#89100005)

procedure

sequence: 1

procedure: Angiography (SNOMED CT#77343006)

procedure

sequence: 2

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

Insurances

-SequenceFocalCoveragePreAuthRef
*1trueCoverage/example-01123456

item

sequence: 1

careTeamSequence: 1

productOrService: Angiography (SNOMED CT#77343006)

serviced: 2023-12-09

UnitPrices

-ValueCurrency
*10000.00INR

Nets

-ValueCurrency
*10000.00INR

item

sequence: 2

careTeamSequence: 1

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

UnitPrices

-ValueCurrency
*40000INR

Nets

-ValueCurrency
*40000INR

item

sequence: 3

careTeamSequence: 1

productOrService: Intensive care unit (SNOMED CT#309904001)

serviced: 2023-12-11

quantity: 10 day

UnitPrices

-ValueCurrency
*2000INR

Nets

-ValueCurrency
*20000INR

item

sequence: 4

careTeamSequence: 1

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

UnitPrices

-ValueCurrency
*100INR

Nets

-ValueCurrency
*100INR

Totals

-ValueCurrency
*70100INR
" ] ; # 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: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 "predetermination"] ; # fhir:patient [ fhir:link ; fhir:reference [ fhir:v "Patient/example-01" ] ] ; # fhir:billablePeriod [ fhir:start [ fhir:v "2023-12-09T11:01:00+05:00"^^xsd:dateTime ] ; fhir:end [ fhir:v "2023-12-30T11:01:00+05:00"^^xsd:dateTime ] ] ; # fhir:created [ fhir:v "2023-12-11T11:01:00+05:00"^^xsd:dateTime] ; # fhir:insurer [ fhir:link ; fhir:reference [ fhir:v "Organization/example-02" ] ] ; # fhir:provider [ fhir:link ; fhir:reference [ fhir:v "Organization/example-03" ] ] ; # fhir:priority [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ; fhir:code [ fhir:v "normal" ] ] ) ] ; # fhir:prescription [ fhir:link ; fhir:reference [ fhir:v "MedicationRequest/example-03" ] ] ; # fhir:careTeam ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:provider [ fhir:link ; fhir:reference [ fhir:v "Practitioner/example-01" ] ] ; fhir:role [ fhir:coding ( [ a sct:223366009 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "223366009" ] ; fhir:display [ fhir:v "Healthcare professional (occupation)" ] ] ) ] ; fhir:qualification [ fhir:coding ( [ a sct:394658006 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "394658006" ] ; fhir:display [ fhir:v "Clinical specialty (qualifier value)" ] ] ) ] ] ) ; # fhir:supportingInfo ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category"^^xsd:anyURI ] ; fhir:code [ fhir:v "INV" ] ; fhir:display [ fhir:v "Document Type - Investigation" ] ] ) ] ; fhir:code [ 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:value [ a fhir:Reference ; fhir:link ; fhir:reference [ fhir:v "DocumentReference/example-03" ] ] ] ) ; # 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 "I46.9" ] ; fhir:display [ fhir:v "Cardiac arrest, unspecified" ] ] ) ] ; 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:77343006 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "77343006" ] ; fhir:display [ fhir:v "Angiography" ] ] ) ] ] [ fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ; fhir:procedure [ a fhir:CodeableConcept ; 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: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" ] ] ; fhir:preAuthRef ( [ fhir:v "123456" ] ) ] ) ; # fhir:item ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:careTeamSequence ( [ 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:serviced [ fhir:v "2023-12-09"^^xsd:date ] ; fhir:unitPrice [ fhir:value [ fhir:v "10000.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ; fhir:net [ fhir:value [ fhir:v "10000.00"^^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: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:unitPrice [ fhir:value [ fhir:v "40000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ; fhir:net [ fhir:value [ fhir:v "40000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] [ fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ; fhir:careTeamSequence ( [ fhir:v "1"^^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:serviced [ fhir:v "2023-12-11"^^xsd:date ] ; 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:sequence [ fhir:v "4"^^xsd:positiveInteger ] ; fhir:careTeamSequence ( [ fhir:v "1"^^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:total [ fhir:value [ fhir:v "70100"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] . # # -------------------------------------------------------------------------------------