FHIR Implementation Guide for ABDM
7.0.0 - active
FHIR Implementation Guide for ABDM
7.0.0 - active
FHIR Implementation Guide for ABDM - Local Development build (v7.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
@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 -------------------------------------------------------------------
<http://hl7.org/fhir/ClaimResponse/ClaimResponse-enhancement-example-01> a fhir:ClaimResponse ;
fhir:nodeRole fhir:treeRoot ;
fhir:Resource.id [ fhir:value "ClaimResponse-enhancement-example-01"] ;
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse" ;
fhir:index 0 ;
fhir:link <https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse>
]
] ;
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ] ;
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse ClaimResponse-enhancement-example-01</b></p><a name=\"ClaimResponse-enhancement-example-01\"> </a><a name=\"hcClaimResponse-enhancement-example-01\"> </a><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\"/><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>: <span title=\"Codes:{http://snomed.info/sct 737481003}\">Inpatient care management (procedure)</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-example-01.html\">ABC Male, DoB: 1981-01-12 ( Medical record number: 22-7225-4829-5255)</a></p><p><b>created</b>: 2023-12-12 15:32:26+0530</p><p><b>insurer</b>: <a href=\"Organization-example-02.html\">Organization XYZ Insurance Co. Ltd.</a></p><p><b>requestor</b>: <a href=\"Organization-example-03.html\">Organization XYZ Hospital Co. Ltd.</a></p><p><b>request</b>: <a href=\"Claim-Claim-enhancement-example-01.html\">Claim: identifier = 7612345; status = active; type = Inpatient care management (procedure); subType = Emergency Claim; use = preauthorization; billablePeriod = 2025-03-07 11:01:00+0500 --> 2025-04-07 11:01:00+0500; created = 2025-03-13 11:01:00+0500; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: The enclosed services are authorized for your provision within 30 days of this notice.</p><p><b>preAuthRef</b>: 123456</p><p><b>payeeType</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</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>10000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligpercent}\">Eligible %</span></p><p><b>reason</b>: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-adjudication-reason covered}\">Product or Service requested is covered by the policy.</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>10000</td><td>Indian rupee</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 2</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</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>10000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligpercent}\">Eligible %</span></p><p><b>reason</b>: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-adjudication-reason covered}\">Product or Service requested is covered by the policy.</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>10000</td><td>Indian rupee</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</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>20000</td><td>Indian rupee</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligpercent}\">Eligible %</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>20000</td><td>Indian rupee</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-01.html\">Coverage: identifier = https://xyzinsurance.in/policynumber/#235037120; status = active; type = PAY; subscriberId = ABC123456BI007; relationship = Self; period = (?) --> 2026-03-17</a></td></tr></table></div>"
] ;
fhir:ClaimResponse.status [ fhir:value "active"] ;
fhir:ClaimResponse.type [
fhir:CodeableConcept.coding [
fhir:index 0 ;
a sct:737481003 ;
fhir:Coding.system [ fhir:value "http://snomed.info/sct" ] ;
fhir:Coding.code [ fhir:value "737481003" ] ;
fhir:Coding.display [ fhir:value "Inpatient care management (procedure)" ]
]
] ;
fhir:ClaimResponse.use [ fhir:value "preauthorization"] ;
fhir:ClaimResponse.patient [
fhir:link <http://hl7.org/fhir/Patient/example-01> ;
fhir:Reference.reference [ fhir:value "Patient/example-01" ]
] ;
fhir:ClaimResponse.created [ fhir:value "2023-12-12T15:32:26.605+05:30"^^xsd:dateTime] ;
fhir:ClaimResponse.insurer [
fhir:link <http://hl7.org/fhir/Organization/example-02> ;
fhir:Reference.reference [ fhir:value "Organization/example-02" ]
] ;
fhir:ClaimResponse.requestor [
fhir:link <http://hl7.org/fhir/Organization/example-03> ;
fhir:Reference.reference [ fhir:value "Organization/example-03" ]
] ;
fhir:ClaimResponse.request [
fhir:link <http://hl7.org/fhir/Claim/Claim-enhancement-example-01> ;
fhir:Reference.reference [ fhir:value "Claim/Claim-enhancement-example-01" ]
] ;
fhir:ClaimResponse.outcome [ fhir:value "complete"] ;
fhir:ClaimResponse.disposition [ fhir:value "The enclosed services are authorized for your provision within 30 days of this notice."] ;
fhir:ClaimResponse.preAuthRef [ fhir:value "123456"] ;
fhir:ClaimResponse.payeeType [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payeetype" ] ;
fhir:Coding.code [ fhir:value "provider" ]
]
] ;
fhir:ClaimResponse.item [
fhir:index 0 ;
fhir:ClaimResponse.item.itemSequence [ fhir:value "1"^^xsd:positiveInteger ] ;
fhir:ClaimResponse.item.adjudication [
fhir:index 0 ;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
fhir:Coding.code [ fhir:value "submitted" ] ;
fhir:Coding.display [ fhir:value "Submitted Amount" ]
]
] ;
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "10000"^^xsd:decimal ] ;
fhir:Money.currency [ fhir:value "INR" ]
]
], [
fhir:index 1 ;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
fhir:Coding.code [ fhir:value "eligpercent" ] ;
fhir:Coding.display [ fhir:value "Eligible %" ]
]
] ;
fhir:ClaimResponse.item.adjudication.reason [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-adjudication-reason" ] ;
fhir:Coding.code [ fhir:value "covered" ] ;
fhir:Coding.display [ fhir:value "Product or Service requested is covered by the policy." ]
]
] ;
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "10000"^^xsd:decimal ] ;
fhir:Money.currency [ fhir:value "INR" ]
]
]
], [
fhir:index 1 ;
fhir:ClaimResponse.item.itemSequence [ fhir:value "2"^^xsd:positiveInteger ] ;
fhir:ClaimResponse.item.adjudication [
fhir:index 0 ;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
fhir:Coding.code [ fhir:value "submitted" ] ;
fhir:Coding.display [ fhir:value "Submitted Amount" ]
]
] ;
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "10000"^^xsd:decimal ] ;
fhir:Money.currency [ fhir:value "INR" ]
]
], [
fhir:index 1 ;
fhir:ClaimResponse.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
fhir:Coding.code [ fhir:value "eligpercent" ] ;
fhir:Coding.display [ fhir:value "Eligible %" ]
]
] ;
fhir:ClaimResponse.item.adjudication.reason [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-adjudication-reason" ] ;
fhir:Coding.code [ fhir:value "covered" ] ;
fhir:Coding.display [ fhir:value "Product or Service requested is covered by the policy." ]
]
] ;
fhir:ClaimResponse.item.adjudication.amount [
fhir:Money.value [ fhir:value "10000"^^xsd:decimal ] ;
fhir:Money.currency [ fhir:value "INR" ]
]
]
] ;
fhir:ClaimResponse.total [
fhir:index 0 ;
fhir:ClaimResponse.total.category [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
fhir:Coding.code [ fhir:value "submitted" ] ;
fhir:Coding.display [ fhir:value "Submitted Amount" ]
]
] ;
fhir:ClaimResponse.total.amount [
fhir:Money.value [ fhir:value "20000"^^xsd:decimal ] ;
fhir:Money.currency [ fhir:value "INR" ]
]
], [
fhir:index 1 ;
fhir:ClaimResponse.total.category [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
fhir:Coding.code [ fhir:value "eligpercent" ] ;
fhir:Coding.display [ fhir:value "Eligible %" ]
]
] ;
fhir:ClaimResponse.total.amount [
fhir:Money.value [ fhir:value "20000"^^xsd:decimal ] ;
fhir:Money.currency [ fhir:value "INR" ]
]
] ;
fhir:ClaimResponse.insurance [
fhir:index 0 ;
fhir:ClaimResponse.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
fhir:ClaimResponse.insurance.focal [ fhir:value "true"^^xsd:boolean ] ;
fhir:ClaimResponse.insurance.coverage [
fhir:link <http://hl7.org/fhir/Coverage/example-01> ;
fhir:Reference.reference [ fhir:value "Coverage/example-01" ]
]
] .
<http://hl7.org/fhir/Patient/example-01> a fhir:Patient .
<http://hl7.org/fhir/Organization/example-02> a fhir:Organization .
<http://hl7.org/fhir/Organization/example-03> a fhir:Organization .
<http://hl7.org/fhir/Claim/Claim-enhancement-example-01> a fhir:Claim .
<http://hl7.org/fhir/Coverage/example-01> a fhir:Coverage .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/ClaimResponse/ClaimResponse-enhancement-example-01.ttl> a owl:Ontology ;
owl:imports fhir:fhir.ttl ;
owl:versionIRI <http://build.fhir.org/ClaimResponse/ClaimResponse-enhancement-example-01.ttl> .
IG © 2024+ National Resource Center for EHR Standards. Package ndhm.in#7.0.0 based on FHIR 4.0.1. Generated 2026-07-15
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