FHIR CI-Build

This is the Continuous Integration Build of FHIR (will be incorrect/inconsistent at times).
See the Directory of published versions

Example Claim/100153 (Turtle)

Financial Management Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Device, Encounter, Patient, Practitioner, RelatedPerson

Raw Turtle (+ also see Turtle/RDF Format Specification)

PreAuthorization with Orthodontic Treatment Plan

@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 xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

[a fhir:Claim;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "100153"]; # 
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Oral Health Claim</div>"
  ]; # 
  fhir:Claim.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://happyvalley.com/claim" ];
     fhir:Identifier.value [ fhir:value "12355" ]
  ]; # 
  fhir:Claim.status [ fhir:value "active"]; # 
  fhir:Claim.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
       fhir:Coding.code [ fhir:value "oral" ]
     ]
  ]; # 
  fhir:Claim.use [ fhir:value "preauthorization"]; # 
  fhir:Claim.patient [
     fhir:Reference.reference [ fhir:value "Patient/1" ]
  ]; # 
  fhir:Claim.created [ fhir:value "2015-03-16"^^xsd:date]; # 
  fhir:Claim.insurer [
     fhir:Reference.reference [ fhir:value "Organization/2" ]
  ]; # 
  fhir:Claim.provider [
     fhir:Reference.reference [ fhir:value "Organization/1" ]
  ]; # 
  fhir:Claim.priority [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.code [ fhir:value "normal" ]
     ]
  ]; # 
  fhir:Claim.fundsReserve [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.code [ fhir:value "provider" ]
     ]
  ]; # 
  fhir:Claim.payee [
     fhir:Claim.payee.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.code [ fhir:value "provider" ]
       ]
     ]
  ]; # 
  fhir:Claim.careTeam [
     fhir:index 0;
     fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.careTeam.provider [
       fhir:Reference.reference [ fhir:value "Practitioner/example" ]
     ]
  ]; # 
  fhir:Claim.diagnosis [
     fhir:index 0;
     fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.diagnosis.diagnosisCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10" ];
         fhir:Coding.code [ fhir:value "K07.3" ] #   <code value=\"123457\"\/>  
       ]
     ]
  ]; # 
  fhir:Claim.insurance [
     fhir:index 0;
     fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ];
     fhir:Claim.insurance.coverage [
       fhir:Reference.reference [ fhir:value "Coverage/9876B1" ]
     ]
  ]; # 
  fhir:Claim.item [
     fhir:index 0;
     fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.item.careTeamSequence [
       fhir:value "1"^^xsd:positiveInteger;
       fhir:index 0
     ];
     fhir:Claim.item.diagnosisSequence [
       fhir:value "1"^^xsd:positiveInteger;
       fhir:index 0
     ];
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
         fhir:Coding.code [ fhir:value "ORTHPLAN" ]
       ]
     ];
     fhir:Claim.item.servicedDate [ fhir:value "2015-05-16"^^xsd:date ];
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "9000.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ]; #   Start Date  
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "9000.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.detail [
       fhir:index 0;
       fhir:Claim.item.detail.sequence [ fhir:value "1"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
           fhir:Coding.code [ fhir:value "ORTHOEXAM" ]
         ]
       ]; #   Exam Fee  
       fhir:Claim.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "1000.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "1000.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ]
     ], [
       fhir:index 1;
       fhir:Claim.item.detail.sequence [ fhir:value "2"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
           fhir:Coding.code [ fhir:value "ORTHODIAG" ]
         ]
       ]; #   Diagnostic Fee  
       fhir:Claim.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "1500.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "1500.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ]
     ], [
       fhir:index 2;
       fhir:Claim.item.detail.sequence [ fhir:value "3"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
           fhir:Coding.code [ fhir:value "ORTHOINITIAL" ]
         ]
       ]; #   Initial Payment  
       fhir:Claim.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "500.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "500.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ]
     ], [
       fhir:index 3;
       fhir:Claim.item.detail.sequence [ fhir:value "4"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
           fhir:Coding.code [ fhir:value "ORTHOMONTHS" ]
         ]
       ]; #   Duration in Months  
       fhir:Claim.item.detail.quantity [
         fhir:Quantity.value [ fhir:value "24"^^xsd:decimal ]
       ]
     ], [
       fhir:index 4;
       fhir:Claim.item.detail.sequence [ fhir:value "5"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
           fhir:Coding.code [ fhir:value "ORTHOPERIODIC" ]
         ]
       ]; #   Periodic Payments  
       fhir:Claim.item.detail.quantity [
         fhir:Quantity.value [ fhir:value "24"^^xsd:decimal ]
       ];
       fhir:Claim.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "250.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "250.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ]
     ]
  ], [
     fhir:index 1;
     fhir:Claim.item.sequence [ fhir:value "2"^^xsd:positiveInteger ];
     fhir:Claim.item.careTeamSequence [
       fhir:value "1"^^xsd:positiveInteger;
       fhir:index 0
     ];
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
         fhir:Coding.code [ fhir:value "21211" ]
       ]
     ];
     fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "105.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "105.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.bodySite [
       fhir:index 0;
       fhir:Claim.item.bodySite.site [
         fhir:index 0;
         fhir:CodeableReference.concept [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oraltoothcodes" ];
             fhir:Coding.code [ fhir:value "21" ]
           ]
         ]
       ];
       fhir:Claim.item.bodySite.subSite [
         fhir:index 0;
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oralsurfacecodes" ];
           fhir:Coding.code [ fhir:value "L" ]
         ]
       ]
     ]
  ], [
     fhir:index 2;
     fhir:Claim.item.sequence [ fhir:value "3"^^xsd:positiveInteger ];
     fhir:Claim.item.careTeamSequence [
       fhir:value "1"^^xsd:positiveInteger;
       fhir:index 0
     ];
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
         fhir:Coding.code [ fhir:value "27211" ]
       ]
     ];
     fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "1100.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "1100.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.bodySite [
       fhir:index 0;
       fhir:Claim.item.bodySite.site [
         fhir:index 0;
         fhir:CodeableReference.concept [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oraltoothcodes" ];
             fhir:Coding.code [ fhir:value "36" ]
           ]
         ]
       ]
     ];
     fhir:Claim.item.detail [
       fhir:index 0;
       fhir:Claim.item.detail.sequence [ fhir:value "1"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
           fhir:Coding.code [ fhir:value "27211" ]
         ]
       ];
       fhir:Claim.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "750.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "750.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ]
     ], [
       fhir:index 1;
       fhir:Claim.item.detail.sequence [ fhir:value "2"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
           fhir:Coding.code [ fhir:value "lab" ]
         ]
       ];
       fhir:Claim.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "350.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "350.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ]
     ]
  ]] . # 

# - ontology header ------------------------------------------------------------

[a owl:Ontology;
  owl:imports fhir:fhir.ttl] .

# -------------------------------------------------------------------------------------


Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.