Release 5 Preview #2

Coverageeligibilityresponse-example-benefits.ttl

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

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

General Person Primary Coverage with Benefit Details

@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 -------------------------------------------------------------------

<http://hl7.org/fhir/CoverageEligibilityResponse/E2501> a fhir:CoverageEligibilityResponse;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "E2501"];
  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 CoverageEligibilityResponse.</div>"
  ];
  fhir:CoverageEligibilityResponse.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse" ];
     fhir:Identifier.value [ fhir:value "881234" ]
  ];
  fhir:CoverageEligibilityResponse.status [ fhir:value "active"];
  fhir:CoverageEligibilityResponse.purpose [
     fhir:value "validation";
     fhir:index 0
  ], [
     fhir:value "benefits";
     fhir:index 1
  ];
  fhir:CoverageEligibilityResponse.patient [
     fhir:link <http://hl7.org/fhir/Patient/pat1>;
     fhir:Reference.reference [ fhir:value "Patient/pat1" ]
  ];
  fhir:CoverageEligibilityResponse.servicedDate [ fhir:value "2014-09-17"^^xsd:date];
  fhir:CoverageEligibilityResponse.created [ fhir:value "2014-08-16"^^xsd:date];
  fhir:CoverageEligibilityResponse.request [
     fhir:link <http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402>;
     fhir:Reference.reference [ fhir:value "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402" ]
  ];
  fhir:CoverageEligibilityResponse.outcome [ fhir:value "complete"];
  fhir:CoverageEligibilityResponse.disposition [ fhir:value "Policy is currently in-force."];
  fhir:CoverageEligibilityResponse.insurer [
     fhir:link <http://hl7.org/fhir/Organization/2>;
     fhir:Reference.reference [ fhir:value "Organization/2" ]
  ];
  fhir:CoverageEligibilityResponse.insurance [
     fhir:index 0;
     fhir:CoverageEligibilityResponse.insurance.coverage [
       fhir:link <http://hl7.org/fhir/Coverage/9876B1>;
       fhir:Reference.reference [ fhir:value "Coverage/9876B1" ]
     ];
     fhir:CoverageEligibilityResponse.insurance.inforce [ fhir:value "true"^^xsd:boolean ];
     fhir:CoverageEligibilityResponse.insurance.item [
       fhir:index 0;
       fhir:CoverageEligibilityResponse.insurance.item.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ];
           fhir:Coding.code [ fhir:value "30" ];
           fhir:Coding.display [ fhir:value "Health Benefit Plan Coverage" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.network [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ];
           fhir:Coding.code [ fhir:value "in" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.unit [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ];
           fhir:Coding.code [ fhir:value "individual" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.term [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ];
           fhir:Coding.code [ fhir:value "annual" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.benefit [
         fhir:index 0;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "benefit" ]
           ]
         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
           fhir:Money.value [ fhir:value "500000"^^xsd:decimal ];
           fhir:Money.currency [ fhir:value "SAR" ]
         ]
       ], [
         fhir:index 1;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "copay-maximum" ]
           ]
         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
           fhir:Money.value [ fhir:value "100"^^xsd:decimal ];
           fhir:Money.currency [ fhir:value "SAR" ]
         ]
       ], [
         fhir:index 2;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "copay-percent" ]
           ]
         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedUnsignedInt [ fhir:value "20"^^xsd:nonNegativeInteger ]
       ]
     ], [
       fhir:index 1;
       fhir:CoverageEligibilityResponse.insurance.item.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ];
           fhir:Coding.code [ fhir:value "69" ];
           fhir:Coding.display [ fhir:value "Maternity" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.network [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ];
           fhir:Coding.code [ fhir:value "in" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.unit [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ];
           fhir:Coding.code [ fhir:value "individual" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.term [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ];
           fhir:Coding.code [ fhir:value "annual" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.benefit [
         fhir:index 0;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "benefit" ]
           ]
         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
           fhir:Money.value [ fhir:value "15000"^^xsd:decimal ];
           fhir:Money.currency [ fhir:value "SAR" ]
         ]
       ]
     ], [
       fhir:index 2;
       fhir:CoverageEligibilityResponse.insurance.item.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ];
           fhir:Coding.code [ fhir:value "F3" ];
           fhir:Coding.display [ fhir:value "Dental Coverage" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.network [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ];
           fhir:Coding.code [ fhir:value "in" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.unit [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ];
           fhir:Coding.code [ fhir:value "individual" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.term [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ];
           fhir:Coding.code [ fhir:value "annual" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.benefit [
         fhir:index 0;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "benefit" ]
           ]
         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
           fhir:Money.value [ fhir:value "2000"^^xsd:decimal ];
           fhir:Money.currency [ fhir:value "SAR" ]
         ]
       ]
     ], [
       fhir:index 3;
       fhir:CoverageEligibilityResponse.insurance.item.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ];
           fhir:Coding.code [ fhir:value "F6" ];
           fhir:Coding.display [ fhir:value "Vision Coverage" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.network [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ];
           fhir:Coding.code [ fhir:value "in" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.unit [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ];
           fhir:Coding.code [ fhir:value "individual" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.term [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ];
           fhir:Coding.code [ fhir:value "annual" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.benefit [
         fhir:index 0;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "benefit" ]
           ]
         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
           fhir:Money.value [ fhir:value "400"^^xsd:decimal ];
           fhir:Money.currency [ fhir:value "SAR" ]
         ]
       ]
     ], [
       fhir:index 4;
       fhir:CoverageEligibilityResponse.insurance.item.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ];
           fhir:Coding.code [ fhir:value "49" ];
           fhir:Coding.display [ fhir:value "Hospital Room and Board" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.network [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ];
           fhir:Coding.code [ fhir:value "in" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.unit [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ];
           fhir:Coding.code [ fhir:value "individual" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.term [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ];
           fhir:Coding.code [ fhir:value "day" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.benefit [
         fhir:index 0;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "room" ]
           ]
         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "shared" ]
       ], [
         fhir:index 1;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "benefit" ]
           ]
         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
           fhir:Money.value [ fhir:value "600"^^xsd:decimal ];
           fhir:Money.currency [ fhir:value "SAR" ]
         ]
       ]
     ]
  ] .

<http://hl7.org/fhir/Patient/pat1> a fhir:Patient .

<http://hl7.org/fhir/Organization/2> a fhir:Organization .

<http://hl7.org/fhir/Coverage/9876B1> a fhir:Coverage .

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

<http://hl7.org/fhir/CoverageEligibilityResponse/E2501.ttl> a owl:Ontology;
  owl:imports fhir:fhir.ttl;
  owl:versionIRI <http://build.fhir.org/CoverageEligibilityResponse/E2501.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.