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Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson |
Raw Turtle (+ also see Turtle/RDF Format Specification)
General Person Primary Coverage EOB Example
@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:ExplanationOfBenefit ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "EB3500"] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the ExplanationOfBenefit</div>" ] ; # fhir:identifier ( [ fhir:system [ fhir:v "http://www.BenefitsInc.com/fhir/explanationofbenefit"^^xsd:anyURI ] ; fhir:value [ fhir:v "987654321" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "oral" ] ] ) ] ; # fhir:use [ fhir:v "claim"] ; # fhir:patient [ fhir:reference [ fhir:v "Patient/pat1" ] ] ; # fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; # fhir:enterer [ fhir:reference [ fhir:v "Practitioner/1" ] ] ; # fhir:insurer [ fhir:reference [ fhir:v "Organization/3" ] ] ; # fhir:provider [ fhir:reference [ fhir:v "Practitioner/1" ] ] ; # fhir:payee [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ] ; fhir:code [ fhir:v "provider" ] ] ) ] ; fhir:party [ fhir:reference [ fhir:v "Organization/2" ] ] ] ; # fhir:facility [ fhir:reference [ fhir:v "Location/1" ] ] ; # fhir:claim [ fhir:reference [ fhir:v "Claim/100150" ] ] ; # fhir:claimResponse [ fhir:reference [ fhir:v "ClaimResponse/R3500" ] ] ; # fhir:outcome [ fhir:v "complete"] ; # fhir:disposition [ fhir:v "Claim settled as per contract."] ; # fhir:careTeam ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:provider [ fhir:reference [ fhir:v "Practitioner/example" ] ] ] ) ; # fhir:insurance ( [ fhir:focal [ fhir:v "true"^^xsd:boolean ] ; fhir:coverage [ fhir:reference [ fhir:v "Coverage/9876B1" ] ] ] ) ; # fhir:item ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-USCLS"^^xsd:anyURI ] ; fhir:code [ fhir:v "1205" ] ] ) ] ; fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ; fhir:unitPrice [ fhir:value [ fhir:v "135.57"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:net [ fhir:value [ fhir:v "135.57"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:udi ( [ fhir:reference [ fhir:v "Device/example" ] ] ) ; fhir:encounter ( [ fhir:reference [ fhir:v "Encounter/example" ] ] ) ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligible" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "120.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligpercent" ] ] ) ] ; fhir:quantity [ fhir:value [ fhir:v "0.80"^^xsd:decimal ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "96.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ] [ fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ; fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ fhir:code [ fhir:v "group" ] ] ) ] ; fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ; fhir:net [ fhir:value [ fhir:v "200.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "180.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ; fhir:detail ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:productOrService [ fhir:coding ( [ fhir:code [ fhir:v "group" ] ] ) ] ; fhir:net [ fhir:value [ fhir:v "200.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:udi ( [ fhir:reference [ fhir:v "Device/example" ] ] ) ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "180.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ; fhir:subDetail ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:productOrService [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-USCLS"^^xsd:anyURI ] ; fhir:code [ fhir:v "1205" ] ] ) ] ; fhir:unitPrice [ fhir:value [ fhir:v "200.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:net [ fhir:value [ fhir:v "200.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:udi ( [ fhir:reference [ fhir:v "Device/example" ] ] ) ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligible" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "200.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligpercent" ] ] ) ] ; fhir:quantity [ fhir:value [ fhir:v "0.90"^^xsd:decimal ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "180.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ] ) ] ) ] ) ; # fhir:total ( [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "submitted" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "135.57"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "96.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] )] . # # -------------------------------------------------------------------------------------
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.
FHIR ®© HL7.org 2011+. FHIR R6 hl7.fhir.core#6.0.0-ballot2 generated on Wed, Oct 2, 2024 17:57+0000.
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