QI-Core Implementation Guide
8.0.0-ballot - STU 8 - ballot

QI-Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 8.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-qi-core/ and changes regularly. See the Directory of published versions

## : Claim example

Page standards status: Informative

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
    @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:id [ fhir:v "example"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim>     ] )
      ] ; #
      fhir:language [ fhir:v "en"] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: Claim example</b></p><a name=\"example\"> </a><a name=\"hcexample\"> </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\">Language: en</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-qicore-claim.html\">QICore Claim</a></p></div><p><b>identifier</b>: <code>http://example.org/claim</code>/6612346</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type vision}\">Vision</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-example.html\">Jim Chalmers  Male, DoB: 1974-12-25 ( Medical record number (use: usual, period: 2001-05-06 --&gt; (ongoing)))</a></p><p><b>created</b>: 2014-08-16</p><p><b>insurer</b>: <a href=\"Organization-example.html\">Organization Health Level Seven International</a></p><p><b>provider</b>: <a href=\"Practitioner-example.html\">Practitioner Adam Careful </a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><p><b>prescription</b>: <a href=\"MedicationRequest-example.html\">MedicationRequest: status = active; intent = order; medication[x] = -&gt;Medication alemtuzumab 10 MG/ML [Lemtrada]; authoredOn = 2015-03-25 19:32:52-0500</a></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td><td><a href=\"Practitioner-example.html\">Practitioner Adam Careful </a></td></tr></table><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Practitioner-example.html\">Practitioner Adam Careful </a></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm H44.23}\">Degenerative myopia, bilateral</span></td></tr></table><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.html\">Coverage: identifier = Member Number; status = active; type = Other Private Insurance; dependent = 0; relationship = Self; period = 2011-05-23 --&gt; 2012-05-23; order = 9</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://example.org/fhir/CodeSystem/ex-visionservice glasses}\">glasses</span></p><p><b>serviced</b>: 2014-08-16</p><h3>UnitPrices</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>214.00</td><td>United States dollar</td></tr></table><blockquote><p><b>detail</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://example.org/fhir/CodeSystem/ex-visionservice frame}\">frame</span></p><h3>UnitPrices</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>100.00</td><td>United States dollar</td></tr></table><h3>Nets</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>100.00</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>sequence</b>: 2</p><p><b>productOrService</b>: <span title=\"Codes:{http://example.org/fhir/CodeSystem/ex-visionservice lens}\">lens</span></p><p><b>quantity</b>: 2</p><h3>UnitPrices</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>50.00</td><td>United States dollar</td></tr></table><h3>Nets</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>100.00</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>sequence</b>: 3</p><p><b>productOrService</b>: <span title=\"Codes:{http://example.org/fhir/CodeSystem/ex-visionservice fst}\">fst</span></p><h3>UnitPrices</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>200.00</td><td>United States dollar</td></tr></table><p><b>factor</b>: 0.07</p><h3>Nets</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>14.00</td><td>United States dollar</td></tr></table></blockquote></blockquote></div>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:identifier ( [
    fhir:system [
    fhir:v "http://example.org/claim"^^xsd:anyURI ;
    fhir:l <http://example.org/claim>     ] ;
    fhir:value [ fhir:v "6612346" ]
      ] ) ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:type [
        ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/claim-type>       ] ;
    fhir:code [ fhir:v "vision" ]     ] )
      ] ; #
      fhir:use [ fhir:v "claim"] ; #
      fhir:patient [
    fhir:l fhir:Patient/example ;
    fhir:reference [ fhir:v "Patient/example" ]
      ] ; #
      fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; #
      fhir:insurer [
    fhir:l fhir:Organization/example ;
    fhir:reference [ fhir:v "Organization/example" ]
      ] ; #
      fhir:provider [
    fhir:l fhir:Practitioner/example ;
    fhir:reference [ fhir:v "Practitioner/example" ]
      ] ; #
      fhir:priority [
        ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/processpriority>       ] ;
    fhir:code [ fhir:v "normal" ]     ] )
      ] ; #
      fhir:prescription [
    fhir:l fhir:MedicationRequest/example ;
    fhir:reference [ fhir:v "MedicationRequest/example" ]
      ] ; #
      fhir:payee [
    fhir:type [
          ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/payeetype>         ] ;
    fhir:code [ fhir:v "provider" ]       ] )     ] ;
    fhir:party [
    fhir:l fhir:Practitioner/example ;
    fhir:reference [ fhir:v "Practitioner/example" ]     ]
      ] ; #
      fhir:careTeam ( [
    fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    fhir:provider [
    fhir:l fhir:Practitioner/example ;
    fhir:reference [ fhir:v "Practitioner/example" ]     ]
      ] ) ; #
      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-cm"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/sid/icd-10-cm>         ] ;
    fhir:code [ fhir:v "H44.23" ]       ] )     ]
      ] ) ; #
      fhir:insurance ( [
    fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    fhir:focal [ fhir:v true ] ;
    fhir:coverage [
    fhir:l fhir:Coverage/example ;
    fhir:reference [ fhir:v "Coverage/example" ]     ]
      ] ) ; #
      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://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ;
    fhir:l <http://example.org/fhir/CodeSystem/ex-visionservice>         ] ;
    fhir:code [ fhir:v "glasses" ]       ] )     ] ;
    fhir:serviced [
    a fhir:Date ;
    fhir:v "2014-08-16"^^xsd:date     ] ;
    fhir:unitPrice [
    fhir:value [ fhir:v 214.00 ] ;
    fhir:currency [ fhir:v "USD" ]     ] ;
        ( fhir:detail [
    fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    fhir:productOrService [
            ( fhir:coding [
    fhir:system [
    fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ;
    fhir:l <http://example.org/fhir/CodeSystem/ex-visionservice>           ] ;
    fhir:code [ fhir:v "frame" ]         ] )       ] ;
    fhir:unitPrice [
    fhir:value [ fhir:v 100.00 ] ;
    fhir:currency [ fhir:v "USD" ]       ] ;
    fhir:net [
    fhir:value [ fhir:v 100.00 ] ;
    fhir:currency [ fhir:v "USD" ]       ]     ] [
    fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
    fhir:productOrService [
            ( fhir:coding [
    fhir:system [
    fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ;
    fhir:l <http://example.org/fhir/CodeSystem/ex-visionservice>           ] ;
    fhir:code [ fhir:v "lens" ]         ] )       ] ;
    fhir:quantity [
    fhir:value [ fhir:v "2"^^xsd:decimal ]       ] ;
    fhir:unitPrice [
    fhir:value [ fhir:v 50.00 ] ;
    fhir:currency [ fhir:v "USD" ]       ] ;
    fhir:net [
    fhir:value [ fhir:v 100.00 ] ;
    fhir:currency [ fhir:v "USD" ]       ]     ] [
    fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
    fhir:productOrService [
            ( fhir:coding [
    fhir:system [
    fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ;
    fhir:l <http://example.org/fhir/CodeSystem/ex-visionservice>           ] ;
    fhir:code [ fhir:v "fst" ]         ] )       ] ;
    fhir:unitPrice [
    fhir:value [ fhir:v 200.00 ] ;
    fhir:currency [ fhir:v "USD" ]       ] ;
    fhir:factor [ fhir:v 0.07 ] ;
    fhir:net [
    fhir:value [ fhir:v 14.00 ] ;
    fhir:currency [ fhir:v "USD" ]       ]     ] )
      ] ) . #