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Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Patient, Practitioner |
Raw Turtle (+ also see Turtle/RDF Format Specification)
Primary insurance response to a 3Tier Vision Claim
@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:ClaimResponse ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "R3502"] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the ClaimResponse</div>" ] ; # fhir:identifier ( [ fhir:system [ fhir:v "http://thebenefitcompany.com/claimresponse"^^xsd:anyURI ] ; fhir:value [ fhir:v "CR6532875367" ] ] ) ; # 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 "vision" ] ] ) ] ; # fhir:use [ fhir:v "claim"] ; # fhir:patient [ fhir:reference [ fhir:v "Patient/1" ] ] ; # fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; # fhir:insurer [ fhir:reference [ fhir:v "Organization/2" ] ] ; # fhir:requestor [ fhir:reference [ fhir:v "Organization/1" ] ] ; # fhir:request [ fhir:identifier [ fhir:system [ fhir:v "http://happysight.com/claim"^^xsd:anyURI ] ; fhir:value [ fhir:v "6612346" ] ] ] ; # fhir:outcome [ fhir:v "complete"] ; # fhir:disposition [ fhir:v "Claim settled as per contract."] ; # fhir:payeeType [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ] ; fhir:code [ fhir:v "provider" ] ] ) ] ; # fhir:item ( [ fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligible" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "235.40"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "copay" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "20.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligpercent" ] ] ) ] ; fhir:quantity [ fhir:value [ fhir:v "80.00"^^xsd:decimal ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "172.32"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ; fhir:detail ( [ fhir:detailSequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:noteNumber ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligible" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "100.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "copay" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "20.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligpercent" ] ] ) ] ; fhir:quantity [ fhir:value [ fhir:v "80.00"^^xsd:decimal ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "80.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ] [ fhir:detailSequence [ fhir:v "2"^^xsd:positiveInteger ] ; fhir:noteNumber ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligible" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "110.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligpercent" ] ] ) ] ; fhir:quantity [ fhir:value [ fhir:v "80.00"^^xsd:decimal ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "88.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ; fhir:subDetail ( [ fhir:subDetailSequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:noteNumber ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligible" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "60.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligpercent" ] ] ) ] ; fhir:quantity [ fhir:value [ fhir:v "80.00"^^xsd:decimal ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "48.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ] [ fhir:subDetailSequence [ fhir:v "2"^^xsd:positiveInteger ] ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligible" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "30.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligpercent" ] ] ) ] ; fhir:quantity [ fhir:value [ fhir:v "80.00"^^xsd:decimal ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "24.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ] [ fhir:subDetailSequence [ fhir:v "3"^^xsd:positiveInteger ] ; fhir:noteNumber ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:adjudication ( [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligible" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "10.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "eligpercent" ] ] ) ] ; fhir:quantity [ fhir:value [ fhir:v "80.00"^^xsd:decimal ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "8.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ] ) ] [ fhir:detailSequence [ fhir:v "3"^^xsd:positiveInteger ] ; fhir:noteNumber ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; 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 "80.00"^^xsd:decimal ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "14.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ] ) ] ) ; # Adjudication details fhir:total ( [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "submitted" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "235.40"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:amount [ fhir:value [ fhir:v "182.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ; # fhir:payment [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-paymenttype"^^xsd:anyURI ] ; fhir:code [ fhir:v "complete" ] ] ) ] ; fhir:adjustment [ fhir:value [ fhir:v "75.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:adjustmentReason [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payment-adjustment-reason"^^xsd:anyURI ] ; fhir:code [ fhir:v "a002" ] ; fhir:display [ fhir:v "Prior Overpayment" ] ] ) ] ; fhir:date [ fhir:v "2014-08-16"^^xsd:date ] ; fhir:amount [ fhir:value [ fhir:v "107.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:identifier [ fhir:system [ fhir:v "http://thebenefitcompany.com/paymentidentifier"^^xsd:anyURI ] ; fhir:value [ fhir:v "201416-123456" ] ] ] ; # Payment details fhir:processNote ( [ fhir:number [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/note-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "display" ] ] ) ] ; fhir:text [ fhir:v "After hours surcharge declined" ] ; fhir:language [ fhir:coding ( [ fhir:system [ fhir:v "urn:ietf:bcp:47"^^xsd:anyURI ] ; fhir:code [ fhir:v "en-CA" ] ] ) ] ] )] . # # -------------------------------------------------------------------------------------
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 Tue, Dec 10, 2024 20:36+0000.
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