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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)
General Person Primary Coverage with Benefit Details and new insurance
@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:CoverageEligibilityResponse ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "E2502"] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>" ] ; # fhir:contained ( [ a fhir:Coverage ; fhir:id [ fhir:v "coverage-1" ] ; fhir:identifier ( [ fhir:system [ fhir:v "http://benefitsinc.com/certificate"^^xsd:anyURI ] ; fhir:value [ fhir:v "12345" ] ] ) ; fhir:status [ fhir:v "active" ] ; fhir:kind [ fhir:v "insurance" ] ; fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ; fhir:code [ fhir:v "EHCPOL" ] ] ) ] ; fhir:subscriber [ fhir:reference [ fhir:v "Patient/f201" ] ] ; fhir:beneficiary [ fhir:reference [ fhir:v "Patient/f201" ] ] ; fhir:dependent [ fhir:v "1" ] ; fhir:relationship [ fhir:coding ( [ fhir:code [ fhir:v "self" ] ] ) ] ; fhir:insurer [ fhir:identifier [ fhir:system [ fhir:v "http://www.bindb.com/bin"^^xsd:anyURI ] ; fhir:value [ fhir:v "123456" ] ] ] ; fhir:class ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ; fhir:code [ fhir:v "EHCPOL" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "CBI35" ] ] ; fhir:name [ fhir:v "Corporate Baker's Inc. Plan#35" ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "subplan" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "123" ] ] ; fhir:name [ fhir:v "Trainee Part-time Benefits" ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "sequence" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "1" ] ] ] ) ] ) ; # fhir:identifier ( [ fhir:system [ fhir:v "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse"^^xsd:anyURI ] ; fhir:value [ fhir:v "8812342" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:purpose ( [ fhir:v "validation"] [ fhir:v "benefits"] ) ; # fhir:patient [ fhir:reference [ fhir:v "Patient/f201" ] ] ; # fhir:created [ fhir:v "2014-09-16"^^xsd:date] ; # fhir:requestor [ fhir:identifier [ fhir:system [ fhir:v "http://national.org/clinic"^^xsd:anyURI ] ; fhir:value [ fhir:v "OR1234" ] ] ] ; # fhir:request [ fhir:link <http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405> ; fhir:reference [ fhir:v "http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405" ] ] ; # fhir:outcome [ fhir:v "complete"] ; # fhir:disposition [ fhir:v "Policy is currently in-force."] ; # fhir:insurer [ fhir:reference [ fhir:v "Organization/2" ] ] ; # fhir:insurance ( [ fhir:coverage [ fhir:reference [ fhir:v "#coverage-1" ] ] ; fhir:inforce [ fhir:v "true"^^xsd:boolean ] ; fhir:item ( [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ; fhir:code [ fhir:v "30" ] ; fhir:display [ fhir:v "Health Benefit Plan Coverage" ] ] ) ] ; fhir:network [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ; fhir:code [ fhir:v "in" ] ] ) ] ; fhir:unit [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ; fhir:code [ fhir:v "individual" ] ] ) ] ; fhir:term [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ; fhir:code [ fhir:v "annual" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "500000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:used [ a fhir:Money ; fhir:value [ fhir:v "3748.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "copay-maximum" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "100"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "copay-percent" ] ] ) ] ; fhir:allowed [ fhir:v "20"^^xsd:nonNegativeInteger ] ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ; fhir:code [ fhir:v "69" ] ; fhir:display [ fhir:v "Maternity" ] ] ) ] ; fhir:network [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ; fhir:code [ fhir:v "in" ] ] ) ] ; fhir:unit [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ; fhir:code [ fhir:v "individual" ] ] ) ] ; fhir:term [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ; fhir:code [ fhir:v "annual" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "15000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ; fhir:code [ fhir:v "F3" ] ; fhir:display [ fhir:v "Dental Coverage" ] ] ) ] ; fhir:network [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ; fhir:code [ fhir:v "in" ] ] ) ] ; fhir:unit [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ; fhir:code [ fhir:v "individual" ] ] ) ] ; fhir:term [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ; fhir:code [ fhir:v "annual" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "2000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ; fhir:code [ fhir:v "F6" ] ; fhir:display [ fhir:v "Vision Coverage" ] ] ) ] ; fhir:excluded [ fhir:v "true"^^xsd:boolean ] ; fhir:name [ fhir:v "Vision" ] ; # this benefit category is not covered under the plan fhir:description [ fhir:v "Vision products and services such as exams, glasses and contact lenses." ] ] ) ] ) ; # fhir:form [ fhir:coding ( [ fhir:system [ fhir:v "http://national.org/form"^^xsd:anyURI ] ; fhir:code [ fhir:v "ELRSP/2017/01" ] ] ) ]] . # # -------------------------------------------------------------------------------------
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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