CARIN Consumer Directed Payer Data Exchange
0.3.1 - STU1

CARIN Consumer Directed Payer Data Exchange, published by HL7 Financial Management Working Group. This is not an authorized publication; it is the continuous build for version 0.3.1). This version is based on the current content of https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions

: Claim Adjudication Category - TTL Representation

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@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:CodeSystem;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "ClaimAdjudicationCategoryCS"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimAdjudicationCategoryCS defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">benefitPaymentStatusCode<a name=\"ClaimAdjudicationCategoryCS-benefitPaymentStatusCode\"> </a></td><td>Benefit payment status code</td><td>Benefit payment status code</td></tr><tr><td style=\"white-space:nowrap\">paymentDenialCode<a name=\"ClaimAdjudicationCategoryCS-paymentDenialCode\"> </a></td><td>Payment denial code</td><td>Payment Denial Code</td></tr><tr><td style=\"white-space:nowrap\">submittedamount<a name=\"ClaimAdjudicationCategoryCS-submittedamount\"> </a></td><td>submitted amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">allowedamount<a name=\"ClaimAdjudicationCategoryCS-allowedamount\"> </a></td><td>allowed amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">deductibleamount<a name=\"ClaimAdjudicationCategoryCS-deductibleamount\"> </a></td><td>deductible amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">coinsuranceamount<a name=\"ClaimAdjudicationCategoryCS-coinsuranceamount\"> </a></td><td>coinsurance amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">copayamount<a name=\"ClaimAdjudicationCategoryCS-copayamount\"> </a></td><td>copay amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">noncoveredamount<a name=\"ClaimAdjudicationCategoryCS-noncoveredamount\"> </a></td><td>noncovered amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">cobamount<a name=\"ClaimAdjudicationCategoryCS-cobamount\"> </a></td><td>cob amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">paymentamount<a name=\"ClaimAdjudicationCategoryCS-paymentamount\"> </a></td><td>payment amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">patientpayamount<a name=\"ClaimAdjudicationCategoryCS-patientpayamount\"> </a></td><td>patient pay amount</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">denialreason<a name=\"ClaimAdjudicationCategoryCS-denialreason\"> </a></td><td>payment denial reason</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">innetworkbenefitpaymentstatus<a name=\"ClaimAdjudicationCategoryCS-innetworkbenefitpaymentstatus\"> </a></td><td>in network benefit payment status</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">outofnetworkbenefitpaymentstatus<a name=\"ClaimAdjudicationCategoryCS-outofnetworkbenefitpaymentstatus\"> </a></td><td>out of network benefit payment status</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">otherbenefitpaymentstatus<a name=\"ClaimAdjudicationCategoryCS-otherbenefitpaymentstatus\"> </a></td><td>other benefit payment status</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">allowedunits<a name=\"ClaimAdjudicationCategoryCS-allowedunits\"> </a></td><td>allowed units</td><td>Undefined</td></tr><tr><td style=\"white-space:nowrap\">inoutnetwork<a name=\"ClaimAdjudicationCategoryCS-inoutnetwork\"> </a></td><td>In or Out of Network</td><td>Undefined</td></tr></table></div>"
  ];
  fhir:CodeSystem.url [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/ClaimAdjudicationCategoryCS"];
  fhir:CodeSystem.version [ fhir:value "0.3.1"];
  fhir:CodeSystem.name [ fhir:value "ClaimAdjudicationCategoryCS"];
  fhir:CodeSystem.title [ fhir:value "Claim Adjudication Category"];
  fhir:CodeSystem.status [ fhir:value "active"];
  fhir:CodeSystem.date [ fhir:value "2020-08-04T02:04:45+00:00"^^xsd:dateTime];
  fhir:CodeSystem.publisher [ fhir:value "HL7 Financial Management Working Group"];
  fhir:CodeSystem.contact [
     fhir:index 0;
     fhir:ContactDetail.name [ fhir:value "HL7 Financial Management Working Group" ];
     fhir:ContactDetail.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "url" ];
       fhir:ContactPoint.value [ fhir:value "http://www.hl7.org/Special/committees/fm/index.cfm" ]     ], [
       fhir:index 1;
       fhir:ContactPoint.system [ fhir:value "email" ];
       fhir:ContactPoint.value [ fhir:value "fm@lists.HL7.org" ]     ]
  ];
  fhir:CodeSystem.description [ fhir:value "Values for EOB.item.adjudication.category and total.category"];
  fhir:CodeSystem.jurisdiction [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ];
       fhir:Coding.code [ fhir:value "US" ]     ]
  ];
  fhir:CodeSystem.content [ fhir:value "complete"];
  fhir:CodeSystem.count [ fhir:value "17"^^xsd:nonNegativeInteger];
  fhir:CodeSystem.concept [
     fhir:index 0;
     fhir:CodeSystem.concept.code [ fhir:value "benefitPaymentStatusCode" ];
     fhir:CodeSystem.concept.display [ fhir:value "Benefit payment status code" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Benefit payment status code" ]
  ], [
     fhir:index 1;
     fhir:CodeSystem.concept.code [ fhir:value "paymentDenialCode" ];
     fhir:CodeSystem.concept.display [ fhir:value "Payment denial code" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Payment Denial Code" ]
  ], [
     fhir:index 2;
     fhir:CodeSystem.concept.code [ fhir:value "submittedamount" ];
     fhir:CodeSystem.concept.display [ fhir:value "submitted amount" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ], [
     fhir:index 3;
     fhir:CodeSystem.concept.code [ fhir:value "allowedamount" ];
     fhir:CodeSystem.concept.display [ fhir:value "allowed amount" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ], [
     fhir:index 4;
     fhir:CodeSystem.concept.code [ fhir:value "deductibleamount" ];
     fhir:CodeSystem.concept.display [ fhir:value "deductible amount" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ], [
     fhir:index 5;
     fhir:CodeSystem.concept.code [ fhir:value "coinsuranceamount" ];
     fhir:CodeSystem.concept.display [ fhir:value "coinsurance amount" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ], [
     fhir:index 6;
     fhir:CodeSystem.concept.code [ fhir:value "copayamount" ];
     fhir:CodeSystem.concept.display [ fhir:value "copay amount" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ], [
     fhir:index 7;
     fhir:CodeSystem.concept.code [ fhir:value "noncoveredamount" ];
     fhir:CodeSystem.concept.display [ fhir:value "noncovered amount" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ], [
     fhir:index 8;
     fhir:CodeSystem.concept.code [ fhir:value "cobamount" ];
     fhir:CodeSystem.concept.display [ fhir:value "cob amount" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ], [
     fhir:index 9;
     fhir:CodeSystem.concept.code [ fhir:value "paymentamount" ];
     fhir:CodeSystem.concept.display [ fhir:value "payment amount" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ], [
     fhir:index 10;
     fhir:CodeSystem.concept.code [ fhir:value "patientpayamount" ];
     fhir:CodeSystem.concept.display [ fhir:value "patient pay amount" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ], [
     fhir:index 11;
     fhir:CodeSystem.concept.code [ fhir:value "denialreason" ];
     fhir:CodeSystem.concept.display [ fhir:value "payment denial reason" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ], [
     fhir:index 12;
     fhir:CodeSystem.concept.code [ fhir:value "innetworkbenefitpaymentstatus" ];
     fhir:CodeSystem.concept.display [ fhir:value "in network benefit payment status" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ], [
     fhir:index 13;
     fhir:CodeSystem.concept.code [ fhir:value "outofnetworkbenefitpaymentstatus" ];
     fhir:CodeSystem.concept.display [ fhir:value "out of network benefit payment status" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ], [
     fhir:index 14;
     fhir:CodeSystem.concept.code [ fhir:value "otherbenefitpaymentstatus" ];
     fhir:CodeSystem.concept.display [ fhir:value "other benefit payment status" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ], [
     fhir:index 15;
     fhir:CodeSystem.concept.code [ fhir:value "allowedunits" ];
     fhir:CodeSystem.concept.display [ fhir:value "allowed units" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ], [
     fhir:index 16;
     fhir:CodeSystem.concept.code [ fhir:value "inoutnetwork" ];
     fhir:CodeSystem.concept.display [ fhir:value "In or Out of Network" ];
     fhir:CodeSystem.concept.definition [ fhir:value "Undefined" ]
  ].

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

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.