CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue ButtonĀ®), published by HL7 Financial Management Working Group. This is not an authorized publication; it is the continuous build for version 2.0.0). This version is based on the current content of https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions
@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 "EOBInpatient1"] ; # fhir:meta [ fhir:lastUpdated [ fhir:v "2019-12-12T09:14:11+00:00"^^xsd:dateTime ] ; ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|2.0.0"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|2.0.0> ] ) ] ; # fhir:language [ fhir:v "en-US"] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en-US\" lang=\"en-US\"><p><b>Generated Narrative: ExplanationOfBenefit</b><a name=\"EOBInpatient1\"> </a></p><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\">Resource ExplanationOfBenefit "EOBInpatient1" Updated "2019-12-12 09:14:11+0000" (Language "en-US") </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html\">C4BB ExplanationOfBenefit Inpatient Institutional (version 2.0.0)</a></p></div><p><b>identifier</b>: Unique Claim ID: AW123412341234123412341234123412</p><p><b>status</b>: active</p><p><b>type</b>: Institutional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#institutional)</span></p><p><b>subType</b>: Inpatient <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBInstitutionalClaimSubType.html\">C4BB Institutional Claim SubType Code System</a>#inpatient)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient-Patient2.html\">Patient/Patient2</a> " TEST"</p><p><b>billablePeriod</b>: 2019-01-01 --> 2019-10-31</p><p><b>created</b>: 2019-11-02 00:00:00+0000</p><p><b>insurer</b>: <a href=\"Organization-Payer1.html\">Organization/Payer1: XXX Health Plan</a> "Organization Payer 1"</p><p><b>provider</b>: <a href=\"Organization-ProviderOrganization1.html\">Organization/ProviderOrganization1: XXX Health Plan</a> "Orange Medical Group"</p><p><b>outcome</b>: partial</p><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 2</p><p><b>category</b>: Admission Period <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSupportingInfoType.html\">C4BB Supporting Info Type Code System</a>#admissionperiod)</span></p><p><b>timing</b>: 2011-05-23 --> 2011-05-25</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 3</p><p><b>category</b>: Claim Received Date <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSupportingInfoType.html\">C4BB Supporting Info Type Code System</a>#clmrecvddate)</span></p><p><b>timing</b>: 2011-05-30</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 4</p><p><b>category</b>: Type of Bill <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSupportingInfoType.html\">C4BB Supporting Info Type Code System</a>#typeofbill)</span></p><p><b>code</b>: Dummy <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-AHANUBCTypeOfBill.html\">AHA NUBC Type Of Bill Codes</a>#Dummy)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 5</p><p><b>category</b>: Point Of Origin <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSupportingInfoType.html\">C4BB Supporting Info Type Code System</a>#pointoforigin)</span></p><p><b>code</b>: Dummy <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-AHANUBCPointOfOriginNonnewborn.html\">AHA NUBC Point of Origin for Non-newborn</a>#Dummy)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 6</p><p><b>category</b>: Admission Type <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSupportingInfoType.html\">C4BB Supporting Info Type Code System</a>#admtype)</span></p><p><b>code</b>: Dummy <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-AHANUBCPriorityTypeOfAdmitOrVisit.html\">AHA NUBC Priority (Type) of Admission or Visit</a>#Dummy)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 7</p><p><b>category</b>: Discharge Status <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSupportingInfoType.html\">C4BB Supporting Info Type Code System</a>#discharge-status)</span></p><p><b>code</b>: 11 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-AHANUBCPatientDischargeStatus.html\">AHA NUBC Patient Discharge Status Codes</a>#11)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 8</p><p><b>category</b>: Medical Record Number <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSupportingInfoType.html\">C4BB Supporting Info Type Code System</a>#medicalrecordnumber)</span></p><p><b>value</b>: 1234-234-1243-12345678901m</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 9</p><p><b>category</b>: Patient Account Number <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBSupportingInfoType.html\">C4BB Supporting Info Type Code System</a>#patientaccountnumber)</span></p><p><b>value</b>: 1234-234-1243-12345678901a</p></blockquote><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>Concussion with loss of consciousness of 30 minutes or less, initial encounter <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-icd10CM.html\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a>#S06.0X1A)</span></td><td>Principal Diagnosis <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-ex-diagnosistype.html\">Example Diagnosis Type Codes</a>#principal)</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>true</td><td><a href=\"Coverage-Coverage3.html\">Coverage/Coverage3</a></td></tr></table><h3>Items</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Revenue</b></td><td><b>ProductOrService</b></td><td><b>Serviced[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>Dummy <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-AHANUBCRevenueCodes.html\">AHA NUBC Revenue Codes</a>#Dummy)</span></td><td>Not Applicable <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-data-absent-reason.html\">DataAbsentReason</a>#not-applicable)</span></td><td>2019-11-02</td></tr></table><blockquote><p><b>adjudication</b></p><p><b>category</b>: Benefit Payment Status <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBAdjudicationDiscriminator.html\">C4BB Adjudication Discriminator Code System</a>#benefitpaymentstatus)</span></p><p><b>reason</b>: In Network <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBPayerAdjudicationStatus.html\">C4BB Payer Adjudication Status Code System</a>#innetwork)</span></p></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Billing Network Status <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBAdjudicationDiscriminator.html\">C4BB Adjudication Discriminator Code System</a>#billingnetworkstatus)</span></p><p><b>reason</b>: In Network <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBPayerAdjudicationStatus.html\">C4BB Payer Adjudication Status Code System</a>#innetwork)</span></p></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Payment Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBAdjudication.html\">C4BB Adjudication Code System</a>#paidtoprovider)</span></p><blockquote><p><b>amount</b></p><p><span title=\"US Dollar\">US$620.00</span> (USD)</p></blockquote></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Submitted Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></p><blockquote><p><b>amount</b></p><p><span title=\"US Dollar\">US$2,650.00</span> (USD)</p></blockquote></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Patient Pay Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBAdjudication.html\">C4BB Adjudication Code System</a>#paidbypatient)</span></p><blockquote><p><b>amount</b></p><p><span title=\"US Dollar\">US$0.00</span> (USD)</p></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: Payment Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBAdjudication.html\">C4BB Adjudication Code System</a>#paidtoprovider)</span></p><h3>Amounts</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>620</td><td>USD</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: Submitted Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></p><h3>Amounts</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>2650</td><td>USD</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: Patient Pay Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4BBAdjudication.html\">C4BB Adjudication Code System</a>#paidbypatient)</span></p><h3>Amounts</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>0</td><td>USD</td></tr></table></blockquote></div>" ] ; # fhir:identifier ( [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType"^^xsd:anyURI ] ; fhir:code [ fhir:v "uc" ] ] ) ] ; fhir:system [ fhir:v "https://www.xxxplan.com/fhir/EOBIdentifier"^^xsd:anyURI ] ; fhir:value [ fhir:v "AW123412341234123412341234123412" ] ] ) ; # 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 "institutional" ] ] ) ; fhir:text [ fhir:v "Institutional" ] ] ; # fhir:subType [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBInstitutionalClaimSubType"^^xsd:anyURI ] ; fhir:code [ fhir:v "inpatient" ] ] ) ; fhir:text [ fhir:v "Inpatient" ] ] ; # fhir:use [ fhir:v "claim"] ; # fhir:patient [ fhir:reference [ fhir:v "Patient/Patient2" ] ] ; # fhir:billablePeriod [ fhir:start [ fhir:v "2019-01-01"^^xsd:date ] ; fhir:end [ fhir:v "2019-10-31"^^xsd:date ] ] ; # fhir:created [ fhir:v "2019-11-02T00:00:00+00:00"^^xsd:dateTime] ; # fhir:insurer [ fhir:reference [ fhir:v "Organization/Payer1" ] ; fhir:display [ fhir:v "XXX Health Plan" ] ] ; # fhir:provider [ fhir:reference [ fhir:v "Organization/ProviderOrganization1" ] ; fhir:display [ fhir:v "XXX Health Plan" ] ] ; # fhir:outcome [ fhir:v "partial"] ; # fhir:supportingInfo ( [ fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ; fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"^^xsd:anyURI ] ; fhir:code [ fhir:v "admissionperiod" ] ] ) ] ; fhir:timing [ a fhir:Period ; fhir:start [ fhir:v "2011-05-23"^^xsd:date ] ; fhir:end [ fhir:v "2011-05-25"^^xsd:date ] ] ] [ fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ; fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"^^xsd:anyURI ] ; fhir:code [ fhir:v "clmrecvddate" ] ] ) ] ; fhir:timing [ fhir:v "2011-05-30"^^xsd:date ] ] [ fhir:sequence [ fhir:v "4"^^xsd:positiveInteger ] ; fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"^^xsd:anyURI ] ; fhir:code [ fhir:v "typeofbill" ] ] ) ] ; fhir:code [ ( fhir:coding [ fhir:system [ fhir:v "https://www.nubc.org/CodeSystem/TypeOfBill"^^xsd:anyURI ] ; fhir:code [ fhir:v "Dummy" ] ] ) ] ] [ fhir:sequence [ fhir:v "5"^^xsd:positiveInteger ] ; fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"^^xsd:anyURI ] ; fhir:code [ fhir:v "pointoforigin" ] ] ) ] ; fhir:code [ ( fhir:coding [ fhir:system [ fhir:v "https://www.nubc.org/CodeSystem/PointOfOrigin"^^xsd:anyURI ] ; fhir:code [ fhir:v "Dummy" ] ] ) ] ] [ fhir:sequence [ fhir:v "6"^^xsd:positiveInteger ] ; fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"^^xsd:anyURI ] ; fhir:code [ fhir:v "admtype" ] ] ) ] ; fhir:code [ ( fhir:coding [ fhir:system [ fhir:v "https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit"^^xsd:anyURI ] ; fhir:code [ fhir:v "Dummy" ] ] ) ] ] [ fhir:sequence [ fhir:v "7"^^xsd:positiveInteger ] ; fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"^^xsd:anyURI ] ; fhir:code [ fhir:v "discharge-status" ] ] ) ] ; fhir:code [ ( fhir:coding [ fhir:system [ fhir:v "https://www.nubc.org/CodeSystem/PatDischargeStatus"^^xsd:anyURI ] ; fhir:code [ fhir:v "11" ] ] ) ] ] [ fhir:sequence [ fhir:v "8"^^xsd:positiveInteger ] ; fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"^^xsd:anyURI ] ; fhir:code [ fhir:v "medicalrecordnumber" ] ] ) ] ; fhir:value [ fhir:v "1234-234-1243-12345678901m" ] ] [ fhir:sequence [ fhir:v "9"^^xsd:positiveInteger ] ; fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType"^^xsd:anyURI ] ; fhir:code [ fhir:v "patientaccountnumber" ] ] ) ] ; fhir:value [ fhir:v "1234-234-1243-12345678901a" ] ] ) ; # 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:code [ fhir:v "S06.0X1A" ] ] ) ] ; ( fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ] ; fhir:code [ fhir:v "principal" ] ] ) ] ) ] ) ; # fhir:insurance ( [ fhir:focal [ fhir:v "true"^^xsd:boolean ] ; fhir:coverage [ fhir:reference [ fhir:v "Coverage/Coverage3" ] ] ] ) ; # fhir:item ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:revenue [ ( fhir:coding [ fhir:system [ fhir:v "https://www.nubc.org/CodeSystem/RevenueCodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "Dummy" ] ] ) ] ; fhir:productOrService [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/data-absent-reason"^^xsd:anyURI ] ; fhir:code [ fhir:v "not-applicable" ] ; fhir:display [ fhir:v "Not Applicable" ] ] ) ] ; fhir:serviced [ fhir:v "2019-11-02"^^xsd:date ] ] ) ; # fhir:adjudication ( [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"^^xsd:anyURI ] ; fhir:code [ fhir:v "benefitpaymentstatus" ] ] ) ] ; fhir:reason [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus"^^xsd:anyURI ] ; fhir:code [ fhir:v "innetwork" ] ] ) ] ] [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator"^^xsd:anyURI ] ; fhir:code [ fhir:v "billingnetworkstatus" ] ] ) ] ; fhir:reason [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus"^^xsd:anyURI ] ; fhir:code [ fhir:v "innetwork" ] ] ) ] ] [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication"^^xsd:anyURI ] ; fhir:code [ fhir:v "paidtoprovider" ] ] ) ; fhir:text [ fhir:v "Payment Amount" ] ] ; fhir:amount [ fhir:value [ fhir:v "620"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; fhir:code [ fhir:v "submitted" ] ] ) ; fhir:text [ fhir:v "Submitted Amount" ] ] ; fhir:amount [ fhir:value [ fhir:v "2650"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication"^^xsd:anyURI ] ; fhir:code [ fhir:v "paidbypatient" ] ] ) ; fhir:text [ fhir:v "Patient Pay Amount" ] ] ; fhir:amount [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) ; # fhir:total ( [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication"^^xsd:anyURI ] ; fhir:code [ fhir:v "paidtoprovider" ] ] ) ; fhir:text [ fhir:v "Payment Amount" ] ] ; fhir:amount [ fhir:value [ fhir:v "620"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ; fhir:code [ fhir:v "submitted" ] ] ) ; fhir:text [ fhir:v "Submitted Amount" ] ] ; fhir:amount [ fhir:value [ fhir:v "2650"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:category [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication"^^xsd:anyURI ] ; fhir:code [ fhir:v "paidbypatient" ] ] ) ; fhir:text [ fhir:v "Patient Pay Amount" ] ] ; fhir:amount [ fhir:value [ fhir:v "0"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) . #
IG © 2022+ HL7 Financial Management Working Group. Package hl7.fhir.us.carin-bb#2.0.0 based on FHIR 4.0.1. Generated 2023-08-02
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