CARIN Consumer Directed Payer Data Exchange
0.1.3 - 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 0.1.3). This version is based on the current content of https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions

: EOBInpatient1 - 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:ExplanationOfBenefit;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "EOBInpatient1"];
  fhir:Resource.meta [
     fhir:Meta.lastUpdated [ fhir:value "2019-12-12T09:14:11+00:00"^^xsd:dateTime ];
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional>     ]
  ];
  fhir:Resource.language [ fhir:value "en-US"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en-US\" lang=\"en-US\"><p><b>Generated Narrative</b></p><h3>Ids</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table><h3>Meta</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table><p><b>language</b>: en-US</p><p><b>identifier</b>: Claim Number: AW123412341234123412341234123412</p><p><b>status</b>: active</p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Inpatient Institution</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient-Patient1.html\">Generated Summary: language: en-US; Member ID: 1234-234-1243-12345678901, Medical record number: 1234-234-1243-12345678901m, Unique Member ID: 1234-234-1243-12345678901u, Patient Account Number: 1234-234-1243-12345678901a; active; Johnny Example1 ; ph: (301)666-1212; gender: male; birthDate: 1986-01-01; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-NullFlavor UNK}\">unknown</span></a></p><p><b>billablePeriod</b>: Jan 1, 2019, 12:00:00 AM --&gt; Oct 31, 2019, 12:00:00 AM</p><p><b>created</b>: Jul 2, 2019, 12:00:00 AM</p><p><b>insurer</b>: <a href=\"Organization-OrganizationPayer1.html\">XXX Health Plan. Generated Summary: language: en-US; National Provider Identifier: 345678, Payer ID: 901234; active; name: Payer 1</a></p><p><b>provider</b>: <a href=\"Organization-OrganizationProvider1.html\">XXX Health Plan. Generated Summary: language: en-US; National Provider Identifier: 345678, Tax ID number: 123-45-6789; active; name: Provider 1</a></p><p><b>outcome</b>: partial</p><h3>Diagnoses</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td>*</td><td>1</td><td><span title=\"Codes: {http://hl7.org/fhir/sid/icd-10-cm S06.0x1A}\">S06.0x1A</span></td><td><span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType principal}\">Principal</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>true</td><td><a href=\"Coverage-Coverage1.html\">Generated Summary: language: en-US; Member ID: 1234-234-1243-12345678901; status: active; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}\">health insurance plan policy</span>; subscriberId: 12345678901; dependent: 01; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span>; period: Jan 1, 2019, 12:00:00 AM --&gt; Oct 31, 2019, 12:00:00 AM; network: XYZ123-UPMC CONSUMER ADVA</a></td></tr></table><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication paidtoprovider}\">Payment Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication paidbypatient}\">Patient Pay Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication innetwork}\">In-network</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote></div>"
  ];
  fhir:ExplanationOfBenefit.identifier [
     fhir:index 0;
     fhir:Identifier.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/IdentifierTypeCS" ];
         fhir:Coding.code [ fhir:value "cn" ]       ]     ];
     fhir:Identifier.system [ fhir:value "https://www.xxxplan.com/fhir/EOBIdentifier" ];
     fhir:Identifier.value [ fhir:value "AW123412341234123412341234123412" ]
  ];
  fhir:ExplanationOfBenefit.status [ fhir:value "active"];
  fhir:ExplanationOfBenefit.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
       fhir:Coding.code [ fhir:value "institutional" ]     ];
     fhir:CodeableConcept.text [ fhir:value "Inpatient Institution" ]
  ];
  fhir:ExplanationOfBenefit.use [ fhir:value "claim"];
  fhir:ExplanationOfBenefit.patient [
     fhir:Reference.reference [ fhir:value "Patient/Patient1" ]
  ];
  fhir:ExplanationOfBenefit.billablePeriod [
     fhir:Period.start [ fhir:value "2019-01-01T00:00:00+00:00"^^xsd:dateTime ];
     fhir:Period.end [ fhir:value "2019-10-31T00:00:00+00:00"^^xsd:dateTime ]
  ];
  fhir:ExplanationOfBenefit.created [ fhir:value "2019-07-02T00:00:00+00:00"^^xsd:dateTime];
  fhir:ExplanationOfBenefit.insurer [
     fhir:Reference.reference [ fhir:value "Organization/OrganizationPayer1" ];
     fhir:Reference.display [ fhir:value "XXX Health Plan" ]
  ];
  fhir:ExplanationOfBenefit.provider [
     fhir:Reference.reference [ fhir:value "Organization/OrganizationProvider1" ];
     fhir:Reference.display [ fhir:value "XXX Health Plan" ]
  ];
  fhir:ExplanationOfBenefit.outcome [ fhir:value "partial"];
  fhir:ExplanationOfBenefit.diagnosis [
     fhir:index 0;
     fhir:ExplanationOfBenefit.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:ExplanationOfBenefit.diagnosis.diagnosisCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ];
         fhir:Coding.code [ fhir:value "S06.0x1A" ]       ]     ];
     fhir:ExplanationOfBenefit.diagnosis.type [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType" ];
         fhir:Coding.code [ fhir:value "principal" ]       ]     ]
  ];
  fhir:ExplanationOfBenefit.insurance [
     fhir:index 0;
     fhir:ExplanationOfBenefit.insurance.focal [ fhir:value "true"^^xsd:boolean ];
     fhir:ExplanationOfBenefit.insurance.coverage [
       fhir:Reference.reference [ fhir:value "Coverage/Coverage1" ]     ]
  ];
  fhir:ExplanationOfBenefit.total [
     fhir:index 0;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication" ];
         fhir:Coding.code [ fhir:value "paidtoprovider" ]       ];
       fhir:CodeableConcept.text [ fhir:value "Payment Amount" ]     ];
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "620"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]     ]
  ], [
     fhir:index 1;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ];
         fhir:Coding.code [ fhir:value "submitted" ]       ];
       fhir:CodeableConcept.text [ fhir:value "Submitted Amount" ]     ];
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "2650"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]     ]
  ], [
     fhir:index 2;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication" ];
         fhir:Coding.code [ fhir:value "paidbypatient" ]       ];
       fhir:CodeableConcept.text [ fhir:value "Patient Pay Amount" ]     ];
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]     ]
  ], [
     fhir:index 3;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication" ];
         fhir:Coding.code [ fhir:value "innetwork" ]       ]     ];
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]     ]
  ].

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

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