Da Vinci Health Record Exchange (HRex), published by HL7 International / Clinical Interoperability Council. This guide is not an authorized publication; it is the continuous build for version 1.1.0-preview built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ehrx/ and changes regularly. See the Directory of published versions
Page standards status: Informative |
@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 "UnsolicitedReferralAuthorizationResponseExample"] ; #
fhir:meta [
( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-claimresponse"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-claimresponse> ] )
] ; #
fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ClaimResponse</b><a name=\"UnsolicitedReferralAuthorizationResponseExample\"> </a><a name=\"hcUnsolicitedReferralAuthorizationResponseExample\"> </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 ClaimResponse "UnsolicitedReferralAuthorizationResponseExample" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-hrex-claimresponse.html\">HRex Prior authorization</a></p></div><p><b>identifier</b>: <code>http://example.org/PATIENT_EVENT_TRACE_NUMBER</code>/111099</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.3.1.1@3.1.1&canonical=http://example.org/new-payer/fhir/Patient/pat1\">http://example.org/new-payer/fhir/Patient/pat1</a></p><p><b>created</b>: 2005-05-02 11:02:00+0500</p><p><b>insurer</b>: <a href=\"Organization-full.html\">Organization/full</a> "New Health Plan"</p><p><b>requestor</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.3.1.1@3.1.1&canonical=http://example.org/someProvider/fhir/Organization/good-health-clinic\">http://example.org/someProvider/fhir/Organization/good-health-clinic</a></p><p><b>outcome</b>: complete</p><p><b>preAuthRef</b>: A1B2C3D4</p><blockquote><p><b>addItem</b></p><p><b>Authorized Date</b>: 2005-05-02 --> 2005-06-02</p><p><b>Pre Authorized Issue Date</b>: 2005-05-02</p><p><b>Authorized Provider</b>: <a href=\"Practitioner-full.html\">Practitioner/full</a> " BONE"</p><p><b>Item Trace Number</b>: <code>http://example.org/new-payer/fhir/NamingSystem/auth-numbers</code>/A1B2C3D4</p><p><b>itemSequence</b>: 1</p><p><b>productOrService</b>: Consultation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1365#3)</span></p><p><b>location</b>: 11 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-CMSPlaceofServiceCodes.html\">CMS Place of Service Codes (POS)</a>#11)</span></p><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>Submitted Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></td></tr></table></blockquote></div>"
] ; #
fhir:identifier ( [
fhir:system [ fhir:v "http://example.org/PATIENT_EVENT_TRACE_NUMBER"^^xsd:anyURI ] ;
fhir:value [ fhir:v "111099" ] ;
fhir:assigner [
fhir:identifier [
fhir:system [ fhir:v "http://example.org/USER_ASSIGNED"^^xsd:anyURI ] ;
fhir:value [ fhir:v "9012345678" ] ] ]
] ) ; #
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 "professional" ] ] )
] ; #
fhir:use [ fhir:v "preauthorization"] ; #
fhir:patient [
fhir:link <http://example.org/new-payer/fhir/Patient/pat1> ;
fhir:reference [ fhir:v "http://example.org/new-payer/fhir/Patient/pat1" ]
] ; #
fhir:created [ fhir:v "2005-05-02T11:02:00+05:00"^^xsd:dateTime] ; #
fhir:insurer [
fhir:reference [ fhir:v "Organization/full" ]
] ; #
fhir:requestor [
fhir:link <http://example.org/someProvider/fhir/Organization/good-health-clinic> ;
fhir:reference [ fhir:v "http://example.org/someProvider/fhir/Organization/good-health-clinic" ]
] ; #
fhir:outcome [ fhir:v "complete"] ; #
fhir:preAuthRef [ fhir:v "A1B2C3D4"] ; #
fhir:addItem ( [
( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedDate"^^xsd:anyURI ] ;
fhir:value [
a fhir:Period ;
fhir:start [ fhir:v "2005-05-02"^^xsd:date ] ;
fhir:end [ fhir:v "2005-06-02"^^xsd:date ] ] ] [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemPreAuthIssueDate"^^xsd:anyURI ] ;
fhir:value [ fhir:v "2005-05-02"^^xsd:date ] ] [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemAuthorizedProvider"^^xsd:anyURI ] ;
fhir:value [
a fhir:Reference ;
fhir:reference [ fhir:v "Practitioner/full" ] ] ] [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-itemTraceNumber"^^xsd:anyURI ] ;
fhir:value [
a fhir:Identifier ;
fhir:system [ fhir:v "http://example.org/new-payer/fhir/NamingSystem/auth-numbers"^^xsd:anyURI ] ;
fhir:value [ fhir:v "A1B2C3D4" ] ] ] ) ;
( fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
fhir:productOrService [
( fhir:coding [
fhir:system [ fhir:v "http://codesystem.x12.org/005010/1365"^^xsd:anyURI ] ;
fhir:code [ fhir:v "3" ] ;
fhir:display [ fhir:v "Consultation" ] ] ) ] ;
fhir:location [
a fhir:CodeableConcept ;
( fhir:coding [
fhir:system [ fhir:v "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"^^xsd:anyURI ] ;
fhir:code [ fhir:v "11" ] ] ) ] ;
( fhir:adjudication [
( fhir:extension [
( fhir:extension [
fhir:url [ fhir:v "number"^^xsd:anyURI ] ;
fhir:value [ fhir:v "AUTH0001" ] ] [
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-reviewActionCode"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
( fhir:coding [
fhir:system [ fhir:v "http://codesystem.x12.org/005010/306"^^xsd:anyURI ] ;
fhir:code [ fhir:v "A1" ] ;
fhir:display [ fhir:v "Certified in total" ] ] ) ] ] ) ;
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/extension-reviewAction"^^xsd:anyURI ] ] ) ;
fhir:category [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "submitted" ] ] ) ] ] )
] ) . #
IG © 2019+ HL7 International / Clinical Interoperability Council. Package hl7.fhir.us.davinci-hrex#1.1.0-preview based on FHIR 4.0.1. Generated 2024-04-15
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