@prefix fhir: . @prefix owl: . @prefix rdfs: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:ExplanationOfBenefit ; fhir:nodeRole fhir:treeRoot ; fhir:Resource.id [ fhir:value "PCT-AEOB-Summary-1"] ; fhir:Resource.meta [ fhir:Meta.profile [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob-summary" ; fhir:index -1 ; fhir:link ] ] ; fhir:Resource.language [ fhir:value "en"] ; fhir:DomainResource.text [ fhir:Narrative.status [ fhir:value "extensions" ] ; fhir:Narrative.div "

Generated Narrative: ExplanationOfBenefit PCT-AEOB-Summary-1

Service Description: Example service

In Network Provider Options Link: http://example.org/out-of-network.html

status: Active

type: Estimate Summary

use: Predetermination

patient: Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)

billablePeriod: 2022-01-01 --> 2022-01-01

created: 2021-10-12

insurer: Umbrella Insurance Company (Payer) (Electronic Transmitter Identification Number: ETIN-3200002)

provider: ?rref?

outcome: Processing Complete

Insurances

-FocalCoverage
*trueCoverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --> 2022-01-01

total

category: Submitted Amount

Amounts

-ValueCurrency
*200United States dollar

total

category: Member liability

Amounts

-ValueCurrency
*20United States dollar

total

category: Eligible Amount

Amounts

-ValueCurrency
*190United States dollar

ProcessNotes

-ExtensionText
*processNote disclaimer text

benefitPeriod: 2022-01-01 --> 2022-01-01

benefitBalance

category: Medical Care

unit: Individual

term: Annual

Financials

-ExtensionTypeAllowed[x]Used[x]
*Allowed$1.00 (USD)$1.00 (USD)
" ] ; fhir:DomainResource.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription" ] ; fhir:Extension.valueString [ fhir:value "Example service" ] ], [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink" ] ; fhir:Extension.valueUrl [ fhir:value "http://example.org/out-of-network.html" ] ] ; fhir:ExplanationOfBenefit.status [ fhir:value "active"] ; fhir:ExplanationOfBenefit.type [ fhir:CodeableConcept.coding [ fhir:index -1 ; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse" ] ; fhir:Coding.code [ fhir:value "estimate-summary" ] ; fhir:Coding.display [ fhir:value "Estimate Summary" ] ] ] ; fhir:ExplanationOfBenefit.use [ fhir:value "predetermination"] ; fhir:ExplanationOfBenefit.patient [ fhir:link ; fhir:Reference.reference [ fhir:value "Patient/patient1001" ] ] ; fhir:ExplanationOfBenefit.billablePeriod [ fhir:Period.start [ fhir:value "2022-01-01"^^xsd:date ] ; fhir:Period.end [ fhir:value "2022-01-01"^^xsd:date ] ] ; fhir:ExplanationOfBenefit.created [ fhir:value "2021-10-12"^^xsd:date] ; fhir:ExplanationOfBenefit.insurer [ fhir:link ; fhir:Reference.reference [ fhir:value "Organization/org1001" ] ] ; fhir:ExplanationOfBenefit.provider [ fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/data-absent-reason" ] ; fhir:Extension.valueCode [ fhir:value "not-applicable" ] ] ] ; fhir:ExplanationOfBenefit.outcome [ fhir:value "complete"] ; fhir:ExplanationOfBenefit.insurance [ fhir:index -1 ; fhir:ExplanationOfBenefit.insurance.focal [ fhir:value "true"^^xsd:boolean ] ; fhir:ExplanationOfBenefit.insurance.coverage [ fhir:link ; fhir:Reference.reference [ fhir:value "Coverage/coverage1001" ] ] ] ; fhir:ExplanationOfBenefit.total [ fhir:index -1 ; fhir:ExplanationOfBenefit.total.category [ fhir:CodeableConcept.coding [ fhir:index -1 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ; fhir:Coding.code [ fhir:value "submitted" ] ; fhir:Coding.display [ fhir:value "Submitted Amount" ] ] ] ; fhir:ExplanationOfBenefit.total.amount [ fhir:Money.value [ fhir:value "200"^^xsd:decimal ] ; fhir:Money.currency [ fhir:value "USD" ] ] ], [ fhir:index -1 ; fhir:ExplanationOfBenefit.total.category [ fhir:CodeableConcept.coding [ fhir:index -1 ; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS" ] ; fhir:Coding.code [ fhir:value "memberliability" ] ; fhir:Coding.display [ fhir:value "Member liability" ] ] ] ; fhir:ExplanationOfBenefit.total.amount [ fhir:Money.value [ fhir:value "20"^^xsd:decimal ] ; fhir:Money.currency [ fhir:value "USD" ] ] ], [ fhir:index -1 ; fhir:ExplanationOfBenefit.total.category [ fhir:CodeableConcept.coding [ fhir:index -1 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ; fhir:Coding.code [ fhir:value "eligible" ] ; fhir:Coding.display [ fhir:value "Eligible Amount" ] ] ] ; fhir:ExplanationOfBenefit.total.amount [ fhir:Money.value [ fhir:value "190"^^xsd:decimal ] ; fhir:Money.currency [ fhir:value "USD" ] ] ] ; fhir:ExplanationOfBenefit.processNote [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/processNoteClass" ] ; fhir:Extension.valueCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index -1 ; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAEOBProcessNoteCS" ] ; fhir:Coding.code [ fhir:value "disclaimer" ] ; fhir:Coding.display [ fhir:value "Disclaimer" ] ] ] ] ; fhir:ExplanationOfBenefit.processNote.text [ fhir:value "processNote disclaimer text" ] ] ; fhir:ExplanationOfBenefit.benefitPeriod [ fhir:Period.start [ fhir:value "2022-01-01"^^xsd:date ] ; fhir:Period.end [ fhir:value "2022-01-01"^^xsd:date ] ] ; fhir:ExplanationOfBenefit.benefitBalance [ fhir:index -1 ; fhir:ExplanationOfBenefit.benefitBalance.category [ fhir:CodeableConcept.coding [ fhir:index -1 ; fhir:Coding.system [ fhir:value "https://x12.org/codes/service-type-codes" ] ; fhir:Coding.code [ fhir:value "1" ] ; fhir:Coding.display [ fhir:value "Medical Care" ] ] ; fhir:CodeableConcept.text [ fhir:value "Medical Care" ] ] ; fhir:ExplanationOfBenefit.benefitBalance.unit [ fhir:CodeableConcept.coding [ fhir:index -1 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ] ; fhir:Coding.code [ fhir:value "individual" ] ] ] ; fhir:ExplanationOfBenefit.benefitBalance.term [ fhir:CodeableConcept.coding [ fhir:index -1 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ] ; fhir:Coding.code [ fhir:value "annual" ] ] ] ; fhir:ExplanationOfBenefit.benefitBalance.financial [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/remaining-benefit" ] ; fhir:Extension.valueMoney [ fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ; fhir:Money.currency [ fhir:value "USD" ] ] ] ; fhir:ExplanationOfBenefit.benefitBalance.financial.type [ fhir:CodeableConcept.coding [ fhir:index -1 ; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType" ] ; fhir:Coding.code [ fhir:value "allowed" ] ] ] ; fhir:ExplanationOfBenefit.benefitBalance.financial.allowedMoney [ fhir:Money.value [ fhir:value "1"^^xsd:decimal ] ; fhir:Money.currency [ fhir:value "USD" ] ] ; fhir:ExplanationOfBenefit.benefitBalance.financial.usedMoney [ fhir:Money.value [ fhir:value "1"^^xsd:decimal ] ; fhir:Money.currency [ fhir:value "USD" ] ] ] ] . a fhir:us . a fhir:us . a fhir:us . # - ontology header ------------------------------------------------------------ a owl:Ontology ; owl:imports fhir:fhir.ttl ; owl:versionIRI . # -------------------------------------------------------------------------------------