Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.2 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions

• Narrative Content
• XML
• JSON
• TTL

: PCT-AEOB-Summary-1

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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 -------------------------------------------------------------------

<http://hl7.org/fhir/ExplanationOfBenefit/PCT-AEOB-Summary-1> 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 <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob-summary>
     ]
  ] ;
  fhir:Resource.language [ fhir:value "en"] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ] ;
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ExplanationOfBenefit PCT-AEOB-Summary-1</b></p><a name=\"PCT-AEOB-Summary-1\"> </a><a name=\"hcPCT-AEOB-Summary-1\"> </a><div style=\"display: inline-block; background-color: #fbffeb; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-davinci-pct-aeob-summary.html\">PCT Advanced EOB Summary</a></p></div><p><b>Service Description</b>: Example service</p><p><b>In Network Provider Options Link</b>: <a href=\"http://example.org/out-of-network.html\">http://example.org/out-of-network.html</a></p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse estimate-summary}\">Estimate Summary</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)</a></p><p><b>billablePeriod</b>: 2022-01-01 --&gt; 2022-01-01</p><p><b>created</b>: 2021-10-12</p><p><b>insurer</b>: <a href=\"Organization-org1001.html\">Umbrella Insurance Company (Payer) (Electronic Transmitter Identification Number: ETIN-3200002)</a></p><p><b>provider</b>: ?rref?</p><p><b>outcome</b>: Processing Complete</p><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-coverage1001.html\">Coverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --&gt; 2022-01-01</a></td></tr></table><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 style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS memberliability}\">Member liability</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>20</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}\">Eligible Amount</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>190</td><td>United States dollar</td></tr></table></blockquote><h3>ProcessNotes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Text</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>processNote disclaimer text</td></tr></table><p><b>benefitPeriod</b>: 2022-01-01 --&gt; 2022-01-01</p><blockquote><p><b>benefitBalance</b></p><p><b>category</b>: <span title=\"Codes:{https://x12.org/codes/service-type-codes 1}\">Medical Care</span></p><p><b>unit</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-unit individual}\">Individual</span></p><p><b>term</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-term annual}\">Annual</span></p><h3>Financials</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Type</b></td><td><b>Allowed[x]</b></td><td><b>Used[x]</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType allowed}\">Allowed</span></td><td><span title=\"US Dollar\">$1.00</span> (USD)</td><td><span title=\"US Dollar\">$1.00</span> (USD)</td></tr></table></blockquote></div>"
  ] ;
  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 <http://hl7.org/fhir/Patient/patient1001> ;
     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 <http://hl7.org/fhir/Organization/org1001> ;
     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 <http://hl7.org/fhir/Coverage/coverage1001> ;
       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" ]
       ]
     ]
  ] .

<http://hl7.org/fhir/Patient/patient1001> a fhir:Patient .

<http://hl7.org/fhir/Organization/org1001> a fhir:Organization .

<http://hl7.org/fhir/Coverage/coverage1001> a fhir:Coverage .

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

<http://hl7.org/fhir/ExplanationOfBenefit/PCT-AEOB-Summary-1.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/ExplanationOfBenefit/PCT-AEOB-Summary-1.ttl> .