DHIN 2025Connectathon FHIR IG
0.2.0 - ci-build Nigeria flag

DHIN 2025Connectathon FHIR IG, published by DHIN. This guide is not an authorized publication; it is the continuous build for version 0.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/Nigeria-FHIR-Community/2025Connectathon/ and changes regularly. See the Directory of published versions

: Eligibility Response - X-ray Pre-Auth Approved - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:CoverageEligibilityResponse ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "NgCoverageEligibilityResponse-ChikaXrayApproved"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-coverage-eligibility-response"^^xsd:anyURI ;
fhir:l <https://sandbox.dhin-hie.org/ig/StructureDefinition/ng-coverage-eligibility-response>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityResponse NgCoverageEligibilityResponse-ChikaXrayApproved</b></p><a name=\"NgCoverageEligibilityResponse-ChikaXrayApproved\"> </a><a name=\"hcNgCoverageEligibilityResponse-ChikaXrayApproved\"> </a><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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ng-coverage-eligibility-response.html\">NG Claim Coverage Eligibility Response</a></p></div><p><b>identifier</b>: <code>https://sandbox.dhin-hie.org/ig/CodeSystem/eligibility-request-id</code>/ELAPPROVE02</p><p><b>status</b>: Active</p><p><b>purpose</b>: Coverage Validation</p><p><b>patient</b>: <a href=\"Patient-Patient-Chika-Okafor.html\">Chika Okafor</a></p><p><b>created</b>: 2025-11-07 00:09:00+0100</p><p><b>requestor</b>: <a href=\"Organization-Organization-PortHarcourt-Hospital.html\">Port Harcourt Emergency Hospital</a></p><p><b>request</b>: <a href=\"CoverageEligibilityRequest-NgCoverageEligibilityRequest-ChikaEmergency.html\">CoverageEligibilityRequest: identifier = https://sandbox.dhin-hie.org/ig/CodeSystem/eligibility-request-id#ELAPPROVE01; status = active; purpose = validation; created = 2025-11-06 23:47:00+0100</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Pre-authorization APPROVED. Approved amount: ₦15,000. Patient copay: ₦1,500. Authorization code: PA-2025-8847. Valid until: 10-Nov-2025.</p><p><b>insurer</b>: <a href=\"Organization-Organization-Truth-HMO.html\">Truth HMO</a></p><blockquote><p><b>insurance</b></p><p><b>coverage</b>: <a href=\"Coverage-Coverage-Chika-TruthHMO.html\">Truth HMO Policy - Chika Okafor</a></p><p><b>inforce</b>: true</p><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 73610}\">Ankle X-ray - Right ankle sprain (ICD-10: S93.4)</span></p><p><b>description</b>: Pre-authorization approved for emergency ankle X-ray. Valid until 10-Nov-2025.</p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-type benefit}\">Benefit</span></p><p><b>allowed</b>: <span title=\"Nigerian Naira\">NGN15,000.00</span> (NGN)</p><p><b>used</b>: <span title=\"Nigerian Naira\">NGN0.00</span> (NGN)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-type copay}\">Copayment per service</span></p><p><b>allowed</b>: <span title=\"Nigerian Naira\">NGN1,500.00</span> (NGN)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-type room}\">HMO Coverage Amount</span></p><p><b>allowed</b>: <span title=\"Nigerian Naira\">NGN13,500.00</span> (NGN)</p></blockquote><p><b>authorizationRequired</b>: true</p><p><b>authorizationSupporting</b>: <span title=\"Codes:\">Emergency presentation with suspected fracture</span></p><p><b>authorizationUrl</b>: <a href=\"CodeSystem-eligibility-request-id.html\">Eligibility Request ID CodeSystem</a></p></blockquote></blockquote><p><b>preAuthRef</b>: PA-2025-8847</p></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:identifier ( [
fhir:system [
fhir:v "https://sandbox.dhin-hie.org/ig/CodeSystem/eligibility-request-id"^^xsd:anyURI ;
fhir:l <https://sandbox.dhin-hie.org/ig/CodeSystem/eligibility-request-id>     ] ;
fhir:value [ fhir:v "ELAPPROVE02" ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:purpose ( [ fhir:v "validation"] ) ; # 
  fhir:patient [
fhir:l fhir:Patient/Patient-Chika-Okafor ;
fhir:reference [ fhir:v "Patient/Patient-Chika-Okafor" ] ;
fhir:display [ fhir:v "Chika Okafor" ]
  ] ; # 
  fhir:created [ fhir:v "2025-11-07T00:09:00+01:00"^^xsd:dateTime] ; # 
  fhir:requestor [
fhir:l fhir:Organization/Organization-PortHarcourt-Hospital ;
fhir:reference [ fhir:v "Organization/Organization-PortHarcourt-Hospital" ] ;
fhir:display [ fhir:v "Port Harcourt Emergency Hospital" ]
  ] ; # 
  fhir:request [
fhir:l fhir:CoverageEligibilityRequest/NgCoverageEligibilityRequest-ChikaEmergency ;
fhir:reference [ fhir:v "CoverageEligibilityRequest/NgCoverageEligibilityRequest-ChikaEmergency" ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:disposition [ fhir:v "Pre-authorization APPROVED. Approved amount: ₦15,000. Patient copay: ₦1,500. Authorization code: PA-2025-8847. Valid until: 10-Nov-2025."] ; # 
  fhir:insurer [
fhir:l fhir:Organization/Organization-Truth-HMO ;
fhir:reference [ fhir:v "Organization/Organization-Truth-HMO" ] ;
fhir:display [ fhir:v "Truth HMO" ]
  ] ; # 
  fhir:insurance ( [
fhir:coverage [
fhir:l fhir:Coverage/Coverage-Chika-TruthHMO ;
fhir:reference [ fhir:v "Coverage/Coverage-Chika-TruthHMO" ] ;
fhir:display [ fhir:v "Truth HMO Policy - Chika Okafor" ]     ] ;
fhir:inforce [ fhir:v true ] ;
    ( fhir:item [
fhir:productOrService [
        ( fhir:coding [
fhir:system [
fhir:v "http://www.ama-assn.org/go/cpt"^^xsd:anyURI ;
fhir:l <http://www.ama-assn.org/go/cpt>           ] ;
fhir:code [ fhir:v "73610" ] ;
fhir:display [ fhir:v "Radiologic examination, ankle; complete, minimum of 3 views" ]         ] ) ;
fhir:text [ fhir:v "Ankle X-ray - Right ankle sprain (ICD-10: S93.4)" ]       ] ;
fhir:description [ fhir:v "Pre-authorization approved for emergency ankle X-ray. Valid until 10-Nov-2025." ] ;
      ( fhir:benefit [
fhir:type [
          ( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/benefit-type"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/benefit-type>             ] ;
fhir:code [ fhir:v "benefit" ] ;
fhir:display [ fhir:v "Benefit" ]           ] )         ] ;
fhir:allowed [
a fhir:Money ;
fhir:value [ fhir:v "15000"^^xsd:decimal ] ;
fhir:currency [ fhir:v "NGN" ]         ] ;
fhir:used [
a fhir:Money ;
fhir:value [ fhir:v "0"^^xsd:decimal ] ;
fhir:currency [ fhir:v "NGN" ]         ]       ] [
fhir:type [
          ( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/benefit-type"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/benefit-type>             ] ;
fhir:code [ fhir:v "copay" ] ;
fhir:display [ fhir:v "Copayment per service" ]           ] )         ] ;
fhir:allowed [
a fhir:Money ;
fhir:value [ fhir:v "1500"^^xsd:decimal ] ;
fhir:currency [ fhir:v "NGN" ]         ]       ] [
fhir:type [
          ( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/benefit-type"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/benefit-type>             ] ;
fhir:code [ fhir:v "room" ] ;
fhir:display [ fhir:v "Room" ]           ] ) ;
fhir:text [ fhir:v "HMO Coverage Amount" ]         ] ;
fhir:allowed [
a fhir:Money ;
fhir:value [ fhir:v "13500"^^xsd:decimal ] ;
fhir:currency [ fhir:v "NGN" ]         ]       ] ) ;
fhir:authorizationRequired [ fhir:v true ] ;
      ( fhir:authorizationSupporting [
fhir:text [ fhir:v "Emergency presentation with suspected fracture" ]       ] ) ;
fhir:authorizationUrl [
fhir:v "https://sandbox.dhin-hie.org/ig/CodeSystem/eligibility-request-id#PA-2025-8847"^^xsd:anyURI ;
fhir:l <https://sandbox.dhin-hie.org/ig/CodeSystem/eligibility-request-id#PA-2025-8847>       ]     ] )
  ] ) ; # 
  fhir:preAuthRef [ fhir:v "PA-2025-8847"] . #