FHIR Implementation Guide for HCX - Local Development build (v0.7.1). See the Directory of published versions
@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 sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:Claim ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "example-01"] ; #
fhir:meta [
fhir:versionId [ fhir:v "1" ] ;
fhir:lastUpdated [ fhir:v "2020-10-07T03:26:09.060+00:00"^^xsd:dateTime ] ;
fhir:source [ fhir:v "#BHZcRrcF4oS0JQ42"^^xsd:anyURI ]
] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Claim</b><a name=\"example-01\"> </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 Claim "example-01" Version "1" Updated "2020-10-07 03:26:09+0000" </p><p style=\"margin-bottom: 0px\">Information Source: #BHZcRrcF4oS0JQ42!</p></div><p><b>identifier</b>: id: dc82673b-8c71-29js-8a17-16dj3i20352n</p><p><b>status</b>: active</p><p><b>type</b>: Institutional <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#institutional)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <span/></p><p><b>billablePeriod</b>: 1979-02-27 16:01:08-0500 --> 1979-02-28 16:01:08-0500</p><p><b>created</b>: 1979-02-28 16:01:08-0500</p><p><b>insurer</b>: <span/></p><p><b>provider</b>: <span/></p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><h3>Payees</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td>*</td><td>Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-payeetype.html\">Claim Payee Type Codes</a>#provider)</span></td><td><span/></td></tr></table><h3>CareTeams</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td>*</td><td>1</td><td><span/></td></tr></table><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 1</p><p><b>procedure</b>: PROC-1 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4/codesystem-icd-10-procedures.html\">ICD-10 Procedure Codes</a>#123001)</span></p></blockquote><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 2</p><p><b>procedure</b>: PROC-2 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4/codesystem-icd-10-procedures.html\">ICD-10 Procedure Codes</a>#123002)</span></p></blockquote><blockquote><p><b>procedure</b></p><p><b>sequence</b>: 3</p><p><b>procedure</b>: PROC-3 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4/codesystem-icd-10-procedures.html\">ICD-10 Procedure Codes</a>#123003)</span></p></blockquote><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>true</td><td><span>: Cigna Health</span></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: Encounter for problem <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#185347001)</span></p></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 2</p><p><b>procedureSequence</b>: 1</p><p><b>productOrService</b>: Hearing examination (procedure) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#398171003)</span></p><h3>Nets</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>516.65</td><td>USD</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 3</p><p><b>procedureSequence</b>: 2</p><p><b>productOrService</b>: Combined chemotherapy and radiation therapy (procedure) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#703423002)</span></p><h3>Nets</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>16924.49</td><td>USD</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 4</p><p><b>procedureSequence</b>: 3</p><p><b>productOrService</b>: High resolution computed tomography of chest without contrast (procedure) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#16335031000119103)</span></p><h3>Nets</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>516.65</td><td>USD</td></tr></table></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>129.16</td><td>USD</td></tr></table></div>"
] ; #
fhir:identifier ( [
fhir:system [ fhir:v "https://www.tmh.in/claim-request"^^xsd:anyURI ] ;
fhir:value [ fhir:v "dc82673b-8c71-29js-8a17-16dj3i20352n" ]
] ) ; #
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 "institutional" ] ] )
] ; #
fhir:use [ fhir:v "claim"] ; #
fhir:patient [
fhir:id [ fhir:v "RVH1003" ] ;
fhir:identifier [
fhir:type [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SN" ] ;
fhir:display [ fhir:v "Subscriber Number" ] ] ) ] ;
fhir:system [ fhir:v "http://gicofIndia.com/beneficiaries"^^xsd:anyURI ] ;
fhir:value [ fhir:v "BEN-101" ] ]
] ; #
fhir:billablePeriod [
fhir:start [ fhir:v "1979-02-27T16:01:08-05:00"^^xsd:dateTime ] ;
fhir:end [ fhir:v "1979-02-28T16:01:08-05:00"^^xsd:dateTime ]
] ; #
fhir:created [ fhir:v "1979-02-28T16:01:08-05:00"^^xsd:dateTime] ; #
fhir:insurer [
fhir:id [ fhir:v "GICOFINDIA" ] ;
fhir:identifier [
fhir:system [ fhir:v "http://irdai.gov.in/insurers"^^xsd:anyURI ] ;
fhir:value [ fhir:v "112" ] ]
] ; #
fhir:provider [
fhir:id [ fhir:v "Tmh01" ] ;
fhir:identifier [
fhir:system [ fhir:v "http://abdm.gov.in/facilities"^^xsd:anyURI ] ;
fhir:value [ fhir:v "HFR-ID-FOR-TMH" ] ]
] ; #
fhir:priority [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ;
fhir:code [ fhir:v "normal" ] ] )
] ; #
fhir:payee [
fhir:type [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ] ;
fhir:code [ fhir:v "provider" ] ] ) ] ;
fhir:party [
fhir:id [ fhir:v "Tmh02" ] ;
fhir:identifier [
fhir:system [ fhir:v "http://abdm.gov.in/facilities"^^xsd:anyURI ] ;
fhir:value [ fhir:v "HFR-ID-FOR-TMH" ] ] ]
] ; #
fhir:careTeam ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:provider [
fhir:id [ fhir:v "Tmh03" ] ;
fhir:identifier [
fhir:system [ fhir:v "http://abdm.gov.in/facilities"^^xsd:anyURI ] ;
fhir:value [ fhir:v "HFR-ID-FOR-TMH" ] ] ]
] ) ; #
fhir:procedure ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:procedure [
a fhir:CodeableConcept ;
( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/sid/ex-icd-10-procedures"^^xsd:anyURI ] ;
fhir:code [ fhir:v "123001" ] ] ) ]
] [
fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
fhir:procedure [
a fhir:CodeableConcept ;
( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/sid/ex-icd-10-procedures"^^xsd:anyURI ] ;
fhir:code [ fhir:v "123002" ] ] ) ]
] [
fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
fhir:procedure [
a fhir:CodeableConcept ;
( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/sid/ex-icd-10-procedures"^^xsd:anyURI ] ;
fhir:code [ fhir:v "123003" ] ] ) ]
] ) ; #
fhir:insurance ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
fhir:coverage [
fhir:display [ fhir:v "Cigna Health" ] ]
] ) ; #
fhir:item ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:productOrService [
( fhir:coding [
a sct:185347001 ;
fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
fhir:code [ fhir:v "185347001" ] ;
fhir:display [ fhir:v "Encounter for problem" ] ] ) ;
fhir:text [ fhir:v "Encounter for problem" ] ]
] [
fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
( fhir:procedureSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
fhir:productOrService [
( fhir:coding [
a sct:398171003 ;
fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
fhir:code [ fhir:v "398171003" ] ;
fhir:display [ fhir:v "Hearing examination (procedure)" ] ] ) ;
fhir:text [ fhir:v "Hearing examination (procedure)" ] ] ;
fhir:net [
fhir:value [ fhir:v "516.65"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ]
] [
fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
( fhir:procedureSequence [ fhir:v "2"^^xsd:positiveInteger ] ) ;
fhir:productOrService [
( fhir:coding [
a sct:703423002 ;
fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
fhir:code [ fhir:v "703423002" ] ;
fhir:display [ fhir:v "Combined chemotherapy and radiation therapy (procedure)" ] ] ) ;
fhir:text [ fhir:v "Combined chemotherapy and radiation therapy (procedure)" ] ] ;
fhir:net [
fhir:value [ fhir:v "16924.49"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ]
] [
fhir:sequence [ fhir:v "4"^^xsd:positiveInteger ] ;
( fhir:procedureSequence [ fhir:v "3"^^xsd:positiveInteger ] ) ;
fhir:productOrService [
( fhir:coding [
a sct:16335031000119103 ;
fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
fhir:code [ fhir:v "16335031000119103" ] ;
fhir:display [ fhir:v "High resolution computed tomography of chest without contrast (procedure)" ] ] ) ;
fhir:text [ fhir:v "High resolution computed tomography of chest without contrast (procedure)" ] ] ;
fhir:net [
fhir:value [ fhir:v "516.65"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ]
] ) ; #
fhir:total [
fhir:value [ fhir:v "129.16"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] . #
IG © 2021+ HCX Open Community. Package hcxprotocol.io#0.7.1 based on FHIR 4.0.1. Generated 2023-03-10
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