FHIR Implementation Guide for HCX - Local Development build (v0.7.0). 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:Resource.id [ fhir:value "example-01"];
fhir:Resource.meta [
fhir:Meta.versionId [ fhir:value "1" ];
fhir:Meta.lastUpdated [ fhir:value "2020-10-07T03:26:09.060+00:00"^^xsd:dateTime ];
fhir:Meta.source [ fhir:value "#BHZcRrcF4oS0JQ42" ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.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/4.0.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#institutional)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <span></span></p><p><b>billablePeriod</b>: 1979-02-27 04:01:08-0500 --> 1979-02-28 04:01:08-0500</p><p><b>created</b>: 1979-02-28 04:01:08-0500</p><p><b>insurer</b>: <span></span></p><p><b>provider</b>: <span></span></p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/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/4.0.0/CodeSystem-payeetype.html\">ClaimPayeeTypeCodes</a>#provider)</span></td><td><span></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></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:Claim.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "https://www.tmh.in/claim-request" ];
fhir:Identifier.value [ fhir:value "dc82673b-8c71-29js-8a17-16dj3i20352n" ]
];
fhir:Claim.status [ fhir:value "active"];
fhir:Claim.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
fhir:Coding.code [ fhir:value "institutional" ] ]
];
fhir:Claim.use [ fhir:value "claim"];
fhir:Claim.patient [
fhir:Element.id [ fhir:value "RVH1003" ];
fhir:Reference.identifier [
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ];
fhir:Coding.code [ fhir:value "SN" ];
fhir:Coding.display [ fhir:value "Subscriber Number" ] ] ];
fhir:Identifier.system [ fhir:value "http://gicofIndia.com/beneficiaries" ];
fhir:Identifier.value [ fhir:value "BEN-101" ] ]
];
fhir:Claim.billablePeriod [
fhir:Period.start [ fhir:value "1979-02-27T16:01:08-05:00"^^xsd:dateTime ];
fhir:Period.end [ fhir:value "1979-02-28T16:01:08-05:00"^^xsd:dateTime ]
];
fhir:Claim.created [ fhir:value "1979-02-28T16:01:08-05:00"^^xsd:dateTime];
fhir:Claim.insurer [
fhir:Element.id [ fhir:value "GICOFINDIA" ];
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://irdai.gov.in/insurers" ];
fhir:Identifier.value [ fhir:value "112" ] ]
];
fhir:Claim.provider [
fhir:Element.id [ fhir:value "Tmh01" ];
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://abdm.gov.in/facilities" ];
fhir:Identifier.value [ fhir:value "HFR-ID-FOR-TMH" ] ]
];
fhir:Claim.priority [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority" ];
fhir:Coding.code [ fhir:value "normal" ] ]
];
fhir:Claim.payee [
fhir:Claim.payee.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payeetype" ];
fhir:Coding.code [ fhir:value "provider" ] ] ];
fhir:Claim.payee.party [
fhir:Element.id [ fhir:value "Tmh02" ];
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://abdm.gov.in/facilities" ];
fhir:Identifier.value [ fhir:value "HFR-ID-FOR-TMH" ] ] ]
];
fhir:Claim.careTeam [
fhir:index 0;
fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.careTeam.provider [
fhir:Element.id [ fhir:value "Tmh03" ];
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://abdm.gov.in/facilities" ];
fhir:Identifier.value [ fhir:value "HFR-ID-FOR-TMH" ] ] ]
];
fhir:Claim.procedure [
fhir:index 0;
fhir:Claim.procedure.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.procedure.procedureCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/ex-icd-10-procedures" ];
fhir:Coding.code [ fhir:value "123001" ] ] ]
], [
fhir:index 1;
fhir:Claim.procedure.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:Claim.procedure.procedureCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/ex-icd-10-procedures" ];
fhir:Coding.code [ fhir:value "123002" ] ] ]
], [
fhir:index 2;
fhir:Claim.procedure.sequence [ fhir:value "3"^^xsd:positiveInteger ];
fhir:Claim.procedure.procedureCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/ex-icd-10-procedures" ];
fhir:Coding.code [ fhir:value "123003" ] ] ]
];
fhir:Claim.insurance [
fhir:index 0;
fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ];
fhir:Claim.insurance.coverage [
fhir:Reference.display [ fhir:value "Cigna Health" ] ]
];
fhir:Claim.item [
fhir:index 0;
fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
a sct:185347001;
fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
fhir:Coding.code [ fhir:value "185347001" ];
fhir:Coding.display [ fhir:value "Encounter for problem" ] ];
fhir:CodeableConcept.text [ fhir:value "Encounter for problem" ] ]
], [
fhir:index 1;
fhir:Claim.item.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:Claim.item.procedureSequence [
fhir:value "1"^^xsd:positiveInteger;
fhir:index 0 ];
fhir:Claim.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
a sct:398171003;
fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
fhir:Coding.code [ fhir:value "398171003" ];
fhir:Coding.display [ fhir:value "Hearing examination (procedure)" ] ];
fhir:CodeableConcept.text [ fhir:value "Hearing examination (procedure)" ] ];
fhir:Claim.item.net [
fhir:Money.value [ fhir:value "516.65"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
], [
fhir:index 2;
fhir:Claim.item.sequence [ fhir:value "3"^^xsd:positiveInteger ];
fhir:Claim.item.procedureSequence [
fhir:value "2"^^xsd:positiveInteger;
fhir:index 0 ];
fhir:Claim.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
a sct:703423002;
fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
fhir:Coding.code [ fhir:value "703423002" ];
fhir:Coding.display [ fhir:value "Combined chemotherapy and radiation therapy (procedure)" ] ];
fhir:CodeableConcept.text [ fhir:value "Combined chemotherapy and radiation therapy (procedure)" ] ];
fhir:Claim.item.net [
fhir:Money.value [ fhir:value "16924.49"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
], [
fhir:index 3;
fhir:Claim.item.sequence [ fhir:value "4"^^xsd:positiveInteger ];
fhir:Claim.item.procedureSequence [
fhir:value "3"^^xsd:positiveInteger;
fhir:index 0 ];
fhir:Claim.item.productOrService [
fhir:CodeableConcept.coding [
fhir:index 0;
a sct:16335031000119103;
fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
fhir:Coding.code [ fhir:value "16335031000119103" ];
fhir:Coding.display [ fhir:value "High resolution computed tomography of chest without contrast (procedure)" ] ];
fhir:CodeableConcept.text [ fhir:value "High resolution computed tomography of chest without contrast (procedure)" ] ];
fhir:Claim.item.net [
fhir:Money.value [ fhir:value "516.65"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
];
fhir:Claim.total [
fhir:Money.value [ fhir:value "129.16"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
].
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl.
IG © 2021+ HCX Open Community. Package hcxprotocol.io#0.7.0 based on FHIR 4.0.1. Generated 2022-11-04
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