FHIR Implementation Guide for HCX - Local Development build (v0.9.0). 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 xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:ClaimResponse ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "example-01"] ; #
fhir:meta [
fhir:versionId [ fhir:v "1" ] ;
fhir:lastUpdated [ fhir:v "2020-07-03T22:50:39.698+00:00"^^xsd:dateTime ] ;
fhir:source [ fhir:v "#JrkobxCRdZUI6QNh"^^xsd:anyURI ]
] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ClaimResponse</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 ClaimResponse "example-01" Version "1" Updated "2020-07-03 22:50:39+0000" </p><p style=\"margin-bottom: 0px\">Information Source: #JrkobxCRdZUI6QNh!</p></div><p><b>identifier</b>: id: dc82673b-8c71-48c2-2k9s-16dcb3b829m2</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/5.3.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#institutional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <span/></p><p><b>created</b>: 2020-07-03 18:50:39-0400</p><p><b>insurer</b>: <span/></p><p><b>requestor</b>: <span/></p><p><b>request</b>: <span/></p><p><b>outcome</b>: complete</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: Eligible Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#eligible)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>500000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: CoPay <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#copay)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>50000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Eligible % <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#eligpercent)</span></p><p><b>value</b>: 80.00</p></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: Benefit Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#benefit)</span></p><p><b>reason</b>: Plan Limit Reached <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication-reason.html\">Adjudication Reason Codes</a>#ar002)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>360000</td><td>INR</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: Submitted Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>500000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: Benefit Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#benefit)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>360000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>payment</b></p><p><b>type</b>: Complete <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-ex-paymenttype.html\">Example Payment Type Codes</a>#complete)</span></p><p><b>date</b>: 2014-08-31</p><h3>Amounts</h3><table class=\"grid\"><tr><td>-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td>*</td><td>410000</td><td>INR</td></tr></table><p><b>identifier</b>: id: 201408-2-1569478</p></blockquote></div>"
] ; #
fhir:identifier ( [
fhir:system [ fhir:v "https://www.tmh.in/claim-response"^^xsd:anyURI ] ;
fhir:value [ fhir:v "dc82673b-8c71-48c2-2k9s-16dcb3b829m2" ]
] ) ; #
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 "preauthorization"] ; #
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:created [ fhir:v "2020-07-03T18:50:39-04:00"^^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:requestor [
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:request [
fhir:id [ fhir:v "example-01" ] ;
fhir:identifier [
fhir:system [ fhir:v "https://www.tmh.in/claim-request"^^xsd:anyURI ] ;
fhir:value [ fhir:v "dc82673b-8c71-29js-8a17-16dj3i20352n" ] ]
] ; #
fhir:outcome [ fhir:v "complete"] ; #
fhir:item ( [
fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ;
( fhir:adjudication [
fhir:category [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "eligible" ] ] ) ] ;
fhir:amount [
fhir:value [ fhir:v "500000"^^xsd:decimal ] ;
fhir:currency [ fhir:v "INR" ] ] ] [
fhir:category [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "copay" ] ] ) ] ;
fhir:amount [
fhir:value [ fhir:v "50000"^^xsd:decimal ] ;
fhir:currency [ fhir:v "INR" ] ] ] [
fhir:category [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "eligpercent" ] ] ) ] ;
fhir:value [ fhir:v "80.00"^^xsd:decimal ] ] [
fhir:category [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "benefit" ] ] ) ] ;
fhir:reason [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication-reason"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ar002" ] ;
fhir:display [ fhir:v "Plan Limit Reached" ] ] ) ] ;
fhir:amount [
fhir:value [ fhir:v "360000"^^xsd:decimal ] ;
fhir:currency [ fhir:v "INR" ] ] ] )
] ) ; #
fhir:total ( [
fhir:category [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "submitted" ] ] ) ] ;
fhir:amount [
fhir:value [ fhir:v "500000"^^xsd:decimal ] ;
fhir:currency [ fhir:v "INR" ] ]
] [
fhir:category [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "benefit" ] ] ) ] ;
fhir:amount [
fhir:value [ fhir:v "360000"^^xsd:decimal ] ;
fhir:currency [ fhir:v "INR" ] ]
] ) ; #
fhir:payment [
fhir:type [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-paymenttype"^^xsd:anyURI ] ;
fhir:code [ fhir:v "complete" ] ] ) ] ;
fhir:date [ fhir:v "2014-08-31"^^xsd:date ] ;
fhir:amount [
fhir:value [ fhir:v "410000"^^xsd:decimal ] ;
fhir:currency [ fhir:v "INR" ] ] ;
fhir:identifier [
fhir:system [ fhir:v "http://www.BenefitsInc.com/fhir/paymentidentifier"^^xsd:anyURI ] ;
fhir:value [ fhir:v "201408-2-1569478" ] ]
] . #
IG © 2021+ HCX Open Community. Package hcxprotocol.io#0.9.0 based on FHIR 4.0.1. Generated 2023-12-14
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