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Explanationofbenefit-example-2.ttl

Example ExplanationOfBenefit/EB3501 (Turtle)

Maturity Level : N/A
Responsible Owner: Financial Management Work Group Standards Status : Informative Compartments : Device , Encounter , Group , Patient , Practitioner , RelatedPerson

Raw Turtle (+ also see Turtle/RDF Format Specification )

EOB for an Claim that had errors 

@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 -------------------------------------------------------------------

<http://hl7.org/fhir/ExplanationOfBenefit/EB3501> a fhir:ExplanationOfBenefit;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "EB3501"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the ExplanationOfBenefit for a claim that had errors, various other attributes (such as accident and hospitalization) are also completed.</div>"
  ];
  fhir:ExplanationOfBenefit.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/explanationofbenefit" ];
     fhir:Identifier.value [ fhir:value "error-1" ]
  ];
  fhir:ExplanationOfBenefit.status [ fhir:value "active"];
  fhir:ExplanationOfBenefit.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
       fhir:Coding.code [ fhir:value "oral" ]
     ]
  ];
  fhir:ExplanationOfBenefit.subType [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-claimsubtype" ];
       fhir:Coding.code [ fhir:value "emergency" ]
     ]
  ];
  fhir:ExplanationOfBenefit.use [ fhir:value "claim"];
  fhir:ExplanationOfBenefit.patient [
     fhir:link <http://hl7.org/fhir/Patient/pat1>;
     fhir:Reference.reference [ fhir:value "Patient/pat1" ]
  ];
  fhir:ExplanationOfBenefit.billablePeriod [
     fhir:Period.start [ fhir:value "2014-02-01"^^xsd:date ];
     fhir:Period.end [ fhir:value "2014-03-01"^^xsd:date ]
  ];
  fhir:ExplanationOfBenefit.created [ fhir:value "2014-08-16"^^xsd:date];
  fhir:ExplanationOfBenefit.enterer [
     fhir:link <http://hl7.org/fhir/Practitioner/1>;
     fhir:Reference.reference [ fhir:value "Practitioner/1" ]
  ];
  fhir:ExplanationOfBenefit.insurer [
     fhir:link <http://hl7.org/fhir/Organization/2>;
     fhir:Reference.reference [ fhir:value "Organization/2" ]
  ];
  fhir:ExplanationOfBenefit.provider [
     fhir:link <http://hl7.org/fhir/Organization/2>;
     fhir:Reference.reference [ fhir:value "Organization/2" ]
  ];
  fhir:ExplanationOfBenefit.related [
     fhir:index 0;
     fhir:ExplanationOfBenefit.related.reference [
       fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/case-number" ];
       fhir:Identifier.value [ fhir:value "23-56Tu-XX-47-20150M14" ]
     ]
  ];
  fhir:ExplanationOfBenefit.prescription [
     fhir:link <http://hl7.org/fhir/MedicationRequest/medrx002>;
     fhir:Reference.reference [ fhir:value "MedicationRequest/medrx002" ]
  ];
  fhir:ExplanationOfBenefit.originalPrescription [
     fhir:link <http://hl7.org/fhir/MedicationRequest/medrx0301>;
     fhir:Reference.reference [ fhir:value "MedicationRequest/medrx0301" ]
  ];
  fhir:ExplanationOfBenefit.facility [
     fhir:link <http://hl7.org/fhir/Location/1>;
     fhir:Reference.reference [ fhir:value "Location/1" ]
  ];
  fhir:ExplanationOfBenefit.claim [
     fhir:link <http://hl7.org/fhir/Claim/100150>;
     fhir:Reference.reference [ fhir:value "Claim/100150" ]
  ];
  fhir:ExplanationOfBenefit.claimResponse [
     fhir:link <http://hl7.org/fhir/ClaimResponse/R3500>;
     fhir:Reference.reference [ fhir:value "ClaimResponse/R3500" ]
  ];
  fhir:ExplanationOfBenefit.outcome [ fhir:value "error"];
  fhir:ExplanationOfBenefit.disposition [ fhir:value "Could not process."];
  fhir:ExplanationOfBenefit.supportingInfo [
     fhir:index 0;
     fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:ExplanationOfBenefit.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
         fhir:Coding.code [ fhir:value "employmentimpacted" ]
       ]
     ];
     fhir:ExplanationOfBenefit.supportingInfo.timingPeriod [
       fhir:Period.start [ fhir:value "2014-02-14"^^xsd:date ];
       fhir:Period.end [ fhir:value "2014-02-28"^^xsd:date ]
     ]
  ], [
     fhir:index 1;
     fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "2"^^xsd:positiveInteger ];
     fhir:ExplanationOfBenefit.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
         fhir:Coding.code [ fhir:value "hospitalized" ]
       ]
     ];
     fhir:ExplanationOfBenefit.supportingInfo.timingPeriod [
       fhir:Period.start [ fhir:value "2014-02-14"^^xsd:date ];
       fhir:Period.end [ fhir:value "2014-02-16"^^xsd:date ]

<http://hl7.org/fhir/ExplanationOfBenefit/EB3501> a fhir:ExplanationOfBenefit ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "EB3501"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the ExplanationOfBenefit for a claim that had errors, various other attributes (such as accident and hospitalization) are also completed.</div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:identifier ( [
     fhir:system [
       fhir:v "http://www.BenefitsInc.com/fhir/explanationofbenefit"^^xsd:anyURI ;
       fhir:l <http://www.BenefitsInc.com/fhir/explanationofbenefit>
     ] ;
     fhir:value [ fhir:v "error-1" ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [
         fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ;
         fhir:l <http://terminology.hl7.org/CodeSystem/claim-type>
       ] ;
       fhir:code [ fhir:v "oral" ]
     ] )
  ] ; # 
  fhir:subType [
     fhir:coding ( [
       fhir:system [
         fhir:v "http://terminology.hl7.org/CodeSystem/ex-claimsubtype"^^xsd:anyURI ;
         fhir:l <http://terminology.hl7.org/CodeSystem/ex-claimsubtype>
       ] ;
       fhir:code [ fhir:v "emergency" ]
     ] )
  ] ; # 
  fhir:use [ fhir:v "claim"] ; # 
  fhir:subject [
     fhir:l <http://hl7.org/fhir/Patient/pat1> ;
     fhir:reference [ fhir:v "Patient/pat1" ]
  ] ; # 
  fhir:billablePeriod [
     fhir:start [ fhir:v "2014-02-01"^^xsd:date ] ;
     fhir:end [ fhir:v "2014-03-01"^^xsd:date ]
  ] ; # 
  fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; # 
  fhir:enterer [
     fhir:l <http://hl7.org/fhir/Practitioner/1> ;
     fhir:reference [ fhir:v "Practitioner/1" ]
  ] ; # 
  fhir:insurer [
     fhir:l <http://hl7.org/fhir/Organization/2> ;
     fhir:reference [ fhir:v "Organization/2" ]
  ] ; # 
  fhir:provider [
     fhir:l <http://hl7.org/fhir/Organization/2> ;
     fhir:reference [ fhir:v "Organization/2" ]
  ] ; # 
  fhir:related ( [
     fhir:reference [
       fhir:system [
         fhir:v "http://www.BenefitsInc.com/case-number"^^xsd:anyURI ;
         fhir:l <http://www.BenefitsInc.com/case-number>
       ] ;
       fhir:value [ fhir:v "23-56Tu-XX-47-20150M14" ]

     ]
  ];
  fhir:ExplanationOfBenefit.procedure [
     fhir:index 0;
     fhir:ExplanationOfBenefit.procedure.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:ExplanationOfBenefit.procedure.date [ fhir:value "2014-02-14"^^xsd:date ];
     fhir:ExplanationOfBenefit.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:ExplanationOfBenefit.procedure.udi [
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/Device/example>;
       fhir:Reference.reference [ fhir:value "Device/example" ]

  ] ) ; # 
  fhir:prescription [
     fhir:l <http://hl7.org/fhir/MedicationRequest/medrx002> ;
     fhir:reference [ fhir:v "MedicationRequest/medrx002" ]
  ] ; # 
  fhir:originalPrescription [
     fhir:l <http://hl7.org/fhir/MedicationRequest/medrx0301> ;
     fhir:reference [ fhir:v "MedicationRequest/medrx0301" ]
  ] ; # 
  fhir:facility [
     fhir:l <http://hl7.org/fhir/Location/1> ;
     fhir:reference [ fhir:v "Location/1" ]
  ] ; # 
  fhir:claim [
     fhir:l <http://hl7.org/fhir/Claim/100150> ;
     fhir:reference [ fhir:v "Claim/100150" ]
  ] ; # 
  fhir:claimResponse [
     fhir:l <http://hl7.org/fhir/ClaimResponse/R3500> ;
     fhir:reference [ fhir:v "ClaimResponse/R3500" ]
  ] ; # 
  fhir:outcome [ fhir:v "error"] ; # 
  fhir:disposition [ fhir:v "Could not process."] ; # 
  fhir:supportingInfo ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:category [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/claiminformationcategory>
         ] ;
         fhir:code [ fhir:v "employmentimpacted" ]
       ] )
     ] ;
     fhir:timing [
       a fhir:Period ;
       fhir:start [ fhir:v "2014-02-14"^^xsd:date ] ;
       fhir:end [ fhir:v "2014-02-28"^^xsd:date ]

     ]
  ];
  fhir:ExplanationOfBenefit.precedence [ fhir:value "2"^^xsd:positiveInteger];
  fhir:ExplanationOfBenefit.insurance [
     fhir:index 0;
     fhir:ExplanationOfBenefit.insurance.focal [ fhir:value "true"^^xsd:boolean ];
     fhir:ExplanationOfBenefit.insurance.coverage [
       fhir:link <http://hl7.org/fhir/Coverage/9876B1>;
       fhir:Reference.reference [ fhir:value "Coverage/9876B1" ]

  ] [
     fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
     fhir:category [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/claiminformationcategory>
         ] ;
         fhir:code [ fhir:v "hospitalized" ]
       ] )
     ] ;
     fhir:timing [
       a fhir:Period ;
       fhir:start [ fhir:v "2014-02-14"^^xsd:date ] ;
       fhir:end [ fhir:v "2014-02-16"^^xsd:date ]

     ]
  ];
  fhir:ExplanationOfBenefit.accident [
     fhir:ExplanationOfBenefit.accident.date [ fhir:value "2014-02-14"^^xsd:date ];
     fhir:ExplanationOfBenefit.accident.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
         fhir:Coding.code [ fhir:value "SPT" ]
       ]
     ];
     fhir:ExplanationOfBenefit.accident.locationReference [
       fhir:link <http://hl7.org/fhir/Location/ph>;
       fhir:Reference.reference [ fhir:value "Location/ph" ]

  ] ) ; # 
  fhir:procedure ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:date [ fhir:v "2014-02-14"^^xsd:date ] ;
     fhir:procedure [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/sid/ex-icd-10-procedures"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/sid/ex-icd-10-procedures>
         ] ;
         fhir:code [ fhir:v "123001" ]
       ] )
     ] ;
     fhir:udi ( [
       fhir:l <http://hl7.org/fhir/Device/example> ;
       fhir:reference [ fhir:v "Device/example" ]
     ] )
  ] ) ; # 
  fhir:precedence [ fhir:v "2"^^xsd:positiveInteger] ; # 
  fhir:insurance ( [
     fhir:focal [ fhir:v true ] ;
     fhir:coverage [
       fhir:l <http://hl7.org/fhir/Coverage/9876B1> ;
       fhir:reference [ fhir:v "Coverage/9876B1" ]

     ]
  ];
  fhir:ExplanationOfBenefit.total [
     fhir:index 0;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.code [ fhir:value "submitted" ]
       ]
     ];
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "2478.57"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]

  ] ) ; # 
  fhir:accident [
     fhir:date [ fhir:v "2014-02-14"^^xsd:date ] ;
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/v3-ActCode>
         ] ;
         fhir:code [ fhir:v "SPT" ]
       ] )
     ] ;
     fhir:location [
       a fhir:Reference ;
       fhir:l <http://hl7.org/fhir/Location/ph> ;
       fhir:reference [ fhir:v "Location/ph" ]

     ]
  ], [
     fhir:index 1;
     fhir:ExplanationOfBenefit.total.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.code [ fhir:value "benefit" ]
       ]
     ];
     fhir:ExplanationOfBenefit.total.amount [
       fhir:Money.value [ fhir:value "0.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]

  ] ; # 
  fhir:total ( [
     fhir:category [
       fhir:coding ( [
         fhir:code [ fhir:v "submitted" ]
       ] )
     ] ;
     fhir:amount [
       fhir:value [ fhir:v 2478.57 ] ;
       fhir:currency [ fhir:v "USD" ]

     ]
  ];
  fhir:ExplanationOfBenefit.formCode [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/forms-codes" ];
       fhir:Coding.code [ fhir:value "2" ]

  ] [
     fhir:category [
       fhir:coding ( [
         fhir:code [ fhir:v "benefit" ]
       ] )
     ] ;
     fhir:amount [
       fhir:value [ fhir:v 0.00 ] ;
       fhir:currency [ fhir:v "USD" ]

     ]
  ];
  fhir:ExplanationOfBenefit.processNote [
     fhir:index 0;
     fhir:ExplanationOfBenefit.processNote.number [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:ExplanationOfBenefit.processNote.type [ fhir:value "display" ];
     fhir:ExplanationOfBenefit.processNote.text [ fhir:value "Invalid claim" ];
     fhir:ExplanationOfBenefit.processNote.language [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "urn:ietf:bcp:47" ];
         fhir:Coding.code [ fhir:value "en-CA" ]
       ]

  ] ) ; # 
  fhir:formCode [
     fhir:coding ( [
       fhir:system [
         fhir:v "http://terminology.hl7.org/CodeSystem/forms-codes"^^xsd:anyURI ;
         fhir:l <http://terminology.hl7.org/CodeSystem/forms-codes>
       ] ;
       fhir:code [ fhir:v "2" ]
     ] )
  ] ; # 
  fhir:processNote ( [
     fhir:number [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/note-type"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/note-type>
         ] ;
         fhir:code [ fhir:v "display" ]
       ] )
     ] ;
     fhir:text [ fhir:v "Invalid claim" ] ;
     fhir:language [
       fhir:coding ( [
         fhir:system [
           fhir:v "urn:ietf:bcp:47"^^xsd:anyURI ;
           fhir:l <urn:ietf:bcp:47>
         ] ;
         fhir:code [ fhir:v "en-CA" ]
       ] )

     ]
  ] .

  ] ) . # 


<http://hl7.org/fhir/Patient/pat1> a fhir:Patient .

<http://hl7.org/fhir/Practitioner/1> a fhir:Practitioner .

<http://hl7.org/fhir/Organization/2> a fhir:Organization .

<http://hl7.org/fhir/MedicationRequest/medrx002> a fhir:MedicationRequest .

<http://hl7.org/fhir/MedicationRequest/medrx0301> a fhir:MedicationRequest .

<http://hl7.org/fhir/Location/1> a fhir:Location .

<http://hl7.org/fhir/Claim/100150> a fhir:Claim .

<http://hl7.org/fhir/ClaimResponse/R3500> a fhir:ClaimResponse .

<http://hl7.org/fhir/Device/example> a fhir:Device .

<http://hl7.org/fhir/Coverage/9876B1> a fhir:Coverage .

<http://hl7.org/fhir/Location/ph> a fhir:Location .

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

<http://hl7.org/fhir/ExplanationOfBenefit/EB3501.ttl> a owl:Ontology;
  owl:imports fhir:fhir.ttl;
  owl:versionIRI <http://build.fhir.org/ExplanationOfBenefit/EB3501.ttl> .


# -------------------------------------------------------------------------------------

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.