Claim
PaymentNotice
Example
General
Person
Primary
Coverage
with
error
@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 -------------------------------------------------------------------
<http://hl7.org/fhir/PaymentNotice/77654> a fhir:PaymentNotice;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "77654"];
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 PaymentNotice</div>"
];
fhir:PaymentNotice.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://benefitsinc.com/paymentnotice" ];
fhir:Identifier.value [ fhir:value "776543" ]
];
fhir:PaymentNotice.status [ fhir:value "active"];
fhir:PaymentNotice.request [
fhir:link <http://benefitsinc.com/fhir/claim/12345>;
fhir:Reference.reference [ fhir:value "http://benefitsinc.com/fhir/claim/12345" ]
];
fhir:PaymentNotice.response [
fhir:link <http://benefitsinc.com/fhir/claimresponse/CR12345>;
fhir:Reference.reference [ fhir:value "http://benefitsinc.com/fhir/claimresponse/CR12345" ]
];
fhir:PaymentNotice.created [ fhir:value "2014-08-16"^^xsd:date];
fhir:PaymentNotice.provider [
fhir:link <http://hl7.org/fhir/Organization/1>;
fhir:Reference.reference [ fhir:value "Organization/1" ]
];
fhir:PaymentNotice.payment [
fhir:link <http://hl7.org/fhir/PaymentReconciliation/ER2500>;
fhir:Reference.reference [ fhir:value "PaymentReconciliation/ER2500" ]
];
fhir:PaymentNotice.paymentDate [ fhir:value "2014-08-15"^^xsd:date];
fhir:PaymentNotice.payee [
fhir:link <http://hl7.org/fhir/Organization/1>;
fhir:Reference.reference [ fhir:value "Organization/1" ]
];
fhir:PaymentNotice.recipient [
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://regulators.gov" ];
fhir:Identifier.value [ fhir:value "AB123" ]
]
];
fhir:PaymentNotice.amount [
fhir:Money.value [ fhir:value "12500.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:PaymentNotice.paymentStatus [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/paymentstatus" ];
fhir:Coding.code [ fhir:value "paid" ]
]
] .
<http://hl7.org/fhir/Organization/1> a fhir:Organization .
<http://hl7.org/fhir/PaymentReconciliation/ER2500> a fhir:PaymentReconciliation .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/PaymentNotice/77654.ttl> a owl:Ontology;
owl:imports fhir:fhir.ttl;
owl:versionIRI <http://build.fhir.org/PaymentNotice/77654.ttl> .
# -------------------------------------------------------------------------------------
{
"resourceType": "CoverageEligibilityResponse",
"id": "E2503",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
},
"identifier": [
{
"system": "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
"value": "8812343"
}
],
"status": "active",
"purpose": [
"validation"
],
"patient": {
"reference": "Patient/f201"
},
"created": "2014-09-16",
"requestor": {
"identifier": {
"system": "http://national.org/clinic",
"value": "OR1234"
}
},
"request": {
"reference": "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332406"
},
"outcome": "error",
"disposition": "Eligibiliy request could not be processed, please address errors before submitting.",
"insurer": {
"reference": "Organization/2"
},
"form": {
"coding": [
{
"system": "http://national.org/form",
"code": "ELRSP/2017/01"
}
]
},
"error": [
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication-error",
"code": "a001"
}
]
}
}
]
}
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.
Financial
.
Page
versions:
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R4B
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