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| Financial Management Work Group | Maturity Level : N/A | Standards Status : Informative | Compartments : Device , Encounter , Patient , Practitioner , RelatedPerson |
Raw Turtle (+ also see Turtle/RDF Format Specification )
PreAuthorization with Orthodontic Treatment Plan
@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/Claim/100153> a fhir:Claim; fhir:nodeRole fhir:treeRoot; fhir:Resource.id [ fhir:value "100153"]; 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 Oral Health Claim</div>" ]; fhir:Claim.identifier [ fhir:index 0; fhir:Identifier.system [ fhir:value "http://happyvalley.com/claim" ]; fhir:Identifier.value [ fhir:value "12355" ] ]; 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 "oral" ] ] ]; fhir:Claim.use [ fhir:value "preauthorization"]; fhir:Claim.patient [ fhir:link <http://hl7.org/fhir/Patient/1>; fhir:Reference.reference [ fhir:value "Patient/1" ] ]; fhir:Claim.created [ fhir:value "2015-03-16"^^xsd:date]; fhir:Claim.insurer [ fhir:link <http://hl7.org/fhir/Organization/2>; fhir:Reference.reference [ fhir:value "Organization/2" ] ]; fhir:Claim.provider [ fhir:link <http://hl7.org/fhir/Organization/1>; fhir:Reference.reference [ fhir:value "Organization/1" ] ]; fhir:Claim.priority [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "normal" ] ] ]; fhir:Claim.fundsReserve [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "provider" ] ] ]; fhir:Claim.payee [ fhir:Claim.payee.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "provider" ] ][a fhir:Claim ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "100153"] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Oral Health Claim</div>" ] ; # fhir:identifier ( [ fhir:system [ fhir:v "http://happyvalley.com/claim"^^xsd:anyURI ] ; fhir:value [ fhir:v "12355" ] ] ) ; # 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 "oral" ] ] ) ] ; # fhir:use [ fhir:v "preauthorization"] ; # fhir:patient [ fhir:reference [ fhir:v "Patient/1" ] ] ; # fhir:created [ fhir:v "2015-03-16"^^xsd:date] ; # fhir:insurer [ fhir:reference [ fhir:v "Organization/2" ] ] ; # fhir:provider [ fhir:reference [ fhir:v "Organization/1" ] ] ; # fhir:priority [ fhir:coding ( [ fhir:code [ fhir:v "normal" ] ] ) ] ; # fhir:fundsReserve [ fhir:coding ( [ fhir:code [ fhir:v "provider" ] ] ) ] ; # fhir:payee [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "provider" ] ] ) ]]; fhir:Claim.careTeam [ fhir:index 0; fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ]; fhir:Claim.careTeam.provider [ fhir:link <http://hl7.org/fhir/Practitioner/example>; fhir:Reference.reference [ fhir:value "Practitioner/example" ]] ; # fhir:careTeam ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:provider [ fhir:reference [ fhir:v "Practitioner/example" ] ]]; fhir:Claim.diagnosis [ fhir:index 0; fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ]; fhir:Claim.diagnosis.diagnosisCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10" ]; fhir:Coding.code [ fhir:value "K07.3" ] ]] ) ; # fhir:diagnosis ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:diagnosis [ a fhir:CodeableConcept ; fhir:coding ( [ fhir:system [ fhir:v "http://hl7.org/fhir/sid/icd-10"^^xsd:anyURI ] ; fhir:code [ fhir:v "K07.3" ] # <code value=\"123457\"\/> ] ) ]]; 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:link <http://hl7.org/fhir/Coverage/9876B1>; fhir:Reference.reference [ fhir:value "Coverage/9876B1" ]] ) ; # fhir:insurance ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:focal [ fhir:v "true"^^xsd:boolean ] ; fhir:coverage [ fhir:reference [ fhir:v "Coverage/9876B1" ] ]]; fhir:Claim.item [ fhir:index 0; fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ]; fhir:Claim.item.careTeamSequence [ fhir:value "1"^^xsd:positiveInteger; fhir:index 0 ]; fhir:Claim.item.diagnosisSequence [ fhir:value "1"^^xsd:positiveInteger; fhir:index 0 ]; fhir:Claim.item.productOrService [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ]; fhir:Coding.code [ fhir:value "ORTHPLAN" ]] ) ; # fhir:item ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:diagnosisSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "ORTHPLAN" ] ] ) ] ; fhir:serviced [ fhir:v "2015-05-16"^^xsd:date ] ; fhir:unitPrice [ fhir:value [ fhir:v "9000.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; # Start Date fhir:net [ fhir:value [ fhir:v "9000.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:detail ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:productOrService [ fhir:coding ( [ fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "ORTHOEXAM" ] ] ) ] ; # Exam Fee fhir:unitPrice [ fhir:value [ fhir:v "1000.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:net [ fhir:value [ fhir:v "1000.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ]]; fhir:Claim.item.servicedDate [ fhir:value "2015-05-16"^^xsd:date ]; fhir:Claim.item.unitPrice [ fhir:Money.value [ fhir:value "9000.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ]; fhir:Claim.item.net [ fhir:Money.value [ fhir:value "9000.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ]; fhir:Claim.item.detail [ fhir:index 0; fhir:Claim.item.detail.sequence [ fhir:value "1"^^xsd:positiveInteger ]; fhir:Claim.item.detail.productOrService [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ]; fhir:Coding.code [ fhir:value "ORTHOEXAM" ] ] ]; fhir:Claim.item.detail.unitPrice [ fhir:Money.value [ fhir:value "1000.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ]; fhir:Claim.item.detail.net [ fhir:Money.value [ fhir:value "1000.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ]] [ fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ; fhir:productOrService [ fhir:coding ( [ fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "ORTHODIAG" ] ] ) ] ; # Diagnostic Fee fhir:unitPrice [ fhir:value [ fhir:v "1500.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:net [ fhir:value [ fhir:v "1500.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ]], [ fhir:index 1; fhir:Claim.item.detail.sequence [ fhir:value "2"^^xsd:positiveInteger ]; fhir:Claim.item.detail.productOrService [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ]; fhir:Coding.code [ fhir:value "ORTHODIAG" ] ] ]; fhir:Claim.item.detail.unitPrice [ fhir:Money.value [ fhir:value "1500.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ]; fhir:Claim.item.detail.net [ fhir:Money.value [ fhir:value "1500.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ]] [ fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ; fhir:productOrService [ fhir:coding ( [ fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "ORTHOINITIAL" ] ] ) ] ; # Initial Payment fhir:unitPrice [ fhir:value [ fhir:v "500.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:net [ fhir:value [ fhir:v "500.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ]], [ fhir:index 2; fhir:Claim.item.detail.sequence [ fhir:value "3"^^xsd:positiveInteger ]; fhir:Claim.item.detail.productOrService [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ]; fhir:Coding.code [ fhir:value "ORTHOINITIAL" ] ] ]; fhir:Claim.item.detail.unitPrice [ fhir:Money.value [ fhir:value "500.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ]; fhir:Claim.item.detail.net [ fhir:Money.value [ fhir:value "500.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ]] [ fhir:sequence [ fhir:v "4"^^xsd:positiveInteger ] ; fhir:productOrService [ fhir:coding ( [ fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "ORTHOMONTHS" ] ] ) ] ; # Duration in Months fhir:quantity [ fhir:value [ fhir:v "24"^^xsd:decimal ] ]], [ fhir:index 3; fhir:Claim.item.detail.sequence [ fhir:value "4"^^xsd:positiveInteger ]; fhir:Claim.item.detail.productOrService [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ]; fhir:Coding.code [ fhir:value "ORTHOMONTHS" ] ] ]; fhir:Claim.item.detail.quantity [ fhir:Quantity.value [ fhir:value "24"^^xsd:decimal ]] [ fhir:sequence [ fhir:v "5"^^xsd:positiveInteger ] ; fhir:productOrService [ fhir:coding ( [ fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "ORTHOPERIODIC" ] ] ) ] ; # Periodic Payments fhir:quantity [ fhir:value [ fhir:v "24"^^xsd:decimal ] ] ; fhir:unitPrice [ fhir:value [ fhir:v "250.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:net [ fhir:value [ fhir:v "250.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ]], [ fhir:index 4; fhir:Claim.item.detail.sequence [ fhir:value "5"^^xsd:positiveInteger ]; fhir:Claim.item.detail.productOrService [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ]; fhir:Coding.code [ fhir:value "ORTHOPERIODIC" ]] ) ] [ fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ; fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "21211" ] ] ) ] ; fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ; fhir:unitPrice [ fhir:value [ fhir:v "105.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:net [ fhir:value [ fhir:v "105.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:bodySite ( [ fhir:site ( [ fhir:concept [ fhir:coding ( [ fhir:system [ fhir:v "http://fdi.org/fhir/oraltoothcodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "21" ] ] ) ]]; fhir:Claim.item.detail.quantity [ fhir:Quantity.value [ fhir:value "24"^^xsd:decimal ] ]; fhir:Claim.item.detail.unitPrice [ fhir:Money.value [ fhir:value "250.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ]; fhir:Claim.item.detail.net [ fhir:Money.value [ fhir:value "250.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ] ] ], [ fhir:index 1; fhir:Claim.item.sequence [ fhir:value "2"^^xsd:positiveInteger ]; fhir:Claim.item.careTeamSequence [ fhir:value "1"^^xsd:positiveInteger; fhir:index 0 ]; fhir:Claim.item.productOrService [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ]; fhir:Coding.code [ fhir:value "21211" ] ] ]; fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ]; fhir:Claim.item.unitPrice [ fhir:Money.value [ fhir:value "105.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ]; fhir:Claim.item.net [ fhir:Money.value [ fhir:value "105.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ]; fhir:Claim.item.bodySite [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oraltoothcodes" ]; fhir:Coding.code [ fhir:value "21" ] ] ]; fhir:Claim.item.subSite [ fhir:index 0; fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oralsurfacecodes" ]; fhir:Coding.code [ fhir:value "L" ] ] ] ], [ fhir:index 2; fhir:Claim.item.sequence [ fhir:value "3"^^xsd:positiveInteger ]; fhir:Claim.item.careTeamSequence [ fhir:value "1"^^xsd:positiveInteger; fhir:index 0 ]; fhir:Claim.item.productOrService [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ]; fhir:Coding.code [ fhir:value "27211" ] ] ]; fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ]; fhir:Claim.item.unitPrice [ fhir:Money.value [ fhir:value "1100.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ]; fhir:Claim.item.net [ fhir:Money.value [ fhir:value "1100.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ]; fhir:Claim.item.bodySite [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oraltoothcodes" ]; fhir:Coding.code [ fhir:value "36" ] ] ]; fhir:Claim.item.detail [ fhir:index 0; fhir:Claim.item.detail.sequence [ fhir:value "1"^^xsd:positiveInteger ]; fhir:Claim.item.detail.productOrService [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ]; fhir:Coding.code [ fhir:value "27211" ]] ) ; fhir:subSite ( [ fhir:coding ( [ fhir:system [ fhir:v "http://fdi.org/fhir/oralsurfacecodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "L" ] ] ) ] ) ] ) ] [ fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ; fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ; fhir:productOrService [ fhir:coding ( [ fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "27211" ] ] ) ] ; fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ; fhir:unitPrice [ fhir:value [ fhir:v "1100.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:net [ fhir:value [ fhir:v "1100.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:bodySite ( [ fhir:site ( [ fhir:concept [ fhir:coding ( [ fhir:system [ fhir:v "http://fdi.org/fhir/oraltoothcodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "36" ] ] ) ]]; fhir:Claim.item.detail.unitPrice [ fhir:Money.value [ fhir:value "750.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ]; fhir:Claim.item.detail.net [ fhir:Money.value [ fhir:value "750.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ]] ) ] ) ; fhir:detail ( [ fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ; fhir:productOrService [ fhir:coding ( [ fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "27211" ] ] ) ] ; fhir:unitPrice [ fhir:value [ fhir:v "750.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:net [ fhir:value [ fhir:v "750.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ]], [ fhir:index 1; fhir:Claim.item.detail.sequence [ fhir:value "2"^^xsd:positiveInteger ]; fhir:Claim.item.detail.productOrService [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ]; fhir:Coding.code [ fhir:value "lab" ] ] ]; fhir:Claim.item.detail.unitPrice [ fhir:Money.value [ fhir:value "350.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ] ]; fhir:Claim.item.detail.net [ fhir:Money.value [ fhir:value "350.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "USD" ]] [ fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ; fhir:productOrService [ fhir:coding ( [ fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ; fhir:code [ fhir:v "lab" ] ] ) ] ; fhir:unitPrice [ fhir:value [ fhir:v "350.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ; fhir:net [ fhir:value [ fhir:v "350.00"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ]] ] . <http://hl7.org/fhir/Patient/1> a fhir:Patient . <http://hl7.org/fhir/Organization/2> a fhir:Organization . <http://hl7.org/fhir/Organization/1> a fhir:Organization . <http://hl7.org/fhir/Practitioner/example> a fhir:Practitioner . <http://hl7.org/fhir/Coverage/9876B1> a fhir:Coverage . # - ontology header ------------------------------------------------------------ <http://hl7.org/fhir/Claim/100153.ttl> a owl:Ontology; owl:imports fhir:fhir.ttl; owl:versionIRI <http://build.fhir.org/Claim/100153.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.
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FHIR
Release
4B
(v4.3.0)
hl7.fhir.r4b.core#4.3.0
R5
hl7.fhir.core#5.0.0
generated
on
Sat,
May
28,
2022
12:54+1000.
Sun,
Mar
26,
2023
15:24+1100.
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