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| Financial Management Work Group | Maturity Level : N/A | Standards Status : Informative | Compartments : Patient , Practitioner |
Raw Turtle (+ also see Turtle/RDF Format Specification )
General Person Primary Coverage with Benefit Details
@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/CoverageEligibilityResponse/E2501> a fhir:CoverageEligibilityResponse; fhir:nodeRole fhir:treeRoot; fhir:Resource.id [ fhir:value "E2501"]; 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 CoverageEligibilityResponse.</div>" ]; fhir:CoverageEligibilityResponse.identifier [ fhir:index 0; fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse" ]; fhir:Identifier.value [ fhir:value "881234" ] ]; fhir:CoverageEligibilityResponse.status [ fhir:value "active"]; fhir:CoverageEligibilityResponse.purpose [ fhir:value "validation"; fhir:index 0 ], [ fhir:value "benefits"; fhir:index 1 ]; fhir:CoverageEligibilityResponse.patient [ fhir:link <http://hl7.org/fhir/Patient/pat1>; fhir:Reference.reference [ fhir:value "Patient/pat1" ] ]; fhir:CoverageEligibilityResponse.servicedDate [ fhir:value "2014-09-17"^^xsd:date]; fhir:CoverageEligibilityResponse.created [ fhir:value "2014-08-16"^^xsd:date]; fhir:CoverageEligibilityResponse.request [ fhir:link <http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402>; fhir:Reference.reference [ fhir:value "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402" ] ]; fhir:CoverageEligibilityResponse.outcome [ fhir:value "complete"]; fhir:CoverageEligibilityResponse.disposition [ fhir:value "Policy is currently in-force."]; fhir:CoverageEligibilityResponse.insurer [ fhir:link <http://hl7.org/fhir/Organization/2>; fhir:Reference.reference [ fhir:value "Organization/2" ] ]; fhir:CoverageEligibilityResponse.insurance [ fhir:index 0; fhir:CoverageEligibilityResponse.insurance.coverage [ fhir:link <http://hl7.org/fhir/Coverage/9876B1>; fhir:Reference.reference [ fhir:value "Coverage/9876B1" ] ]; fhir:CoverageEligibilityResponse.insurance.inforce [ fhir:value "true"^^xsd:boolean ]; fhir:CoverageEligibilityResponse.insurance.item [ fhir:index 0; fhir:CoverageEligibilityResponse.insurance.item.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ]; fhir:Coding.code [ fhir:value "30" ]; fhir:Coding.display [ fhir:value "Health Benefit Plan Coverage" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.network [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ]; fhir:Coding.code [ fhir:value "in" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.unit [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ]; fhir:Coding.code [ fhir:value "individual" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.term [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ]; fhir:Coding.code [ fhir:value "annual" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.benefit [ fhir:index 0; fhir:CoverageEligibilityResponse.insurance.item.benefit.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "benefit" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [ fhir:Money.value [ fhir:value "500000"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "SAR" ] ] ], [ fhir:index 1; fhir:CoverageEligibilityResponse.insurance.item.benefit.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "copay-maximum" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [ fhir:Money.value [ fhir:value "100"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "SAR" ] ] ], [ fhir:index 2; fhir:CoverageEligibilityResponse.insurance.item.benefit.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "copay-percent" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedUnsignedInt [ fhir:value "20"^^xsd:nonNegativeInteger ] ] ], [ fhir:index 1; fhir:CoverageEligibilityResponse.insurance.item.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ]; fhir:Coding.code [ fhir:value "69" ]; fhir:Coding.display [ fhir:value "Maternity" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.network [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ]; fhir:Coding.code [ fhir:value "in" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.unit [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ]; fhir:Coding.code [ fhir:value "individual" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.term [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ]; fhir:Coding.code [ fhir:value "annual" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.benefit [ fhir:index 0; fhir:CoverageEligibilityResponse.insurance.item.benefit.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "benefit" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [ fhir:Money.value [ fhir:value "15000"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "SAR" ] ] ] ], [ fhir:index 2; fhir:CoverageEligibilityResponse.insurance.item.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ]; fhir:Coding.code [ fhir:value "F3" ]; fhir:Coding.display [ fhir:value "Dental Coverage" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.network [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ]; fhir:Coding.code [ fhir:value "in" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.unit [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ]; fhir:Coding.code [ fhir:value "individual" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.term [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ]; fhir:Coding.code [ fhir:value "annual" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.benefit [ fhir:index 0; fhir:CoverageEligibilityResponse.insurance.item.benefit.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "benefit" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [ fhir:Money.value [ fhir:value "2000"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "SAR" ] ] ] ], [ fhir:index 3; fhir:CoverageEligibilityResponse.insurance.item.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ]; fhir:Coding.code [ fhir:value "F6" ]; fhir:Coding.display [ fhir:value "Vision Coverage" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.network [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ]; fhir:Coding.code [ fhir:value "in" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.unit [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ]; fhir:Coding.code [ fhir:value "individual" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.term [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ]; fhir:Coding.code [ fhir:value "annual" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.benefit [ fhir:index 0; fhir:CoverageEligibilityResponse.insurance.item.benefit.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "benefit" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [ fhir:Money.value [ fhir:value "400"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "SAR" ][a fhir:CoverageEligibilityResponse ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "E2501"] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>" ] ; # fhir:identifier ( [ fhir:system [ fhir:v "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse"^^xsd:anyURI ] ; fhir:value [ fhir:v "881234" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:purpose ( [ fhir:v "validation"] [ fhir:v "benefits"] ) ; # fhir:patient [ fhir:reference [ fhir:v "Patient/pat1" ] ] ; # fhir:serviced [ fhir:v "2014-09-17"^^xsd:date] ; # fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; # Anticipated service date fhir:request [ fhir:link <http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402> ; fhir:reference [ fhir:v "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402" ] ] ; # fhir:outcome [ fhir:v "complete"] ; # fhir:disposition [ fhir:v "Policy is currently in-force."] ; # fhir:insurer [ fhir:reference [ fhir:v "Organization/2" ] ] ; # fhir:insurance ( [ fhir:coverage [ fhir:reference [ fhir:v "Coverage/9876B1" ] ] ; fhir:inforce [ fhir:v "true"^^xsd:boolean ] ; fhir:item ( [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ; fhir:code [ fhir:v "30" ] ; fhir:display [ fhir:v "Health Benefit Plan Coverage" ] ] ) ] ; fhir:network [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ; fhir:code [ fhir:v "in" ] ] ) ] ; fhir:unit [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ; fhir:code [ fhir:v "individual" ] ] ) ] ; fhir:term [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ; fhir:code [ fhir:v "annual" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "500000"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ]] ], [ fhir:index 4; fhir:CoverageEligibilityResponse.insurance.item.category [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ]; fhir:Coding.code [ fhir:value "49" ]; fhir:Coding.display [ fhir:value "Hospital Room and Board" ]] [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "copay-maximum" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "100"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ]]; fhir:CoverageEligibilityResponse.insurance.item.network [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ]; fhir:Coding.code [ fhir:value "in" ]] [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "copay-percent" ] ] ) ] ; fhir:allowed [ fhir:v "20"^^xsd:nonNegativeInteger ] ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ; fhir:code [ fhir:v "69" ] ; fhir:display [ fhir:v "Maternity" ] ] ) ] ; fhir:network [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ; fhir:code [ fhir:v "in" ] ] ) ] ; fhir:unit [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ; fhir:code [ fhir:v "individual" ] ] ) ] ; fhir:term [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ; fhir:code [ fhir:v "annual" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "15000"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ]]; fhir:CoverageEligibilityResponse.insurance.item.unit [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ]; fhir:Coding.code [ fhir:value "individual" ]] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ; fhir:code [ fhir:v "F3" ] ; fhir:display [ fhir:v "Dental Coverage" ] ] ) ] ; fhir:network [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ; fhir:code [ fhir:v "in" ] ] ) ] ; fhir:unit [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ; fhir:code [ fhir:v "individual" ] ] ) ] ; fhir:term [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ; fhir:code [ fhir:v "annual" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "2000"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ]]; fhir:CoverageEligibilityResponse.insurance.item.term [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ]; fhir:Coding.code [ fhir:value "day" ]] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ; fhir:code [ fhir:v "F6" ] ; fhir:display [ fhir:v "Vision Coverage" ] ] ) ] ; fhir:network [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ; fhir:code [ fhir:v "in" ] ] ) ] ; fhir:unit [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ; fhir:code [ fhir:v "individual" ] ] ) ] ; fhir:term [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ; fhir:code [ fhir:v "annual" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "400"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ]]; fhir:CoverageEligibilityResponse.insurance.item.benefit [ fhir:index 0; fhir:CoverageEligibilityResponse.insurance.item.benefit.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "room" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedString [ fhir:value "shared" ] ], [ fhir:index 1; fhir:CoverageEligibilityResponse.insurance.item.benefit.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.code [ fhir:value "benefit" ] ] ]; fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [ fhir:Money.value [ fhir:value "600"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "SAR" ]] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ; fhir:code [ fhir:v "49" ] ; fhir:display [ fhir:v "Hospital Room and Board" ] ] ) ] ; fhir:network [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ; fhir:code [ fhir:v "in" ] ] ) ] ; fhir:unit [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ; fhir:code [ fhir:v "individual" ] ] ) ] ; fhir:term [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ; fhir:code [ fhir:v "day" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "room" ] ] ) ] ; fhir:allowed [ fhir:v "shared" ] ] [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "600"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ]] ] ] . <http://hl7.org/fhir/Patient/pat1> a fhir:Patient . <http://hl7.org/fhir/Organization/2> a fhir:Organization . <http://hl7.org/fhir/Coverage/9876B1> a fhir:Coverage . # - ontology header ------------------------------------------------------------ <http://hl7.org/fhir/CoverageEligibilityResponse/E2501.ttl> a owl:Ontology; owl:imports fhir:fhir.ttl; owl:versionIRI <http://build.fhir.org/CoverageEligibilityResponse/E2501.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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