R4 Ballot #2 (Mixed Normative/Trial use)
This page is part of the FHIR Specification (v3.5.0: R4 Ballot #2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
. Page versions: R5 R4B R4 R3
| Financial Management Work Group | Maturity Level: N/A | Ballot Status: Informative | Compartments: Encounter, Patient, Practitioner, RelatedPerson |
Raw Turtle (+ also see Turtle/RDF Format Specification)
PreAuthorization with Bridge and Crown
Financial
@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/100156> a fhir:Claim;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "100156"];
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:DomainResource.contained [
a fhir:Device;
fhir:index 0;
fhir:Resource.id [ fhir:value "device-bridge" ]
], [
a fhir:ServiceRequest;
fhir:index 1;
fhir:Resource.id [ fhir:value "referral" ];
fhir:ServiceRequest.status [ fhir:value "active" ];
fhir:ServiceRequest.intent [ fhir:value "order" ];
fhir:ServiceRequest.subject [
fhir:link <http://hl7.org/fhir/Patient/1>;
fhir:Reference.reference [ fhir:value "Patient/1" ]
]
];
fhir:Claim.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://happyvalley.com/claim" ];
fhir:Identifier.value [ fhir:value "123466" ]
];
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 "claim"];
fhir:Claim.patient [
fhir:link <http://hl7.org/fhir/Patient/1>;
fhir:Reference.reference [ fhir:value "Patient/1" ]
];
fhir:Claim.created [ fhir:value "2014-08-16"^^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.related [
fhir:index 0;
fhir:Claim.related.claim [
fhir:link <http://hl7.org/fhir/Claim/100151>;
fhir:Reference.reference [ fhir:value "Claim/100151" ]
];
fhir:Claim.related.relationship [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship" ];
fhir:Coding.code [ fhir:value "associated" ]
]
];
fhir:Claim.related.reference [
fhir:Identifier.value [ fhir:value "CASE156746B" ]
]
];
fhir:Claim.payee [
fhir:Claim.payee.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payeetype" ];
fhir:Coding.code [ fhir:value "other" ]
]
];
fhir:Claim.payee.resource [
fhir:Coding.code [ fhir:value "relatedperson" ]
];
fhir:Claim.payee.party [
fhir:link <http://hl7.org/fhir/RelatedPerson/peter>;
fhir:Reference.reference [ fhir:value "RelatedPerson/peter" ]
]
];
fhir:Claim.referral [
fhir:Reference.reference [ fhir:value "#referral" ]
];
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:Claim.information [
fhir:index 0;
fhir:Claim.information.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.information.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
fhir:Coding.code [ fhir:value "prosthesis" ]
]
];
fhir:Claim.information.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/ex-oralprostho" ];
fhir:Coding.code [ fhir:value "2" ];
fhir:Coding.display [ fhir:value "Maryland Bridge" ]
]
];
fhir:Claim.information.timingDate [ fhir:value "2001-04-07"^^xsd:date ]
];
fhir:Claim.procedure [
fhir:index 0;
fhir:Claim.procedure.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.procedure.date [ fhir:value "2014-07-04"^^xsd:date ];
fhir:Claim.procedure.procedureCodeableConcept [
fhir:CodeableConcept.text [ fhir:value "Resection of gum to increase exposed tooth." ]
]
];
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: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.informationSequence [
fhir:value "1"^^xsd:positiveInteger;
fhir:index 0
];
fhir:Claim.item.billcode [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
fhir:Coding.code [ fhir:value "67221" ];
fhir:Coding.display [ fhir:value "Maryland Bridge" ]
]
];
fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
fhir:Claim.item.locationCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace" ];
fhir:Coding.code [ fhir:value "11" ]
]
];
fhir:Claim.item.unitPrice [
fhir:Money.value [ fhir:value "1400.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.factor [ fhir:value "0.75"^^xsd:decimal ];
fhir:Claim.item.net [
fhir:Money.value [ fhir:value "1050.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.udi [
fhir:index 0;
fhir:Reference.reference [ fhir:value "#device-bridge" ]
];
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 "01" ]
]
]
], [
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.billcode [
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.locationCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace" ];
fhir:Coding.code [ fhir:value "11" ]
]
];
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.procedureSequence [
fhir:value "1"^^xsd:positiveInteger;
fhir:index 0
];
fhir:Claim.item.billcode [
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.locationCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-serviceplace" ];
fhir:Coding.code [ fhir:value "11" ]
]
];
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 "24" ]
]
];
fhir:Claim.item.detail [
fhir:index 0;
fhir:Claim.item.detail.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.item.detail.billcode [
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.detail.unitPrice [
fhir:Money.value [ fhir:value "1000.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:Claim.item.detail.factor [ fhir:value "0.75"^^xsd:decimal ];
fhir:Claim.item.detail.net [
fhir:Money.value [ fhir:value "750.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
], [
fhir:index 1;
fhir:Claim.item.detail.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:Claim.item.detail.billcode [
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:Claim.total [
fhir:Money.value [ fhir:value "2255.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "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/Claim/100151> a fhir:Claim .
<http://hl7.org/fhir/RelatedPerson/peter> a fhir:RelatedPerson .
<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/100156.ttl> a owl:Ontology;
owl:imports fhir:fhir.ttl;
owl:versionIRI <http://build.fhir.org/Claim/100156.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.
®© HL7.org 2011+. FHIR Mixed Nomative/Trial Use Ballot #2 (v3.5.0-14907) generated on Sun, Aug 19, 2018 21:52+1000. QA Page
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