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 Orthodontic Treatment Plan
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/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" ]
]
]
];
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.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 "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: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.billcode [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
fhir:Coding.code [ fhir:value "ORTHPLAN" ]
]
];
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.billcode [
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: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 "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:index 2;
fhir:Claim.item.detail.sequence [ fhir:value "3"^^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 "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:index 3;
fhir:Claim.item.detail.sequence [ fhir:value "4"^^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 "ORTHOMONTHS" ]
]
];
fhir:Claim.item.detail.quantity [
fhir:Quantity.value [ fhir:value "24"^^xsd:decimal ]
]
], [
fhir:index 4;
fhir:Claim.item.detail.sequence [ fhir:value "5"^^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 "ORTHOPERIODIC" ]
]
];
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.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.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.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.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.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 "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: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" ]
]
]
] .
<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.
®© 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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